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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:

What’s wrong with the term “Schizophrenia”?

The recent report in the Guardian(1), citing Prof. Bentall’s
comments, argues that the term schizophrenia should be abolished. The
arguments used in the report include poorer outcomes in the developed
world, stigma attached to the “label” of schizophrenia, and the fact that
it does not define a specific illness.

The attempt to rename schizophrenia is reminiscent of the letter by
Kellner and Ramsey(2) calling for abolishment of the term ECT. We agree
with the arguments put forward by Lieberman and First(3) and we respond in
the similar vein as the previous response to renaming ECT(4).

To our minds, there appear to be three main options.

The first option is to change the name as soon as possible and “hide”
behind the new label, avoiding any hint of the terms mind or brain.
However, it is really foolish to expect the newfangled term to be devoid
of any stigma.

The fact the term “epilepsy” consists of a collection of multiple
disorders and is often perceived to be stigmatizing, has not led to its
premature demise. The new name is very likely to be as unpopular as were
Koch’s and Hansen’s for tuberculosis and leprosy, respectively(4). The
media and general public are still likely to call it schizophrenia and the
public will wonder what we are defensive about.

The second option is to keep the present name till there is hard
scientific evidence that the present name is best replaced by another
name(s). Even while renaming dementia praecox as Schizophrenia, Eugene
Bleuler(5) had indicated that it is a group of conditions. It is widely
acknowledged that it is unlikely that schizophrenia represents a single
disease entity. However there has been a considerable amount of work done
in clarifying its core symptoms and improving the specificity and
sensitivity of its diagnosis.

The term schizophrenia serves to communicate a meaningful set of
signs and symptoms, outcome, prognosis, and treatment options to most
clinicians and researchers through the world. This represents one of the
core purposes of diagnosis and classification in psychiatry.

Whilst keeping the term schizophrenia, it is of paramount importance
to educate the public, patients and carers about the current understanding
of the condition and work proactively towards de-stigmatizing not only
schizophrenia but also all psychiatric disorders.

The third option is of course to change the name of the condition and
work towards public education and de-stigmatization.

For example, the Japanese classification has renamed schizophrenia as
“integration disorder” in 2004(6). The change appears understandable in
the light of translation of the word “schizophrenia” in to Japanese, as
“Seishin Bunretsu Byo” means “mind-split-disease”(7). It is not difficult
to see as to how the term would seem pejorative to the patients and their
families. The new term “Togo Shitcho Sho”, with the meaning of
“integration disorder”, seems therefore more positive to the patients and
their families.

One of the dangers of such an exercise is that “nicer sounding names”
would replace the pre-existing term without adequate scientific data. To
argue against another term suggested for replacing schizophrenia,
“dopamine dysregulation disorder”, there is a substantial body of evidence
to suggest that there is more than dopamine that is dysregulated in
schizophrenia. There is therefore a peril of plethora of names emerging
for the same condition, as none of these would have an evidence base
supporting the change in name. It would certainly be a retrograde step to
rename schizophrenia without the backing of valid scientific data.

We suggest that we need to focus on psycho-education, which is
crucial to remove the stigma of having a serious mental disorder. For this
purpose, we do not need to hide behind novel labels.

References

1. Boseley S. Call to wipe out schizophrenia as catch-all tag.
Guardian, 10 October 2006.

2. Kellner CH, Ramsey D. Please, no more “ECT”. Am J Psychiatry 1990;
147: 1092-1093.

3. Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007; 334:
108.

4. Ahuja N. What’s wrong with “ECT”? Am J Psychiatry 1991; 148; 693-
694.

5. Bleuler E. Dementia praecox, oder die Gruppe der Schizophrenien
(Dementia praecox or the group of the schizophrenias) Leipzig, Germany:
Franz Deuticke, 1911.

6. Sugiura T, Sakamoto S, Tanaka E, Tomoda A, Kitamura T. Labelling
effect of Selshin-bunretsu-byou, the Japanese translation for
schizophrenia: an argument for re-labelling. Int J Soc Psychiatry 2001;
47: 43-51.

7. Sato M. Renaming schizophrenia: Japanese perspective. World
Psychiatry 2006; 5: 53–55.

Competing interests:
None declared

Competing interests: No competing interests

23 January 2007
Niraj Ahuja
Consultant Psychiatrist/Honorary Clinical Lecturer
Andrew J Cole, Consultant Psychiatrist/Honorary Clinical Lecturer and Associate Medical Director, Northumberland, Tyne and Wear NHS Trust
Northumberland, Tyne and Wear NHS Trust, NE28 7PD