M I C A	The clinical lead here is misled. The current zeitgeist in Psychiatry is unclear. In effect a psychiatric lead in old times carried an authority and with it a responsibility to personally direct the services in the way that was best for the patient, in the terms of the disability that presented and continued. What disability there was would be was determined by the diagnosis, and looking at that in the light of the circumstances in which the patient would have to live in the future. Here the working diagnosis of schizophrenaia never was first in mind. A wise new york psychiatrist [ Harry Sullivan ]once declared " a little bit of schizophrenia IS schizophrenia". That is to say that in a state of clear consciousness if it is there it IS there. Any behaviour out of the usual in the future signifies that the illness remains, may be active, and can be actively governing behaviour. There is no imitating schizophrenia. It may fluctuate but the conditon is always there, shown as much in the debilitated life style as in the prominenece of symptoms. If it fluctuates it may well be that the illness will be seen by people other than the professional decision maker. Especially as the illness, even when there and active, can go undisclosed by the patient over a short and comfortable interview, where if it is declared, the patient will be at risk of having to do what others decide. But, in fact. illess behaviour cannot be recalled by the patient. [ 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, when the fous of questioning was less evident, then there was a loss of direction in the replies. 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 reflect the initial firm diagnosis because MN offered 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 Report summary Downham; MN back to Inquiry list back to Home Page