Is it time to rename schizophrenia?

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Psychiatry and psychology are not averse to renaming our constructs. For example, with DSM-III, manic-depression became bipolar disorder. Since then, mental retardation became the more descriptive intellectual disability, and the controversial multiple personality disorder became the no less controversial dissociative identity disorder. Schizophrenia started life as dementia praecox. Is it time to change the name again?

There are two arguments for a name change. First, there is much stigma associated with the term schizophrenia. As a class discussion item, ask students what immediately comes to mind when they hear “schizophrenia.” Be ready for students to say things describing people diagnosed with schizophrenia as being violent and having poor hygiene. What your students say is probably a pretty good representation of the public’s perception of schizophrenia. The more stigmatizing the label, the harder it is for clinicians to give the diagnosis to clients. And for those who have the diagnosis, the experience is all the more stressful when they have to manage the knee-jerk reactions of others. As if living with the symptoms of schizophrenia doesn’t make life much more difficult already.

The second argument for a name change is that the word “schizophrenia” is not descriptive of the symptoms, and the name implies that schizophrenia is a single entity. Our modern understanding of schizophrenia is much more nuanced. For example, we now understand schizophrenia to encompass a wide and varying spectrum of symptoms.

The disorder has already undergone a name change in Japan (to integration disorder), South Korea (to attunement disorder) and Hong Kong and Taiwan (disordered thought and perception) (Mesholam-Gately et al., 2021).

Ask your students if they think schizophrenia should be renamed.

A U.S. survey that included participants with mental illness, family members of those with mental illness, mental health providers, and others found much support for a name change; two-thirds supported a name change before seeing some possible names, and three-quarters supported a name change after seeing possible names and their descriptions. The names that received the most support were:

Altered perception syndrome: “Indicates that people with this illness experience sensory information differently in a way that changes their day to day experiences.”

Psychosis spectrum syndrome: “This term refers to a spectrum of common psychosis symptoms, such as hallucinations, delusions and thought difficulties.”

and neuro-emotional integration disorder: “A biopsychosocial (biological, psychological, and social) term describing difficulty integrating cognition, emotion, and behavior” (Mesholam-Gately et al., 2021). (Download the pdf of the survey questions).

Having seen these proposed terms and their descriptions, ask your students again if they think schizophrenia should be renamed.

Personally, I find psychosis spectrum syndrome to be the most descriptive, but I doubt that being psychotic carries any less stigma than schizophrenia does. I can see why altered perception syndrome had the most support as it is probably the most innocuous of the group, but the name makes me think of synesthesia or ESP. I could work with neuro-emotional integration disorder.

If you would like to extend the discussion, give your students a few minutes to consider alternate names. Give them these criteria: “Mental health professionals suggest that a successful name change should be clearly defined, neutral, easily understood, and illustrate the core symptoms of the disorder in order to increase accessibility and communicability by healthcare providers” (Mesholam-Gately et al., 2021). After students have a few minutes to brainstorm some names on their own, ask students to share their ideas in small groups. Ask each group to share their top one to three names. Invite the class to vote on the names.

Reference

Mesholam-Gately, R. I., Varca, N., Spitzer, C., Parrish, E. M., Hogan, V., Behnke, S. H., Larson, L., Rosa-Baez, C., Schwirian, N., Stromeyer, C., Williams, M. J., Saks, E. R., & Keshavan, M. S. (2021). Are we ready for a name change for schizophrenia? A survey of multiple stakeholders. Schizophrenia Research, 238, 152–160. https://doi.org/10.1016/j.schres.2021.08.034