Although heavily influenced in its developmental stage by the EPPIC researchers, the Australian Clinical Guidelines for Early Psychosis do not recommend the use of the schizotypal symptoms. Instead a newly contrived sixteen-item list of ‘Prodromal Symptoms and Signs’ of psychosis is provided:
"Suspiciousness; Depression; Anxiety; Tension; Irritability; Mood swings; Anger; Sleep disturbances.
Appetite changes; Loss of energy or motivation; Memory or concentration difficulties; Perception that things around them have changed; Belief that thoughts have speeded up or slowed down; Deterioration in work or study; Withdrawal and loss of interest in socialising; Emerging unusual beliefs."[23]
The authors of the Clinical Guidelines acknowledge that ‘these signs and symptoms are not usually indicative of a developing psychosis’. This is apparently said to prevent over-zealous usage and to minimise the alarm that might arise in normal people who encounter this list and reflect on themselves. The Clinical Guidelines advise that these signs are only meant to be used as symptoms of impending psychosis when ‘they occur in individuals who have been identified as “at-risk” of psychosis’.
A separate list of indicators identifies those who are at-risk. The idea is to first narrow down the field before applying the prodromal signs and symptoms. The narrowed field primarily focuses on adolescents and young people. But there is a fairly extraordinary mixture of further risk factors that range from the relatively specific ‘Family history of psychotic disorder’ to the equivocal ‘Season of birth’, to the thoroughly non-specific ‘Life events’ and ‘Subjective/functional change in the person’.[24] In actuality, these risk factors have been tailored to fit almost any young person who is a bit worrisome to parents, school teachers or other authority figures.
Apart from supplying its own lists of symptoms and risk factors the Clinical Guidelines also advise that '[i]nformation currently available to promote awareness and identification of symptoms is captured in the pamphlet "Something is Not Quite Right" (SANE Australia)'.[25] SANE Australia is a business name of Schizophrenia Australia Foundation which generally purports to represent the interests of relatives of schizophrenic people. (See Chapter 4).
The SANE pamphlet is directed at parents, teachers, employers and workmates of 'difficult' people. Two checklists of symptoms are supplied to assist in recognising the severity of the underlying mental illness that might be giving rise to the difficulties. Boxes are provided beside each symptom so that observers can tick off a person’s faults. Checklist 1 is:
"Behaviour which is considered normal although difficult. Difficult behaviour at home, school or in the workplace. People may be —
rude irritable over-sensitive
lazy rebellious weepy
argumentative over-emotional withdrawn
thoughtless shy "[26]
Observers are warned that these behaviours may not be cause for alarm but if they persist or are too disruptive then advice should be sought from a GP, school or workplace counsellor, Citizens Advice Bureau or Mental Health Centre.
Checklist 2 is a list of 18 behaviours which are said to be definitely abnormal and which require an urgent medical assessment.
The SANE pamphlet advises that if the person demonstrates 'outright resistance to the idea of visiting the doctor, consult with the doctor yourself to work out a plan over time. It may be possible and appropriate for the doctor to assess the person at home'.[28] In a situation like this, where a person is reluctant to submit to a medical assessment, it is likely that a doctor would see the complaining friends or relatives as the real clients, rather than the person to be assessed. This introduces a great deal of scope for bias in the doctor's assessment which necessarily relies on subjective reports from the complainants. Summary detention in a mental hospital, or coercion to participate in a pre-psychosis treatment programme, are likely outcomes for a person who is the target of these types of complaints.
The SANE checklists of symptoms have been given elevated status by their endorsement in the Clinical Guidelines. The official recognition now makes them part of the consensus understanding of pre-psychotic schizophrenia. The SANE programme of using non-medical people as front-line diagnosticians, and encouraging them to identify and report people who are irritating/offensive/disturbing must give some pause for thought. There is great potential for this system to be exploited by people motivated by personal grudges, or people who might want to punish others for holding opinions or beliefs they disagree with. The possibility of using pre-psychotic intervention for social control is particularly evident in the fourth symptom of the above list: 'be extremely preoccupied with a particular theme, for example, death, politics, or religion'.
The aptly named ‘Something is Not Quite Right’ pamphlet is distributed by SANE with a note on letter-head which announces that the pharmaceutical company Pfizer is one of the organisation’s sponsors. (Pfizer make a new atypical neuroleptic called ziprasidone).
Next: Drug Company Influence
[23] National Early Psychosis Project, Australian Clinical Guidelines for Early Psychosis, p. 13.
[24] Ibid., p. 12.
[25] Ibid., p. 19.
[26] SANE Australia, Something is not quite right.
[27] Ibid.
[28] Ibid.