This is a particularly perceptive and informed article from a journal which I served as an article reviewer/advisor years ago.

Brian Koehler

Excerpts from:

Schizophrenia Bulletin vol. 40 no. 2 pp. 255–258, 2014

Name Change for Schizophrenia

Norman Sartorius*,1, Helen Chiu2, Kua Ee Heok3, Min-Soo Lee4, Wen-Chen Ouyang5, Mitsumoto Sato6,

Yen Kuang Yang7, and Xin Yu8

Concluding Remarks:

“The change of the name of schizophrenia in Japan went

hand in hand with an effort to present an update of the con-

cept of schizophrenia—its origin, pathogenesis, course, and

methods of treatment. The first results of the change were

most encouraging—seen in the relationship of patients and

doctors. It will be of great importance to continue assess-

ing the effects of the change of the name for schizophrenia.

If it turns out that the early positive results are confirmed,

it might be useful that psychiatric societies—such as the

American Psychiatric Association—and patient associa-

tions and governmental and intergovernmental organiza-

tions, such as the World Health Organization, consider

taking the same course that Japan and other countries in

South East Asia have taken.”

Psychiatric disorders carry a stigma that usually leads

to discrimination and resulting problems in many walks

of life. People with mental illness thus have difficulties

getting a job, finding housing, and making (or keeping)

friends or partners. The stigma adds misery to the life of

persons with a mental disorder. It affects their families

as well as professionals and others who provide them

with care.

A number of studies demonstrated that people with

mental disorders avoid seeking help because they are

afraid of stigmatization and its consequences.1–3 If they

come to a service and their condition is given a diagno-

sis, they hide it. Doctors hesitate to tell their patients a

diagnosis because it is stigmatized, linked to notions of

dangerousness; incurability and unpredictability, which

makes patients feel that there is no hope and that there is

no point in following recommendations concerning their

lifestyle or the treatment of their illness.

In recent years, several countries in which psychiatric

diagnoses are used in their local language form decided

to change the name of 2 most severe mental disorders:

schizophrenia and dementia. This in turn should lead to

better collaboration in treatment, facilitate rehabilitation,

and enable the inclusion of patients in their community

and other social networks.

It was accepted that a change of name must be accom-

panied by an updating and revision of the concepts of

diseases: thus for example, the notion that schizophre-

nia inevitably leads to poor outcome would have to be

replaced by available and accepted evidence that many

people with schizophrenia who are given appropriate

treatment recover and can lead a normal life4 and that

the condition of those whose disease is resistant to treat-

ment can be improved to a significant degree.

Proposals to change the name of schizo-

phrenia have been made by user groups in Europe5,6 and

by scientists (eg, salience disorder), but these seem to have

advanced considerably less fast to the acceptance of any

change by European psychiatrists or nongovernmental

organizations of patients and their family than was the

case in Japan and other countries in the Far East.

Japan was the first country to change the previously

used name of schizophrenia, “Seishin-Bunretsu-Byo”

(mind-split-disease) into the new name of “Togo-

Shitcho-Sho” (integration disorder). The change of the

name was accompanied by a shift from the Kraepelinian

“dementia praecox” tradition to a concept based on the

vulnerability to stress model.

The new term for schizophrenia with the updated

concept of the disorder may in the opinion of Japanese

mental health specialists change the public image of

schizophrenia from a concept marked by fatalistic pessi-

mism to one characterized by realistic optimism and thus

promote recovery reducing public stigma and self-stigma.

In Korea, the term for schizophrenia was “Jeongshin-

bunyeol-byung, Jeongshin (‘mind’)-bunyeol (‘splitted’)-

byung (‘disorder’).” The previous name of schizophrenia,

which means “split-mind disorder,” stigmatizes the patients

with schizophrenia, their caregivers, and mental health

professionals.9 In addition, people confused this name

with “dissociative identity disorder.”10 The new term for

schizophrenia is “Johyun-byung (attunement disorder),”

which implies that patients with schizophrenia need to

“tune” their mind as they would do with strings of violin

or guitar. Renaming the split-mind disorder as attunement

disorder is expected to result in a reduction of prejudice

and discrimination against patients with schizophrenia.

In Hong Kong, the old Chinese name of schizo-

phrenia “Jing Shen Fen Lie” (精神分裂) meant liter-

ally “splitting of the mind” and was associated with

stigma. A new name “Si Jue Shi Tiao” (思覺失調) was

introduced for psychosis some 10 years ago. This new

Chinese name denotes “dysfunction of thought and per-

ception” and there is an implication of reversibility and

potential for treatment. This new name is well accepted

by the public and the professionals because it is con-

sidered to be less stigmatizing.1

The changes that have been introduced in China, Hong

Kong, Japan, Korea, and Singapore are a major social

experiment, which will produce data that should be

assembled and studied. If the changes that have been

introduced do reduce or revert stigmatization, as the

preliminary findings seem to indicate, a new avenue of

fighting stigma will be opened. It will then be useful to

proceed to similar reforms and reconceptualization of

other terms used in psychiatry—in other countries of

Asia and elsewhere—because that could make the life

of patients and families better and the image of psychi-

atry more positive. Eventually this might also lead to

a more general exploration of stigmatizing terms still

included in the International Classification of Diseases

and to the increase of attention to the use of words

that might hurt in medicine. The positive results of the

introduction of the concept of recovery as the goal of

treatment is an example of such a change, which has

revitalized thinking about rehabilitation and helped

efforts leading to inclusion of people with a mental ill-

ness into society.

Diagnoses used in psychiatry are heavily

loaded with stigma and changing the name of the men-

tal disorder provides an opportunity to say that we have

learned a great deal about the disorder and that there-

fore it is time to also change its name. It is clear that

the change of the name alone is not enough: it must be

seen and experienced as part of a change of the health

system, which is necessary not only to better protect

human rights of the mentally ill but also because new

knowledge opened new vistas and new avenues of deal-

ing with mental illness.

The change of the name of schizophrenia in Japan went

hand in hand with an effort to present an update of the con-

cept of schizophrenia—its origin, pathogenesis, course, and

methods of treatment. The first results of the change were

most encouraging—seen in the relationship of patients and

doctors. It will be of great importance to continue assess-

ing the effects of the change of the name for schizophrenia.

If it turns out that the early positive results are confirmed,

it might be useful that psychiatric societies—such as the

American Psychiatric Association—and patient associa-

tions and governmental and intergovernmental organiza-

tions, such as the World Health Organization, consider

taking the same course that Japan and other countries in

South East Asia have taken.