The stigma that surrounds mental illness is not only insulting to the roughly one-quarter of the world's population that has one, it can also negatively impact their willingness to seek help and their recovery.
But perhaps no mental illness is more stigmatized than schizophrenia, a devastating ailment that affects around 1 percent of the general population. The poorly understood condition is characterized by symptoms including delusions, hallucination, abnormal social behavior, paranoia and cognitive impairments.
The term "schizophrenia" itself tends to call to mind split personalities, disturbing imaginary voices and visions, and violent outbursts, according to health advocates including Brian Semple of the British non-profit Rethink Mental Illness.
"Unfortunately, there is still a great deal of misunderstanding around schizophrenia," he told Medical News Today.
For this reason, Dr. Jim van Os, a psychiatrist at Maastricht University Medical Centre in The Netherlands, is one of a growing number of clinicians calling for updated classifications around schizophrenia and other psychotic disorders as a way to reduce prejudice and misperceptions.
In a paper published in The British Medical Journal on Tuesday, van Os argues that the term "schizophrenia" -- which he says may needlessly scare patients by calling to mind a debilitating brain disease -- should be removed from the International Classification of Diseases, which is now being revised, and the Diagnostic and Statistical Manual of Mental Disorders. He suggests replacing it with a more neutral, updated label such as "psychosis spectrum disorder."
Taken from Greek words meaning "split" and "mind," the term schizophrenia dates back to the inhumane treatment of psychotic patients in "insane asylums" in the late 19th and early 20th centuries, and still carries these unfortunate connotations. It doesn't refer to any actual symptoms of the disorder.
"If you have depression, then people understand this disease about feeling depressed -- I feel depressed sometimes so I know where this patient is coming from," van Os told The Huffington Post. "But schizophrenia is a rather mystifying term that has nothing to do with psychosis itself... It doesn't help explain to the public what psychosis is about in a way that people can relate to their own experience, which is very important."
Japan and South Korea have already dropped the term, to positive results. After replacing it with a less negatively charged and more accurate descriptor ("integration dysregulation syndrome"), patients were better able to cope with their diagnoses. They were also more likely to seek help and less likely to commit suicide, according to a 2013 study published in the journal Psychological Medicine.
“The real entity that we should be studying and diagnosing is psychosis spectrum disorder."”
- Dr. Jim van Os, of Maastricht University Medical Centre
These illnesses are classified in many different categories. Van Os also argues that current classifications do not acknowledge the continuity between schizophrenia and other psychotic disorders, including schizoaffective disorder, delusional disorder, bipolar disorder with psychotic features and depression with psychotic features.
Instead, psychotic disorders including schizophrenia exist on a spectrum, much like the autism spectrum of disorders, according to van Os. Such a spectrum ranging from mild psychotic episodes to severe schizophrenia.
"The real entity that we should be studying and diagnosing is psychosis spectrum disorder," van Os said.
The problem is that schizophrenia is separated from these other ailments and put into a worst-prognosis category unto itself. In this case, word choice is more than mere semantics.
Van Os hopes that changing the way we talk about the disorder can help us to decrease stigma while also encouraging public understanding and compassionate psychiatric care.
In a response to the BMJ article, Dutch psychiatrist Jan P.L. Leijten said that following van Os's suggestions had yielded positive results with his patients.
"In my own practice I tell people with psychotic problems the same as Jim van Os suggests in this article," Leijten wrote. "It gives the patient a positive perspective and appears the best way to commit [them] to the necessary treatment."
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