Hi all

I made it to the debate at the Maudsley. The Central Line being out of action
made it somewhat more difficult but fortunately I am not far from Ilford and
mainline trains into Liverpool Street.

I arrived ten minutes before the scheduled start and was one of the last people
let in as the lecture theatre was full - quite a number of people must have been
disappointed which shows the interest there was in this debate.

The motion:
'This house believes that schizophrenia does not exist.'

Chair: Professor Robin Murray, Professor of Psychiatry at the Institute of
Psychiatry, London

Supporting the motion:
Professor Jim Van Os, Professor of Psychiatry at Maastricht University
Professor Richard Bentall, Professor of Experimental Clinical Psychology,
University of Manchester

Opposing the motion:
Dr Peter McKenna, Consultant Psychiatrist, Cambridge
Professor Anthony David, Professor Anthony David, Professor of Cognitive
Neuropsychiatry, Institute of Psychiatry, London

Before and after the debate a vote was taken:

Before:
For the motion 86
Against the motion 134
Abstentions/undecided 44

After:
For the motion 97
Against the motion 97
Abstentions/undecided 49

Notes:
1. Some people left before the final vote.
2. Each speaker had seven minutes and there was half an hours discussion at the
end with audience participation.
3. The chair declined to use his casting vote saying that he was undecided.
4. There was a quite a big swing indicating that proponents of the motion swayed
quite a few people.
5. Prof. Murray defined the essence of the debate as being: the fact that
people have symptoms is not in dispute but is it valuable to diagnose?

I suppose everyone came away with different things in what was a session packed
with ideas and viewpoints.

The proponents of the motion talked about the need for care being important not
the diagnosis. Scales for positive, negative, affective, cognitive and motor
skills were mentioned and it was proposed that these should take the place of
diagnoses. Treatment could be based on symptoms.

A study which indicated that 30% of Americans were deluded was raised but the
counter argument was put that it was only a small minority for whom the
delusions were distressing and preoccupying. I think that the proposition that
there is a continuum of increasing severity of symptoms may have been accepted
and that differing diagnostic systems will have different thresholds for making
a diagnosis. Opponents of the motion maintained that the systems of diagnosis
were robust and useful enough and supported by studies whilst proponents
characterised it as flawed. In particular studies which showed distinct
separate groupings of people with symptoms of schizophrenia and mania were
contradicted by those which showed a continuum.

A thread running through the discussion was just what ugly connotations the word
'schizophrenia' had and people would be better off without the diagnosis. Set
against this were certain practical problems of what to tell the social security
or the judge and jury in a case like the Christopher Clunis one. Would talking
about having 'care needs' provide someone with sufficient protection, aid
recovery and avoid stigma? A lot of the audience seemed to be convinced.

Bob



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