Schizophrenia term use 'invalid'

The term schizophrenia should be abolished, experts have said.

They claim the category falsely groups a wide range of symptoms and encourages over-reliance on anti-psychotic drugs rather than psychological intervention.

The academics also said the label stigmatised people as being violent, dangerous and untreatable. But other scientists said the term should not be scrapped without finding another means of classifying patients with psychosis.

"I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients" said

Richard Bentall

Schizophrenia represents a complex mental health disorder. Symptoms vary from person to person, but include delusions, hallucinations and disordered perceptions of reality. It is estimated that one in 100 people will develop schizophrenia at some point in their lifetime.

But experts, speaking on the eve of World Mental Health Day, are calling for the term to be scrapped.

Richard Bentall, professor of experimental clinical psychology, from the University of Manchester, said: "We do not doubt there are people who have distressing experiences such as hearing voices or paranoid fears. "But 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 said this can misinform treatment, and has encouraged the widespread use of "drastic biomedical interventions" as the first-line of treatment, rather than psychological help. Although drugs were useful for some patients, too often they were given at extremely high doses and had some dangerous side-effects.

Professor Bentall said: "Overall, I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients."

Stigmatising patients

Paul Hammersley, also of the University of Manchester, who is involved with the Campaign to Abolish the Schizophrenia Label (Castle), wants the term dropped. He said: "It is associated with violence, dangerousness, unpredictability, inability to recover, constant illness, constant need for medication and an inability to work. I cannot emphasise enough how stigmatising this label is."

But the academics could not give a definitive answer to what should replace the term schizophrenia if it was eliminated.

They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model. And Professor Bentall suggested patients should be treated on the basis of individual symptoms, as opposed to an overarching category.

Robin Murray, professor of psychiatry at the Institute of Psychiatry, London, said most psychiatrists accepted term schizophrenia was imperfect but warned that were it discarded another method of classification must be devised. He said: "If we don't have some way of distinguishing between patients, then those with bipolar disorder or obsessional disorder would be mixed up with those currently diagnosed as having schizophrenia and might receive treatments wholly inappropriate for them.

"Most psychiatrists would still agree that the term schizophrenia is a useful, if provisional, concept. My personal preference would be to replace the unpleasant term schizophrenia with dopamine dysregulation disorder which more accurately reflects what is happening in the brain when someone is psychotic. "

Til Wykes, professor of clinical psychology and rehabilitation at the Institute Of Psychiatry, said: "We should be careful not to throw the baby out with the bath water, as despite its limitations, a diagnosis can help people access much needed services. What all of us have to remember is that these are people with a diagnosis of schizophrenia, not 'the schizophrenic'."