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APA: Drop the Stigmatizing Term "Schizophrenia"

The term "schizophrenia" has become synonymous with dangerousness even though it is a very small minority of persons with this diagnosis who violently hurt others and this may be explained better by the following factors: male gender, young adulthood, misuse of substances, homelessness, having been exposed to violence, sense of powerlessness, helplessness, stigma, etc.

The term is also associated with non-recoverability. Dangerousness and non-recoverability seem to be hard-wired into the diagnosis. The term encompasses a heterogeneous group of people with different symptoms, etiologies, course and outcomes. It is a static, traumatizing and stigmatizing term for those persons given it. It often takes away hope and a sense of agency because people are told that they have a genetic brain disease. Hope, ongoing social and peer support, and a sense of agency and self-efficacy are needed to facilitate recovery. Nine world outcome studies and the World Health Organization studies on “schizophrenia” demonstrate substantial recoveries. People have a better chance of recovery when given good care that is acceptable to them.

Perhaps, many of the neurobiological findings in “schizophrenia,” which are often non-specific and can not be used for diagnosis, could be better explained to be the result of chronic stress, relational and social traumas, social isolation/exclusion, social defeat, economic adversities, low self-esteem, stigma, prenatal stress, migration (particularly from a non-white to a white environment), urban birth/living, low impact SNPs & CNVs (single nucleotide polymorphisms and copy number variants), epigenetic changes to gene expression, the effects of first and second generation antipsychotics (e.g., the Iowa Longitudinal Study), etc.

African Americans are about 3-fold more likely than whites to be diagnosed with "schizophrenia." Social adversity can become biologically embedded and result in epigenetic changes to gene expression, which may be potentially transmitted across generations. Japan (integration disorder), Hong Kong and Taiwan (cognitive-perceptual dysregulation/dysfunction) and South Korea (attunement disorder) have dropped the term "schizophrenia" from their psychiatric nosology. Surveys in Japan have shown that service recipients and professionals alike are pleased with the change. Prominent psychiatrists such as Robin Murray in the UK and Jim van Os in The Netherlands have presented strong and convincing arguments as to why this term should be dropped. The editor of the prestigious journal Schizophrenia Bulletin has also recently wondered whether the term should be replaced. I believe the time is now to drop this stigmatizing, hope-disabling, scientifically controversial term which is saturated with various myths about non-recoverability and dangerousness.

Brian Koehler PhD, MS

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