If Joe from `EastEnders' was unknown and acted that convincingly in front of his GP, he'd pretty soon pick up a label of mental illness

Can actors be convincingly mad?

By which you mean wildly foolish or angry?

No, I mean mentally ill.

Yes, well "mad" went out with "nuts" and "loony" as ways of describing mental illness.

But Grant uses those words to describe Joe on EastEnders.

Grant's hardly your ideal role model. And anyway, since Lorraine explained to him the nature of schizophrenia, his attitudes have changed and he's been very supportive of Joe.

Yes, but we can't be sure whether he's motivated by a genuine desire to help Joe, or because he wants to have intercourse with Joe's mother.

True. But we've seen in his benign attitude shift towards HIV-positive Mark Fowler that Grant is really on the side of the angels.

Mmm. And what's your opinion of Joe?

The actor or the character?

Both. Paul Nicholls has been widely praised by psychiatrists and schizophrenia support groups for his portrayal of the illness, but is it really that convincing?

Yes.

So why did it take the psychiatrists so long to spot it? They were treating him for depression for ages ...

Well for a start they were only actors pretending to be psychiatrists. But even real psychiatrists can't make a spot diagnosis of schizophrenia. When Joe was first seen, he'd had a single psychotic episode ...

Meaning?

Meaning he'd been severely mentally deranged, had lost contact with reality and was having delusions and hallucinations, but a number of illnesses can cause that.

Such as?

Such as schizophrenia or psychotic depression or drug abuse and withdrawal. And schizophrenia's such a big stigma to carry round, you don't go handing out the label until you're certain of the diagnosis.

But surely you've got to protect the public?

That's the stigma. You think schizophrenia means axe murderer, but sufferers are far more likely to harm themselves than the public. And after a single psychotic episode, a quarter of people need no treatment and never have another, two-thirds have recurrent relapses with a lot of normality in between and only 10 per cent are severely disabled and need a lot of looking after.

I hear Joe's leaving the series. Do you think he kills himself?

I'd far rather he moved back to Manchester. But the positive portrayal of a schizophrenic patient rehabilitated in the community could fall foul of the ratings war.

If Nicholls's portrayal is so good, do you think he'd fool a real psychiatrist?

Not now he's been seen by half the population. But certainly if he was unknown and acted that convincingly in front of his GP, he'd pretty soon pick up a label of mental illness.

But surely there are ways of sussing out the bogus patients?

Not if they're good actors. Medicine survives on mutual trust and if you tell us you've got certain symptom or you convincingly demonstrate signs of a disease, we'll faithfully pigeon-hole you and start the treatment.

So all I need is a textbook of psychiatry?

Pretty much. In fact, you don't even need acting qualifications. Twenty- five years ago in America, eight sane people (a painter, a housewife, a paediatrician, a psychiatrist and four psychologists) pitched up to psychiatric hospitals across the country and pretended to have mental illnesses.

Why?

In the name of medical research. They made out-patient appointments, complained of hearing voices and pretended to have other jobs, but made no other significant changes to their life histories.

And what happened?

They gained admission to 12 psychiatric hospitals in five US states on the East and West coasts. Once in, they immediately ceased pretending to have any symptoms of mental illness.

And were promptly kicked out as time-wasters?

Alas, no. None of them were ever detected as frauds by the hospital staff. They were each kept in for between seven and 52 days (average 19) and left with a diagnosis of schizophrenia "in remission".

So nobody twigged at all?

Only the real patients. A third of them were deeply suspicious of the frauds. But it gets worse ...

Go on ...

Well, two other hospitals that heard of the findings swore it couldn't happen within their walls. So staff were warned that over the coming three months, one or more fake patients would attempt to gain admission. Staff were asked to rate each patient according to the likelihood that he or she was a fraud. Of 193 patients, 41 (21 per cent) were judged "highly likely" frauds by at least one staff member and 23 (12 per cent) were deemed suspect by at least one psychiatrist.

And how many actually were?

None. They were all genuine.

FFI visit Bandolier at http://www.jr2.ox.ac.uk/Bandolier