Wanted: patients with mental illness in role of teacher

Editor—Wykurz and Kelly reviewed developing the role of patients as teachers.¹ Mental illnesses are ideally suited for patients to be teachers because diagnosis is based on symptoms that they have first hand experience of. This is especially important for schizophrenia, which is considered to be the worst and most devastating mental illness.

Care of schizophrenia has during the past 50 years changed drastically from care in mental hospitals to outpatient care. Education has naturally changed during these 50 years, but it would be strange if both current care and education were optimal.

Cultural, social, and care factors can dramatically affect schizophrenia, as shown by the World Health Organization's 10 country study, in which cases of continuous psychotic illness varied between 2% in Nigeria and 33% in Japan.² Thus factors other than symptoms, such as discrimination and social problems, need to be investigated. I am not sure if current medical teachers have an accurate picture of such interactions. Ideally, their existence should be described before academic lectures on the disease to have the best effect on students and induce discussion.

As the public is prejudiced about schizophrenia, so are students. Thus they should meet patients with controlled disease rather than those with acute psychosis in hospital wards. Acute psychosis is not highly representative of normal schizophrenia. According to the WHO's fact sheet on mental and neurological disorders nearly half of all patients fully recover from schizophrenia.³

This rate is much better than most doctors think, so students need to meet patients who have recovered from schizophrenia. If students were allowed to meet recovered patients and patients with stable disease, I am sure that psychiatry would become a more attractive discipline, which in the long term should have a positive effect on the quality of psychiatric care.