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Editorials

Renaming schizophrenia

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39057.662373.80 (Published 18 January 2007) Cite this as: BMJ 2007;334:108

Rapid Response:

Change is required; but name or attitude?

Dear Editor

Mental illness attracts attention from lay people or professionals
alike, and rather fortunately or unfortunately, from the media. The
general public always had a concept of madness – and the ICD 10 F20s
diagnosis of Schizophrenia fits well into the same. Whilst the biological
concept appears more prevalent in developed societies compared to the
lesser developed and supernatural believing ones, the general attitude
towards mental symptoms is a negative one. Be it the enduring,
unresponsive nature of the illness or the un-understandable, implausible
symptoms or behaviour. Also, the much highlighted incidents of violence
and attacks by people with mental illness have generated, but very sadly,
a stereotype. Stigma is highly prevalent among people labelled with mental
illness in the community (1).

We agree with the authors Lieberman and First that establishing a
correct diagnosis and then initiating appropriate treatment is much more
important than the name of the illness. The stigma is attached to the
unexplainable presentations of schizophrenia that deviate from the
‘normal’. The stigmatised one at some point does realise this different
status. And this further constitutes a detriment towards return to
‘normalcy’, restriction of social networking (2), social rejection and
self-deprecation (3), impaired functioning and recurrent stress. There is
ample evidence to suggest higher relapse of schizophrenia living in a
hostile and critical environment compared to an accepting one (4).

We also believe that the answer lies in a change of attitude. Public
attitude, corrected through imparting correct information, dispelling
beliefs, stereotypes and fears. The media should as well take on an active
role upon itself, imparting knowledge, preventing stigmatisation and
undoing the incorrect. Even elaborate and definitive steps similar to the
suicide prevention WHO resource for the media professionals may be
necessary (5), which may hopefully establish some guidelines on how to and
how not to report incidents involving the mentally unwell.

And to talk of wrong names and medical incorrectness, malaria still
stands for ‘foul air’.

References:

(1) On stigma and its consequences: evidence from a longitudinal study of
men with dual diagnosis with mental illness and substance abuse. Link BG,
Struening EL, Rahav M et al, 1997. Journal of Health and Social Behaviour
38:177 – 190

(2) Making it crazy: an ethnography of psychiatric clients in an American
community. Estroff S 1981. University of California Press, Berkeley.

(3) From the mental patient to the person. Barham P, Haywood R 1991.
Routledge, London.

(4) Influence of family life on the course of schizophrenic disorders: a
replication. Brown GW, Birley JL, Wing JK 1972. British Journal of
Psychiatry 121: 241 – 258

(5) Preventing suicide: A report for media professionals - Mental and
Behavioural Disorders, Department of Mental Health, World Health
Organization, Geneva 2000

Competing interests:
None declared

Competing interests: No competing interests

23 January 2007
Arnob Chakraborti
Addiction Psychiatry SHO
Luay Kafienah, CAMHS Senior House Officer
St. George's Hospital, Stafford ST16 3AG