Being of Two Minds About Schizophrenia

Since the 1990s, epidemiologists, psychiatrists, historians, and journalists have wondered to what extent schizophrenia was disappearing as a medical diagnosis. An article in The Lancet titled “Is Schizophrenia Disappearing?” suggested a substantial decrease in the reported incidences of the disorder since the mid-1960s; a 2012 publication, Schizophrenia Is a Misdiagnosis, criticized the very validity of the diagnosis and bluntly announced its demise. Articles with similar titles, such as “Schizophrenia Does Not Exist” and “The Concept of Schizophrenia Is Coming to an End,” appeared in the British Medical Journal and The Independent in 2016 and 2017, respectively. The editor of the leading journal in the field, Schizophrenia Bulletin, debated whether to rebaptize the journal and drop “schizophrenia” from its name. In the end, he decided to keep “schizophrenia” in the journal’s title while adding an explanatory subtitle as a disclaimer of sorts. With the added “The Journal of Psychoses and Related Disorders,” the editor seemed to anticipate where the field would soon be headed. Finally, a 2017 article in this very journal claimed that the word schizophrenia might eventually be relegated to the dustbin of history, as had once been the case with the medical use of the term “dropsy.”

Still lacking a laboratory test for diagnosing schizophrenia and having found no precise biomarkers for this collection of symptoms, we are now asked to reimagine schizophrenia as revealing not a different category of mental illness but a spectrum of disorders whose defining characteristics are part of a continuum rather than tokens of essential types or natural kinds. History teaches us that abnormalities in thoughts, emotions, and behaviors were always seen as either categorically different (in the same way that plants are different from animals and minerals, and various trees are different from each other) or as a variation on a spectrum (in the same way we measure height or weight, or high or low blood pressure).

But the decline of the diagnosis was driven not only by general shifts in psychiatric classification as it turned from categories and qualitative methods to spectra and quantitative models. In addition, psychiatrists, psychologists, social activists, survivors, ex-patients, and others argued that the stigmatizing label of “schizophrenia” should be abolished precisely because it carried connotations of hopelessness, chronicity, and even dangerousness that could not help but lead to therapeutic nihilism and the unjustified "counsel of despair."

Doctors and patients who advocate for a name change are searching and pleading for less discriminatory and more appealing diagnoses, with “extreme mental states,” “voice-hearing,” “non-ordinary states,” or “diverse identities” just a few of the suggestions that have been made. In addition, some have urged the American Psychiatric Association to follow the example of Asian countries such as Japan, where psychiatrists replaced the term and diagnosis “schizophrenia,” implying a “split-mind,” with that of “integration disorder,” inaugurating a momentous change that, by all accounts, has proved beneficial to both patients and doctors."

Read the full article on Psychology Today

Reflection: Do you think schizophrenia diagnosis is on the decline? Do you think it's positive or negative that the diagnosis is shifting towards spectrums rather than categories?

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