When Psychiatry, Psychobabble, and Political Correctness collide, the results would be unintentionally amusing if they didn't have serious repercussions. The latest miscarriage produced by the marriage of Psychiatry and PC is reported in a story from Reuters, "Schizophrenia" should be dropped, say experts. Apparently, some "experts" believe that the term stigmatizes people and that their self esteem should be protected by renaming the most devastating of all the Psychiatric illnesses.
The story does make some almost reasonable points, for example that the underlying cause of Schizophrenia is not well understood and that the symptom picture exists on a spectrum (both statements that can be made about almost any illness, in point of fact) but there is a fair amount of silliness mixed in:
Paul Hammersley of the University of Manchester who recently helped launch The Campaign for the Abolition of the Schizophrenia Label (CASL), said there is no agreement on the cause of the illness or its treatment.
CASL argues that the term schizophrenia is extremely damaging to those to whom it is applied and implies unpredictability, being dangerous, unable to cope and someone in need of life-long treatment.
Schizophrenia does not imply "unpredictability, being dangerous, unable to cope" to me and I would certainly qualify as an expert in these matters. It does often imply someone in need of open-ended treatment. If it is taken to mean "unpredictability, being dangerous, unable to cope" it may have more to do with the misconceptions about the illness that the Media promulgate in conjunction with the fact that people who suffer from Schizophrenia and neglect their treatment often, in fact, are unpredictable, occasionally dangerous (though most often dangerous only to themselves) and unable to cope.
An additional argument is also set out in the article:
Speaking at a news conference, Richard Bentall, a professor of clinical psychology at the University of Manchester, said the concept of schizophrenia is scientifically meaningless.
"It groups together a whole range of different problems under one label -- the assumption is that all of these people with all of these different problems have the same brain disease," he added.
In response the article quotes Robin Murray, a professor of psychiatry at the Institute of Psychiatry in London:
He suggested replacing the term schizophrenia with the label dopamine dysregulation disorder, which he said more accurately reflects what is happening in the brain of someone who is psychotic.
Unfortunately Robin Murray accepts the basic premise that the name of the disorder is the problem and attempts, as often too defensive Psychiatrists tend to do, that the concept really is based on science. Here we have a collision between the misuse of ideas about supporting self-esteem and the fundamental PC concept that words are more significant than reality and in fact can change reality.
The fact is that Schizophrenia is a spectrum disorder ranging from severe full blown cases which show a classic course and milder variants which leave a person at risk of decompensation but able to live a full life as long as their illness is treated with respect. There is a fair amount of science behind it; Schizophrenics do tend to have difficulty with Dopamine regulation, but like almost any illness, the true "root causes" lie beyond our current understanding. Contrast this with Diabetes or Pneumonia, two illnesses thought to be straight forward and well understood. In fact, both represent spectrum disorders with multiple causes, varying treatments which depend on the particulars of the illness and which in very real ways involve an interaction with the patient's mind and body, and the proximate, causative insult. While there is much unknown about Schizophrenia, it shares all of these aspects with Diabetes and Pneumonia. Should we now start re-labeling all illnesses to avoid any possibility of stigma; after all, a child with diabetes who cannot eat candy might feel stigmatized when all his or her friends munch on toffees.
People should always be treated with respect and as individuals with their own responsibilities and agency. There is a range of resiliency that affects how people handle adversity. Schizophrenics are no different in this; some are better at dealing with their illness than others. It should go without saying, the diagnosis should never be used as a pejorative but when a patient has a history and presentation which are consistent with the diagnosis, it is kinder to discuss the possibility of Schizophrenia with those who want to know than to disguise the fact with euphemisms in a misguided and patronizing attempt to protect them. The Schizophrenic patients I have worked with, even the most regressed, often fear they are losing their minds when they first become ill. There are few experiences more terrifying. Finding out there is a Medical condition responsible for their distress, even one with such serious potential repercussions, is a necessity if they are to recover and move forward in their lives.
Michael, at Innocent Bystanders, should definitively have the last word on this. I clearly disagree with some of his arguments, but in his post, Rename Schizophrenia? he makes a particularly trenchant point when he suggests there is a serious problem with sanitizing Schizophrenia as "dopamine dysregulation disorder":
Maybe it’s just me, but if stigma is the problem, I don’t think you should switch to a new term that starts with “dope.”
(If you visit his site, be sure to check out the comments; some of them are quite entertaining.)
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