The Gazette 1990

GAZETTE

SEPTEMBER 1990

V I E W P O I NT

The disease concept of Schizophrenia

IContd.

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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.

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

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-

a significant part in the precipi- tation of the disorder. Many psychological theories have been evolved but it is reasonable to say

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