Schizophrenia, The Stigmatized Mental Illness: Psychologist Argues Could Be Better To View Psychosis On A Spectrum

Brain
A prominent Dutch researcher makes the case for reconsidering schizophrenia as part of a "psychosis susceptibility syndrome," rather than a distinct genetic brain disease. Marc Donis, CC BY 2.0

"'Schizophrenia' does not exist," boldly proclaims the headline of an editorial published Tuesday in The BMJ by Dr. Jim van Os, a prominent Dutch researcher and Chairman of the Department of Psychiatry and Psychology at Maastricht University Medical Center.

van Os, isn’t arguing that schizophrenia is an imaginary ill, however. Rather, he believes its most popular characterization is deeply flawed and only serves to confuse people about the nature of mental illness, particularly psychosis. While people diagnosed with other psychotic illnesses such as delusional disorder are understood to be suffering from a broad pattern of symptoms without a clear-cut singular origin — a pattern that can shift over time — schizophrenia is usually considered to only be a "distinct, genetic brain disease" by both the public and health professionals, according to van Os.  

"In fact, even though they constitute 70 percent of psychotic illness morbidity (only 30 percent of people with psychotic illness have symptoms that meet the criteria for schizophrenia) these other categories tend to be ignored in the academic literature and on websites of professional bodies," he wrote. "They are certainly not referred to as brain disorders or similar. It’s as if they don’t exist."

To remedy this invisibility, van Os believes radical steps should be taken. First, schizophrenia should be stricken off the upcoming edition of the International Classification of Diseases (ICD-11), a "standard diagnostic tool for epidemiology, health management and clinical purposes" developed by the World Health Organization. Second, it, along with other psychotic illnesses, should be reclassified in order to better illuminate the complexity of psychosis.

"Scientific evidence indicates that the different psychotic categories can be viewed as part of the same spectrum syndrome, with a lifetime prevalence of 3.5 percent, of which 'schizophrenia' represents the minority (less than a third) with the poorest outcome, on average," he explained. "However, people with this psychosis spectrum syndrome — or, as patients have recently suggested, psychosis susceptibility syndrome — display extreme heterogeneity (difference), both between and within people, in psychopathology, treatment response, and outcome."

This isn’t van Os’s first attempt to spark a debate. In 2014, he gave a presentation at TEDxMaastricht, in which he explained that the focus on genetic factors as an easy explanation for madness can overshadow the importance of environmental and social influences on our mental health. It can also give off the perception that psychosis is impossible to treat without a fundamental rejigging of our genes.

"Psychosis, schizophrenia, these are conditions that typically start in adolescence. There is widespread consensus that in order to recover from psychosis, you need a perspective of hope and possibility to change," he said during the talk. "And I think it is clear that the concept, or stereotype, of psychosis as represented is devoid of exactly that, of hope and change."

As van Os notes, the idea of relabeling schizophrenia isn’t entirely new; nations such as Japan successfully replaced the old term for it, "Seishin-Bunretsu-Byo,' or mind-split disease, with "Togo-Shitcho-Sho," or integration disorder, in 2002. And though the disorder is still prevalent, there is evidence that Japanese residents are now less likely to associate sufferers with the old stereotypes of criminality and violence than before.

"The best way to inform the public and provide patients with diagnoses, therefore, is to forget about 'devastating' schizophrenia as the only category that matters and start doing justice to the broad and heterogeneous psychosis spectrum syndrome that really exists," he concluded in his editorial.

van Os is hardly a crank: not only does he direct the Center of Contextual Neuroscience at Maastricht University Medical Center, but he also serves on the editorial boards of many psychiatry journals, both stateside and in Europe. Nor is he the first to advocate for a wide-spanning renaming of the disorder. Time will tell though whether his call to arms provokes further discussion within the greater mental health community. ICD-11 is scheduled to be released in 2018.

Source: van Os J. "Schizophrenia" does not exist. The BMJ. 2016.

Loading...
Join the Discussion