M I C A	draft The clinical lead here is misleading. This patient is not ill, but is not well. In effect in old times psychiatric lead voice carried an authority and with it a responsibility to direct the services in the way that was best for the patient, and helpful for the staff contact the coming to terms with the disability that presented and continued. What disability there would be was determined by the diagnosis. That was then examined, in the light of the circumstances in which the patient would have to live in the future. Here the working diagnosis was never 'a given'. Any behaviour afterwards that at all uusual signifies that the illness remains, and can become active, and govern behaviour. As the illness fluctuates in activity it may well be that the behaviour indicating illness will be seen only by people other than the professional decision maker. Especially as the illness, even when there and active, can be unrecalled and undisclosed by the patient during a short and comfortable interview. [ Clunis seemed well enough when visited by his Inquiry panel after a long period of detention and treatment in hospital, but the panel noticed that towards the end of an hour interview there wasa lossof direction in th replies, clear evidence that the illness remained present and convincing to people whi knew that the diagnosis of schizophrenia had been made earlier. ] MN as an inpatient and in history exhibited the symtoms and signs of schizophrenia. He uttered violent misbeliefs . He received two depot injections. His signs and symptoms then receded. Subsequent contacts and professional interviews never reverted to reconsider the initial firm diagnosis because MN presented little at interview, and what his family observed was not collected, was not gathered in together with all the history and considered as sufficiently decisive. back to Inquiry list Home Page