Illusions about delusions

Schizophrenia is the psychiatric illness about which the most misconceptions abound. It’s not so much the ‘negative’ symptoms that cause misunderstanding, devastating as they are — social withdrawal, self-neglect, flattening of mood — but the auditory hallucinations and delusions, often of a paranoid nature, that can accompany it.

Nathan Filer, a psychiatric nurse, wrote the best novel I’ve read about schizophrenia, the Costa-winning The Shock of the Fall. The Heartland, his non-fiction book on the subject, is easily as good.

Perhaps it’s the foreign nature of their experiences that gives rise to the myth that schizophrenics are dangerous. In fact they are inclined to harm themselves rather than others, and, as Filer points out, 14 times more likely to be the victims of serious crime than its perpetrators.

He takes nothing for granted, analysing all the assumptions. He uses inverted commas for ‘schizophrenia’, because diagnoses vary between countries and even between clinicians. This is no disrespect to the latter, but simply a reflection of the complexity of the illness. And yet Filer’s sharp intellect never replaces empathy. He discusses theories about aetiology, treatment and prognosis with experts all over the world, while looking at the science and what causes the symptoms. For example, excessive dopamine — thought to be one of the factors involved in the condition — predisposes you to auditory hallucinations and delusions because it increases alertness to harmless stimuli, leading to an erroneous interpretation of them as threats. R.D. Laing described schizophrenia as ‘a special strategy that a person invents to live in an unlivable situation’.

Most importantly, Filer speaks with understanding and sensitivity to individual sufferers. He begins his book by describing, from the point of view of the ‘patient’, the forcible injection of a calm but deluded schizophrenic man who refuses anti-psychotic medication.Most