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GAZETTE
SEPTEMBER 1990
The disease concept of
Schizophrenia
Having recognised the syndrome
can we regard schizophrenia as a
disease? There are two essential
components to any disease theory.
The first is the recognition of a
symptom or syndrome, which we
have been able to establish, the
second is the discovery of under-
lying biological abnormalities.
One pointer to the latter in the
case of schizophrenia is the
evidence for a genetic component
in the aetiology of schizophrenia.
The incidence of schizophrenia in
the general population is of the
order of 1%. The incidence where
one parent is schizophrenic is 12%,
where both parents are schizo-
phrenic is 40%. The most useful
information in genetic studies is
derived from twins. Monozygotic
twins, or identical twins, have the
same genetic makeup. Dizygotic
twins are no more alike than
brothers and sisters. In schizo-
phrenia dizygotic twins are found
to have a concordance rate of 5%,
the same as brothers and sisters,
whereas monozygotic twins have a
concordance rate of 40% or more
in various studies. Perhaps even
more convincingly, monozygotic
twins reared apart have had a
similarly high concordance rate.
Supporting figures have been
found amongst adoptees and no
higher rate of schizophrenia has
been found in adoptees who have
joined families in whom one of the
parents has become schizo-
phrenic.
The aetiology of schizophrenia is
multifactorial and the fact that
50% or more of monozygotic twins
are not concordant illustrates the
fact that environmental factors play
V I E W P O I NT
IContd.
from p.2 71)
in civil law countries, must
necessarily also involve the adopt-
ion of a procedure which would
lessen the function of the police in
the investigation of criminal
offences. In a recent article, Lord
Scarman, writing in the context of
the Guildford Four and Maguire
Seven cases, argued for more
judicial control at the pre-charge
phase of detention and that there
should be a core of trained judicial
officers whose duty it would be to
supervise all aspects of pre-trial
preparation, to determine the rights
of the defendant and to determine
whether the case should go for
trial. He equally strongly argued for
the retention of the adversarial
character of trial by jury.
One must seriously question the
desirability of adopting an in-
quisitorial system, such as exists,
for example, in France. In his paper,
Mr. Barnes himself describes that
system as a "judicial investigation
designed to seek and keep seeking
for the truth". The fundamental
difficulty is, how long must this
"seeking" take? If the "Eksund"
defendants, now in custody in
France, had been in custody in the
UK for over two years still awaiting
trial, would there not have been
protests here about 'justice delayed
being justice denied'? However, it
does appear that such delays are
apparently an integral part of
French and other civil law judicial
systems.
a significant part in the precipi-
tation of the disorder. Many
psychological theories have been
evolved but it is reasonable to say
We, including, the DPP, are rightly
proud of the fact that people are
tried on indictable offences very
shortly after they have been
charged and our judges are most
diligent in ensuring that this con-
tinues to be the case. If we are to
consider any alternatives to our
system for the investigation of
criminal offences, let us look calmly
and coldly at them in the light of
the negative aspects of such
alternatives.
The Law Reform Commission in
its consultation Paper on Child
Sexual Abuse has suggested
alternative methods of obtaining
the testimony of children, including
the use of video recordings.
Perhaps, before we give further
consideration to turning our
criminal procedure system upside
down, ironically at a time when at
least one European country, Italy, is
bringing its procedures more in line
with ours, we could consider what
less radical improvements we can
make to the system as it stands.
Video recordings of interrogation of
suspects is to become the norm in
England and Wales. Having
involuntarily inherited the in-
efficiencies of the 19th century
statute law of the UK criminal
justice system, which inefficiencies
Mr. Barnes has rightly identified in
his paper, we should now volu-
ntarily adopt the more modern
efficiencies of the same system.
•
that no specific form of psycho-
logical stress has been identified as
the specific cause of schizophrenia.
Individuals predisposed to schizo-
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