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Views & Reviews Personal View

“Schizophrenia” does not exist

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i375 (Published 02 February 2016) Cite this as: BMJ 2016;352:i375

Schizophrenia does exist : it is Kraepelin’s disease

Schizophrenia does exist : it is Kraepelin’s disease

We read with interest the personal view by Van Os with the provocative title ‘“Schizophrenia” does not exist’ with the subtitle “Disease classifications should drop this unhelpful description of symptoms”. On reading the article it appears that it would have been more aptly entitled “renaming schizophrenia.”

We support the case for the need to rename schizophrenia as highlighted by Lasalvia et al (1), in their review of the limited literature in the field, who proposed that the term schizophrenia should be abandoned given that the advantages outweigh the disadvantages overall. However the paper does emphasise that it is not just a change in name that is required but complex shifts in public perception, services, legislation along with the education of professionals to improve outcomes for this population. The authors hoped that the Work Group engaged in revising the psychoses for ICD – 11 would give careful attention to the term schizophrenia in view of the exceptional opportunity to remove the word from the public and professional vocabulary. Their review listed proposed terms to replace schizophrenia amongst which were Kraepelin-Bleuler disease and Bleuler’s Syndrome (1).

It was Emil Kraepelin in 1887 who differentiated the two main forms of psychosis namely ‘manic depression’ and ‘dementia praecox’. Kraepelin viewed ‘dementia praecox’ as mental disease with a deteriorating course and biological basis, a notion that has been supported by the extensive research demonstrating that it is a brain disease. However it was Bleuler in 1911 who introduced the name ‘schizophrenia’ to replace Emil Kraepelin's term ‘dementia praecox’. Bleuler stated, “I believe that the tearing apart (‘Zerreissung’) or splitting (‘Spaltung’) of the psychic functions is a prominent symptom of the whole group”. Morever he stated in his 1911 book, “I call dementia praecox ‘schizophrenia’ because (as I hope to demonstrate) the ‘splitting’ of the different psychic functions is one of its most important characteristics.”(2)

In view of the aforementioned, we support the use of medical eponyms and propose renaming schizophrenia, Kraepelin’s disease/syndrome. There are currently hundreds of medical eponyms in use and in neuropsychiatry, we still retain the eponyms Alzheimer, Parkinson, Wernicke, Korsakoff, Wilson and Down.

Concerning the renaming of the other related psychotic conditions such as schizoaffective disorder and schizophreniform disorders, these names could be dropped and replaced with the term psychosis.

Schizophrenia in its severe and chronic forms remains the “heartland of psychiatry “(3) and whilst the controversy over renaming it continues, it may outlive its obituarists!

Mohammed T Abou-Saleha and Helen L Millarb

a. Professor of Psychiatry, St George’s, University of London,United Kingdom
b. Consultant Psychiatrist, Department of Psychiatry, The Carseview Centre, Dundee, Scotland , United Kingdom

References

1.Lasalvia A., Penta E., Sartorius N., Henderson S. Should the label “schizophrenia” be abandoned. Schizophrenia Res 2015; 162:276-84.

2. Bleuler E. The prognosis of dementia praecox: the group of schizophrenias. In:Cutting J, Shepherd M, editors. The Clinical Roots of the Schizophrenia Concept: Translations of Seminal European Contributions on Schizophrenia. Cambridge, Cambridge University Press; 1987.

3. Goodwin, G. M., Geddes, J. R. The British Journal of Psychiatry 2007, 191 (3)
189-191.

Competing interests: No competing interests

23 February 2016
Mohammed T Abou-Saleh
Professor of Psychiatry
Helen L Millar
St George's, University of London
Cranmer Terrace, London SW17 0RE