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BMJ 1998; 316 doi: (Published 07 March 1998) Cite this as: BMJ 1998;316:785
  1. David Shiers, general practitioner, and Ann Shiersdistrict nurse
  1. Staffordshire

    Four years ago our daughter Mary was diagnosed as having schizophrenia. The illness emerged from a difficult adolescence to pitch our family into turmoil from which it is painfully and slowly recovering.

    Mary was born by caesarean section at 33 weeks after my wife had severe toxaemia. The twins arrived 18 months later, and I became a general practitioner in semirural north Staffordshire. Mary's ambition was to ride ponies and marry a farmer. She settled into a normal school with slight developmental delay. She struggled academically, was clumsy in action and speech, and became increasingly temperamental. Psychologists diagnosed minimal birth injury, although she was capable of attending a normal school. But she was unhappy and left at 16 to attend a local learning disability farm project.

    Isolated from her friends, Mary began to mutter under her breath, she had mood swings, and home life became fraught. She attempted suicide by frenziedly pushing paper into an electric socket. Bewildered, we arranged domiciliary assessment and were astonished when the psychiatrist diagnosed schizophrenia. She was nearly 17.

    Family life revolved round Mary's five weekly cycle of psychosis and weekly outpatient trips. Ann stopped district nursing to devote her time …

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