Psychiatry, after a century of research, has no genuine understanding of Schizophrenia-what causes it and exactly what it is. This is somewhat hampered by the fact that there appears no recorded evidence of the illness beyond some 250 to 300 years.

Perhaps it is the consequence of unnoted exchange between physician and patient as it, according to some commentators, surfaced with psychiatry.

I think it will be extremely subjective issue. I would like to offer my unusual opinion. I think, as social animal, human would automatically assess other individual to determine the method to communicate with him/her. One of the most practical unconscious method is by observing their facial expression. However, possibly rarely addressed, facial expression is a learnt concept. We do not see a cat smiling or a mouse frowning, simply because such concept is not applied in their interaction. There is no simple reason why a smile should reflect happiness other than the fact that other people also do the same (or probably some sort of evolutionary reason because the muscle is easiest to move, or practical, or others). If we observe a baby, we will notice some bizarre expression, a smile that "seemingly different" from his adult counterpart. The adult-like fluid expression would show after several years. I believe that facial expression is something that is both copied and learnt by muscular training. The same expression would show only after the facial muscle undergoes repeated endurance training and got larger, just as biceps or triceps do. Facial expression can be seen both as existence of developed muscle and as fluidity of muscular contraction (not necessarily resulting in obvious movement, as antagonizing muscles may also contract together).

However, when we intuitively diagnose someone to have schizophrenia, one of the thing we note first may be their grooming, behavior, and their lack of facial expression. The "sense that something is not right with the expression" may actually be our instinct that the supposedly opposing muscles are both relaxed. When they both contract, it may cause the face to "tighten", while someone with schizophrenia may have wasted, "loose" facial muscle. If it happens for years, as any other muscles in the body, it will result in "disuse atrophy." So, even if they eventually manage to contract the muscle correctly, it may not look correct as the musculature is weakened. Such diagnostic method may diagnose someone with loosening connection to reality, but will also give false positive to someone with poor social skill from the beginning. We may be able to measure lack of "connectiveness" with social environment but we may not measure decrease or change in previously established "connectiveness."

I would like to also subjectively argue that such criteria may end up diagnosing myself as having schizophrenia. I had history of depression during my bachelor thesis, have always lacked social skills since my childhood, and only recently practiced to move my facial muscles more in preparation of becoming full-fledged lecturer. But overall, I think I function optimally without any psychoactive substance (other than caffeine, hehe).

I think if such criteria were to be established, it would be a good idea to give measurable evidence first (for example, by using ENMG or something else) before actually measuring someone's ability to detect facial muscle wasting. After that, it will only then be appropriate for someone to measure schizophrenia instinctually, to prevent overdiagnosis.