Understanding of the term "schizophrenia"by the British public

Abstract

A postal survey of a representative sample of UK adults was conducted. Subjects were asked "What do you understand by the term 'schizophrenia'?".Four hundred four completed questionnaires were received (81% response rate). Forty-two percent of respondents mentionedat least one first rank symptom of schizophrenia or gave a description that reasonably approximated to any diagnostic feature as stated inICD-10. Forty percent mentioned "split" or "multiple" personality. Thirty-eight percent described auditory hallucinations or "hearing voices".Fifteen percent mentioned "delusions" or described passivity experiences. Only 6% of subjects mentioned violence in their descriptions.

According to ICD-10 classification of mental and behavioural disorders, schizophrenia is characterized by gross disturbances of thought, perception and affect, in the face of clear consciousness and intellect. Although there is some concern about misrepresentation of severe mental illnesses such as schizophrenia by the media, a positive trend in public perception has been noted (1). This study aimed to examine the understanding of the term "schizophrenia" by the British public.

METHODS

The study was carried out in a representative sample of 500 UK adults, drawn from a panel of over 1000 subjects who were recruited for a previous study using direct mail shots and adverts in local newspapers (2). Subjects were asked to answer the question "What do you understand by the term 'schizophrenia'?", by writing a short sentence or description.

Responses were classified into eleven different categories as shown in Table 1. Reasonable descriptions of "schizophrenia" were accepted to include any first rank symptom or diagnostic feature as stated in ICD-10, including auditory or visual hallucinations, thought disorder, delusions or passivity experiences. Common lay descriptions that approximated to these clinical symptoms were also accepted as reasonable, including hearing voices, seeing things, disconnection from reality, losing touch with reality, feeling controlled by an outside force. The expression "split personality" was not accepted as a reasonable description of schizophrenia. Other common descriptions that were not accepted as reasonable included unstable or multiple personality, "paranoia", "mental illness" or "mental disorder", and any other disturbance involving "mood", "emotion" or "personality", as well as any reference to violence. We did not expect respondents to provide a description that distinguished between schizophrenia and other psychotic disorders.

Table 1.

Diagnostic features of schizophrenia mentioned by the British public

Split/multiple/unstable personality	58%
Auditory hallucinations/“hearing voices”	38%
Mental disorder or illness	21%
Delusions/passivity experiences	15%
Unstable mood/emotional imbalance	10%
“Paranoia”	7%
Visual hallucinations/“seeing things”	6%
Violence	6%
Thought disorder	5%
Psychosis/disconnection from reality	4%
Other forms of disturbed behaviour (besides violence)	4%
At least one first rank symptom or reasonable diagnostic symptom	42%

RESULTS

Four hundred four completed questionnaires were received (81% response rate). A further three questionnaires were illegible and were therefore disregarded. The mean age of respondents was 44.7 ± 1.4 years; 37% were male; 58% of the subjects were in paid employment, the rest were retired, unemployed, students or housewives. The mean age leaving full-time education was 18.6 ± 0.5 years with a median of 16 years.

Forty-two percent of respondents mentioned at least one first rank symptom of schizophrenia or gave a description that reasonably approximated to a diagnostic feature as stated in ICD-10. Forty percent mentioned "split personality" or "multiple personality"; 38% mentioned auditory hallucinations or "hearing voices"; 15% mentioned "delusions" or described passivity experiences. Only 6% of subjects mentioned violence in their descriptions (Table 1). No respondents gave any indication of the duration of the symptoms that would be required to meet diagnostic criteria for schizophrenia.

DISCUSSION

Irrespective of the particular medical school training, many psychiatrists use a mental map of Schneiderian first and second rank symptoms as a screening tool. Interestingly, a substantial number of lay participants in this survey were able to clearly identify most of these symptoms. Out of the eleven categories used to group the narratives of the participants, five were the major features in diagnosing schizophrenia. Hearing voices was the commonest (38%).

There is some inconsistency in findings from research using lay groups in the community as subjects. A study in US comparing 542 people with mental health professionals showed a wide gap in the perceptions and beliefs concerning schizophrenia, where the lay people thought it was more of an emotional set of symptoms with psychosocial causations, the removal of which will lead to improvement (3). Similar findings were documented in studies done in Kuwait, Taiwan and Japan (4,5). On the contrary, a study from Switzerland on a representative population sample consisting of 844 subjects reported a correct vignette detection rate of 73.6% (6). Our study is unique because we did not use vignettes, and the recognition rates are half way between the extremes discussed in other studies above.

Our data highlight the importance of health education and further research on public understanding of mental disorders.