HEALTH: Light from the Square

'EastEnders' dared to challenge prejudice about Aids. Now it is doing the same for a condition that brings out the darkness in our souls. By Jane Feinmann

The nation has known for months that all is not well with Joe, the troubled teenager in the BBC1 soap EastEnders. Since he arrived in Albert Square more than a year ago, a likeable if somewhat obsessive young man searching for his no-good car-dealer dad, we have watched him descend into mental illness.

For weeks he barricaded himself away, papering the walls of his room with sinister newspaper cuttings and urging his father to cut off the telephone and lay in siege-stores against the evil world outside. And when all the children in Albert Square got obsessed with comic-strip aliens, only Joe believed they were real and about to invade.

We know, because a camera took us there, that Albert Square from inside Joe's head is a surreal, threatening place, frightening enough to send him out on to the balcony of the Vic where he teetered with suicidal intent. All will become clear this Thursday as Joe is finally diagnosed as having schizophrenia: yet another success story for the soap which has already demystified Aids. Its formula for health education is to make us care about the person so that we also come to care about the illness.

"We couldn't have chosen a better way of capturing interest in schizophrenia than with a handsome and now famous young man [Paul Nicholls] acting his socks off in Britain's most popular TV soap," says Fiona Carr of the National Schizophrenia Fellowship, which has worked closely with EastEnders' scriptwriters.

Already the NSF has had scores of calls from people who have had the illness. Jackie, 19, says it has been weird but wonderful to see an actor playing out the nightmare that she herself suffered for three years in her early teens. "I look back now and think, how could I have been so stupid as to really believe the devil was talking to me or try so hard to get out of the house at night because spirit voices told me to. EastEnders has helped me to see that it's something that just happens."

But the fellowship hopes that a wider audience will be touched by the story: schizophrenia is in dire need of a better image. Although relatively common (affecting one in every 100 people, most often in the late teens and early 20s) it is much misunderstood. Public ignorance isolates close relatives of a sufferer and adds to their feelings of guilt, according to Professor Julian Leff of the Maudsley NHS Trust in London, a leading specialist in the illness, who advised the EastEnders team. It also undermines recovery.

He is particularly pleased that the story contradicts the myth that schizophrenia is a Jekyll and Hyde disorder where someone can be normal one minute and a deranged axeman the next. That image is one of the main reasons why diagnosis remains such a stigma. "The proportion of people with schizophrenia who are violent or murderous is tiny," he says. "Sufferers are far more likely to be withdrawn, and less violent than normal."Another myth which has been slow to die has been R D Laing's theory, widely accepted in the Sixties, that schizophrenia is exclusively caused by dysfunctional families. Scans show schizophrenics' brains have structural abnormalities; they are often genetic but, it is thought, may also be caused by exposure to certain viruses in the womb, or birth trauma.

However, psychiatrists have only recently begun to focus on the fact that though family tension may not cause schizophrenia, the reverse is almost inevitably the case. Close relatives may have to cope with the more florid symptoms such as paranoia, delusions and hallucinations; or they have on their hands an adolescent who simply loses all interest in life: he or she may refuse to get up, wash, or change clothes; say little or nothing for days; veer from a state of emotional blankness to ceaseless pestering. "For a long time, I thought she was just a difficult teenager," recalls Jackie's mother, Tina, 42, who has three other children. "There were months when she'd only wear black, only eat toast and lay in bed all day, listening to music on headphones."

An initiative at the Maudsley involves community psychiatric nurses working with the families of schizophrenics to help them deal with their their own emotional turmoil. "For years we've been trying to help people with schizophrenia cope with their anxieties," Professor Leff says. "Now we're taking that further and advising carers on how to control their feelings. It can be very hard living with someone with schizophrenia, but losing your temper or issuing threats may trigger a worsening of the condition."

EastEnders has shown how stress within the family, while not causing the illness, can trigger an attack and how vulnerable a sufferer is to the actions of other people. Joe had a bad attack when his father, David Wicks, walked out, finding his son's demands unbearable, for example. For Tina, coping with Jackie became easier once she understood what was happening. "I'd always thought she was far more ill than the GP did: he just gave her Valium. In the end, I went to the library and read up on mental illness and finally got referred to the Maudsley. It was a huge relief when a doctor told me she had schizophrenia."

Now that Joe has finally been diagnosed, forthcoming episodes of EastEnders are likely to cover service deficiencies such as bed shortages and communication break-downs between hospital and community care. But Joe's story is likely to have a happy ending: new treatments mean the outlook for many schizophrenics is better than it has ever been.

Drugs suppressing dopamine, a chemical messenger in the brain, have been available to treat the disorder since the Fifties, but had severe side- effects, affecting the ability to walk and causing, involuntary and permanent movements of the mouth and tongue. Drugs which have become available only in the past five years are more effective for more people and can be virtually free of side-effects.

Jackie has been treated with clozapine for three years, and has nearly returned to normal life: she has passed exams and found a boyfriend, although so far she has been unable to get a job. "Employers? She's a schizophrenic, isn't she?" Tina says. Perhaps EastEnders may help to end such prejudices n