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Play It Through

You’re Going To Get Mentally Ill – Now What? Part of the Cabaret of Dangerous Ideas #DramatherapistAtEdFringe

Screening for Schizophrenia is now almost as accurate and reliable as screening for cancer. In this talk, Stephen Lawrie, Professor of Psychiatry and Neuro-Imaging at the University of Edinburgh shares his latest research and asks “would you want to know?”

Arguably the “worst disease that afflicts mankind”, Stephen explored what schizophrenia is (how it is similar and different to other forms of psychosis such as bipolar, manic depression or drug induced psychosis).

Schizophrenia usually manifests during a person’s mid 20’s; people over 40 are very unlikely to develop schizophrenia (although alcohol can still increase the risk in this age). Roughly 25% of people with schizophrenia will only have a few episodes, another 25% will have a form which allows them to manage and still lead a fairly normal life. The other 50% are probably not going to be able to graduate university, hold down a job and may need carers or assisted living housing. While there is a popular belief that schizophrenics are dangerous this is not true for most people with schizophrenia but they may be at an increased risk of taking their own life.

There are known risk factors which increase your chances of developing schizophrenia; if a family member has schizophrenia you are at an increased risk, this is higher if several members of your family also have it. There is also a link to childhood trauma (which increases the risk of all mental health conditions). Some gene and chromosome variations increase the risk.

So some people may already know their chances of having schizophrenia may be higher than the general population. With neuro-imaging, blood screening and chromosome examining technology, you can now be shown with somewhere between 70-90% accuracy if you are likely to develop schizophrenia in the next 2 years.

This means that sometimes the results will be wrong – some people will be given false negatives “you are not going to get schizophrenia” but then do. Some people will get false positives “you are going to get schizophrenia” and then don’t. This is also true for cancer screening; sometimes the cancer is missed, sometimes people are given treatment who don’t need it. Currently the researchers are still honing the analysis and machine learning algorithms to get the accuracy consistently closer to 90% or higher.

Stephen Lawrie

What would be the psychological impact of knowing? It might allow you to prepare. You might decide not to have your own children or not to start a university course or accept a particular job. You might be able to do things designed to improve your mental health before the symptoms started.

Interestingly some medical students were keen to know and start precautionary treatment even if their risk was in line with the general population. Some other people who already had a 50% risk due to family history did not want to know their personal risk factor and preferred to live life as it came.

For screening to be offered, there must be treatment available. As a condition, it can be managed using a combination of medication and / or therapy. While this helps most people there are several side effects to the medication and, for a small number of people, therapy can cause harm.

There are other ethical considerations to the use of this screening. In the UK where there is universal healthcare through the NHS, there is not much risk in screening but this might be different in America where screening could make it harder for the individual to get insurance cover.

Would you want to know? And would you be more likely to want to be screened if there was the potential to prevent it from manifesting?

Stephen spoke about therapy as a treatment for schizophrenia several times, often CBT. However, earlier this year, Dramatherapy was recognised in the NICE guidelines as an effective treatment for early interventions in psychosis:

“Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms…
Aims of arts therapies should include:

– enabling people with psychosis or schizophrenia to experience themselves differently and to develop new ways of relating to others

– helping people to express themselves and to organise their experience into a satisfying aesthetic form

– helping people to accept and understand feelings that may have emerged during the creative process (including, in some cases, how they came to have these feelings) at a pace suited to the person. [

NICE Guidelines: Psychosis and schizophrenia in adults: prevention and management (CG178)

Between seeing this talk and publishing this blog, I have also seen Going Slightly Mad by BigMind Theatre Company; a play (based on a true story) which follows Max who has psychosis (with schizophrenia-like symptoms which fit Stephen’s definition, although this is never stated). Max eventually receives support from a dramatherapist; arguably one of the most attuned and attentive member of staff in her treatment team.

Screening for psychotherapy is new. Published research on dramatherapy as part of early treatment for psychosis is new. It would be interesting to know what the impact would be of using dramatherapy between being screened and the onset of schizophrenia. The early data for schizophrenia screening includes some false positives – are there things which can prevent schizophrenia from developing even if all the genetic signs say it will? Are all of these false positives mistakes in the data, or did those patients change something which impacted their mental health enough to change the prognosis? What would be the impact of using dramatherapy with a group of clients who were “going” to develop schizophrenia in the next two years? And after there is enough evidence gathered, it will be fascinating to compare the effectiveness of Dramatherapy in treating schizophrenia.

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