1. Schizophrenia is a disease

• is a disorder of mental and somatic functions,
• causes objective or subjective suffering,
• requires treatment,
• it is a random event, like any illness,
• no one can be blamed for contracting the disease, especially not the patient himself or his family.

2. Schizophrenia is an illness with many dimensions

• unclear position: one disease (monogenicity) or a group of diseases with similar mechanisms of origin (polygenicity) or a group of different diseases (heterogeneity),
• causes unknown, most likely multifactorial,
• is not only a disease of the brain,
• the underlying disorder affects the brain, i.e. central neuronal structures or mechanisms with widespread effects on a wide range of neuropsychiatric functions - it accounts for vulnerability,
• the disorder can be effectively compensated by natural mechanisms,
• their breakdown triggers acute disease crises,
• compensatory efforts and acute crises can have a perpetuating effect on the disorder,
• the symptoms and course of the disease are varied, shaped by: persistent susceptibility factor, periodic breakdown of mechanisms, compensatory and perpetuating influences,
• in addition to disease mechanisms, numerous healthy mechanisms are preserved.

3. Schizophrenia is not only an illness

• is also the experience of the sick person and the group more closely surrounding that person (especially the family), as it involves various crises
• in the person: sense of reality, sense of identity, sense of autonomy, sense of fitness, sense of hope, sense of meaning, sense of existence,
• in the group: bonding, freedom, trust, cooperation, activity, duty, position, (status),
• it is often easier to bear the burden of an illness than the experiences triggered by it,
• this experience has its own dynamics, it can lead to development or to regression.

4. Schizophrenia is not a hereditary disease

• the degree of consanguinity does not determine the illness, but correlates with its risk,
• what is transmitted is unknown - most likely a susceptibility trait that favours the disease rather than the disease itself,
• the pattern of transmission is unknown - most likely polygenic and multifactorial,
• genetic association and coupling analysis - no conclusion so far.

5. Schizophrenia is not an incurable disease

• prognosis is variable and individually difficult,
• forms limited to one episode, late improvements and late recoveries are known,
• it is possible to help effectively to free the patient from symptoms or to reduce them, as well as to reduce individual and social consequences,
• comprehensive, persistent, self-sacrificing help is required.

6. There is schizophrenia - there are no "schizophrenics"

• it is possible to see both sick and healthy aspects of functioning in every sick person,
• there are no absolutely permanent consequences,
• there is no basis or need for uniformity of sick people by replacing their individuality with a diagnostic label, a negative-sounding stereotype, the name of a stigma.

7. A person with schizophrenia does not cease to be a human being, a person, a citizen - like any of us

• the illness does not undermine the sick person's humanity,
• the illness does not violate the human dignity of the person,
• the illness does not limit rights (except in exceptional situations),
• the illness does not deprive one of one's weaknesses or talents, although it may highlight or limit them.

8. Schizophrenic patients do not endanger others more than healthy people

• the majority of violent acts and acts prohibited by law are committed by the healthy, not the sick,
• the relative frequency of acts against health and life is probably higher in the sick group than in the general population, but it has remained at a similar level for decades, and the victims are most often relatives,
• many of the life-threatening acts of the sick could have been prevented if the problem had been recognised and dealt with earlier,
• the risk of suicide far outweighs the risk of aggression.

9. Patients with schizophrenia expect respect, understanding and help

• respect - from everyone. Against: superstitions, stereotypes, stigmas, rejection, marginalisation,
• understanding - from opinion leaders and culture shapers. Against: ignorance, callousness, indifference, appearances and falsehood,
• against: ignorance, callousness, indifference, appearances and falsehood, help - from the self-help community. Against: objectification, instrumentalisation and abandonment.

10. Schizophrenia sheds light on existential questions common to the sick and the healthy

• about the limits of cognition of the world and one's own experiences,
• about the boundaries between illusion and reality,
• about the criteria of truth and falsehood,
• the relationship between freedom and responsibility,
• about the limits and determinants of identity,
• about the meaning of life,
• its metaphysical references.

Cracow, 24-25 November 2000

* Prepared in the course of the work of the Polish group of the international programme initiated by the World Psychiatric Association against stigma and discrimination under the motto: "Schizophrenia - Open the Doors" (Schizophrenia - Open the Doors).
The transcript is an attempt to formulate a common position which, starting from the well-founded claims of modern psychiatry, can at the same time form the basis for a multifaceted social discussion on social attitudes towards schizophrenia and especially towards people who suffer from this illness.

Author:
National Programme Coordinator: dr.med Andrzej Cechnicki
Association for the Development of Psychiatry and Community Care
Krakow, pl. Sikorskiego 2/8, tel: 012 - 422 56 74