We may not have a cure, but at least we can ensure that people can walk down the street without being feared or mocked. Photo: Getty
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Schizophrenia is not a fatal illness, yet sufferers are still dying 20 years too soon

We have to go beyond the well-meaning commitment to “combat stigma” and be willing to share our time – that extra twenty years we currently have to ourselves – even when we are unable to measure what this will mean.

In the UK today, people with schizophrenia have the same life expectancy as the general population of 1930s Britain. Schizophrenia is not a fatal illness. It can be hard to treat and the severity of symptoms can vary enormously. It should not, however, kill you.

On the other hand, here are some things that can: heart disease; diabetes; respiratory disease. Schizophrenia sufferers are dying prematurely, not from the disease itself but from conditions that are treatable and often preventable. This is why today, at the start of Schizophrenia Awareness Week, Rethink are launching their +20 campaign, so called because sufferers of severe mental illness die, on average, 20 years earlier than the rest of the population. 

You may be assuming that the main cause of premature death in schizophrenia is suicide. It is not. Most of these deaths have physical causes, arising due to a mix of factors, such as failure to manage the side-effects of medication, unhealthy lifestyle and poor health monitoring. A fourth factor is “diagnostic overshadowing”, whereby a physical condition is overlooked or not taken seriously due to the patient’s mental state. As the sibling of a schizophrenia sufferer, this last one in particular resonates with me. I know that doctors have done this to my brother; I have done it to him myself.

In theory it should be easy to accept that suffering from severe mental illness does not make one immune to the same ailments which affect the rest of the population. In practice, however, this can seem “a bit much”. Mental illness can be so overwhelming and so all-consuming, it can be hard to believe there is space for anything else. Physical health then becomes subordinate to disease management. Anti-psychotic drugs are necessary, therefore the side-effects must be borne without complaint. Smoking is a comfort, therefore the normal rules of harm do not apply. These are just some of the assumptions that Rethink are seeking to challenge, in what is a drive not just to promote healthy lifestyles, but to show that physical health matters for everyone.  Schizophrenia sufferers do not merely have symptoms to manage but lives to live. And by that one doesn’t have to mean getting a job / a partner / whatever else passes for “normality” – it can simply mean living a life that is of value to you, with as much joy and as little pain as possible.

When I first heard the “20 years earlier” figure, I’ll admit that some small part of me felt relief. So it’s 55 rather than 75, or 66 rather than 86. How bad is that really, given how much pain and suffering the intervening years could contain? You can almost kid yourself it’s a mercy killing. A slow, painful death, borne of ignorance and neglect, can be repositioned – by the living – as what was meant to be. We can pretend it is a rational play-off between quality and quantity of life. It’s not that anyone has sat down and reviewed the pros and cons of all these needless deaths; no one has to. Collectively, as a society, we’re making all the little decisions which mean we never have to face the big one at all. Oh look! It’s just happened! How terrible! The drip-drip effect of not caring quite enough permits us to pretend the end result is out of our hands.

And yet however awful schizophrenia is – and when it is treatment resistant, with no periods of respite, it can be awful – so many other things are entirely within the control of the society surrounding the sufferer: whether you can walk down the street without being feared or mocked; whether anyone visits you when you are too afraid to leave the house; whether anyone cares that you are healthy and secure; whether you find places – any places at all – where there are people with whom you can talk and laugh. None of this can be achieved by some vague but well-meaning commitment to “combat stigma” on the part of non-sufferers. We have to be willing to share our time – that extra twenty years we currently have to ourselves – even when we are unable to measure what this will mean. Even if there is a point at which empathy fails, we have to push onwards.

I am frightened of the future, but I want to face it with my brother. I want him to grow old with me and to live through that extra twenty years – the twenty years I simply expect – with as little fear as possible. I don’t believe any human being loses the ability to be happy, or to feel the warmth that comes from others. Much as I’d like to picture old-aged us by some cosy fireside, exchanging fond reminiscences on 1980s TV, I know it’s unlikely to be that way. But it is possible to imagine life and hope, and for some to be denied this due to stigma is a disgrace.

Glosswitch is a feminist mother of three who works in publishing.

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Leader: Trump and an age of disorder

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions.

The US presidency has not always been held by men of distinction and honour, but Donald Trump is by some distance its least qualified occupant. The leader of the world’s sole superpower has no record of political or military service and is ignorant of foreign affairs. Throughout his campaign, he repeatedly showed himself to be a racist, a misogynist, a braggart and a narcissist.

The naive hope that Mr Trump’s victory would herald a great moderation was dispelled by his conduct during the transition. He compared his country’s intelligence services to those of Nazi Germany and repeatedly denied Russian interference in the election. He derided Nato as “obsolete” and predicted the demise of the European Union. He reaffirmed his commitment to dismantling Obamacare and to overturning Roe v Wade. He doled out jobs to white nationalists, protectionists and family members. He denounced US citizens for demonstrating against him. Asked whether he regretted any part of his vulgar campaign, he replied: “No, I won.”

Of all his predilections, Mr Trump’s affection for Vladimir Putin is perhaps the most troubling. When the 2012 Republican presidential nominee, Mitt Romney, warned that Russia was the “number one geopolitical foe” of the US, he was mocked by Barack Obama. Yet his remark proved prescient. Rather than regarding Mr Putin as a foe, however, Mr Trump fetes him as a friend. The Russian president aims to use the US president’s goodwill to secure the removal of American sanctions, recognition of Russia’s annexation of Crimea and respect for the murderous reign of the Syrian president, Bashar al-Assad. He has a worryingly high chance of success.

Whether or not Mr Trump has personal motives for his fealty (as a lurid security dossier alleges), he and Mr Putin share a political outlook. Both men desire a world in which “strongmen” are free to abuse their citizens’ human rights without fear of external rebuke. Mr Trump’s refusal to commit to Nato’s principle of collective defence provides Mr Putin with every incentive to pursue his expansionist desires. The historic achievement of peace and stability in eastern Europe is in danger.

As he seeks reconciliation with Russia, Mr Trump is simultaneously pursuing conflict with China. He broke with precedent by speaking on the telephone with the Taiwanese president, Tsai Ing-wen, and used Twitter to berate the Chinese government. Rex Tillerson, Mr Trump’s secretary of state nominee, has threatened an American blockade of the South China Sea islands.

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions. The US constitution, with its separation of powers, was designed to restrain autocrats such as the new president. Yet, in addition to the White House, the Republicans also control Congress and two-thirds of governorships and state houses. Mr Trump’s first Supreme Court appointment will ensure a conservative judicial majority. The decline of established print titles and the growth of “fake news” weaken another source of accountability.

In these circumstances, there is a heightened responsibility on the US’s allies to challenge, rather than to indulge, Mr Trump. Angela Merkel’s warning that co-operation was conditional on his respect for liberal and democratic values was a model of the former. Michael Gove’s obsequious interview with Mr Trump was a dismal example of the latter.

Theresa May has rightly rebuked the president for his treatment of women and has toughened Britain’s stance against Russian revanchism. Yet, although the UK must maintain working relations with the US, she should not allow the prospect of a future trade deal to skew her attitude towards Mr Trump. Any agreement is years away and the president’s protectionist proclivities could yet thwart British hopes of a beneficial outcome.

The diplomatic and political conventions embodied by the “special relationship” have endured for more than seven decades. However, Mr Trump’s election may necessitate their demise. It was the belief that the UK must stand “shoulder to shoulder” with the US that led Tony Blair into the ruinous Iraq War. In this new age of disorder, Western leaders must avoid being willing accomplices to Mr Trump’s agenda. Intense scepticism, rather than sycophancy, should define their response.

This article first appeared in the 19 January 2016 issue of the New Statesman, The Trump era