Clinical, biochemical and genetic evidence now indicates that schizophrenia is a disorder of membrane phospholipid metabolism associated with increased loss of highly polyunsaturated fatty acids from membranes owing to enhanced activity of a phospholipase A2. This changes the properties of membranes throughout the body and is responsible for such physical abnormalities as reduced vasodilator responses to niacin and histamine and altered immunological functions. A modest membrane abnormality is likely to produce its most serious consequences in the brain, which requires the co-ordinated sequential and parallel activities of millions of neurons. The concept leads to testable proposals for relatively simple and safe treatment modalities.