“Schizophrenia” is a useful concept

To state that schizophrenia does not exist is a trite assertion with no more meaning than saying, for example, that migraine does not exist.1 It would be equally meaningless to suggest that any abstract noun or concept does or does not exist. The key question is whether it is a useful concept, and even this may have to be asked within a defined context.2

The use of diagnostic criteria for schizophrenia has allowed researchers to identify genes that increase risk, biological concomitants, and treatments that work.3-6 Although the idea that schizophrenia always has a poor outcome and treatment is at best ameliorative is just plain wrong,5 about a third of people with schizophrenia have a poor outcome. Changing the name of their condition won’t do anything to help them. It would be preferable and more achievable simply to communicate with them more accurately about schizophrenia.

The correct response to the heterogeneity of schizophrenia and the even greater heterogeneity of “psychosis” is to study and to try to progressively subgroup these patients, building on accumulated wisdom.6 We already know, for example, that most people with a brief psychotic episode do not need ongoing treatment,7 and that patients with bipolar disorder tend to respond to lithium, whereas those with schizophrenia do not.6 Moving to unproven vague alternatives may or may not reduce stigma but runs the risk of increasing misdiagnosis and would inevitably lose what we already know about how to help patients in clinical settings.