Brain and Body

"Schizophrenia" Does Not Exist, According to This Psychiatric Expert

February 8, 2016 | Kelly Tatera

fMRI of the brain comparing healthy and schizophrenic individuals
Photo credit: Kim J, Matthews NL, Park S./wikipedia (CC by 2.5)

Japan and South Korea have already abandoned the term.

According to the Schizophrenia and Related Disorders Alliance of America (SARDAA), about 3.5 million people in the United States have been diagnosed with schizophrenia, and the disorder can be found in approximately 1.1 percent of the world’s population.

But according to psychiatry professor Jim van Os of the Maastricht University Medical Centre, “schizophrenia” does not exist.

Professor Os argues that the term “schizophrenia” connotates a hopeless chronic brain disease, and that the word should be replaced with something like “psychosis spectrum syndrome” in order to be more accurate. Japan and South Korea have already abandoned the term “schizophrenia.”

The term can be found in both of the official reference texts used to diagnose patients — ICD-10 (International Classification of Diseases, 10th revision) and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). However, Professor Os argues that it should be dropped.

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Why? Psychotic illnesses are classified among a number of different categories, including schizophrenia, bipolar disorder with psychotic features, delusional disorder, schizoaffective disorder, etc. However, these categories "do not represent diagnoses of discrete diseases, because these remain unknown; rather, they describe how symptoms can cluster, to allow grouping of patients,” Os said in a press release.

He further explains that grouping and diagnosing patients based on clustering symptoms allows clinicians to say, for instance,  "You have symptoms of psychosis and mania, and we classify that as schizoaffective disorder." However, if the psychotic symptoms disappear, it could then be reclassified as bipolar disorder, or if the mania symptoms disappear, it could be re-diagnosed as schizophrenia. The psychotic disorders tend to have a lot of overlapping symptoms and this classification system doesn’t always lead to a solid diagnosis.

"That is how our classification system works. We don't know enough to diagnose real diseases, so we use a system of symptom based classification,” Os explains.

Interestingly, Os highlights the language used to typically describe schizophrenia: the American Psychiatric Association (who publishes the DSM) describes schizophrenia as a “chronic brain disorder” on its website, and academic journals describe it as a “devastating, highly heritable brain disorder,” a “debilitating neurological disorder,” or a “brain disorder with predominantly genetic risk factors.”

Os says that this language strongly depicts schizophrenia as a distinct, genetic brain disease, but oddly, this language isn’t used for the other categories of psychotic illness, despite the fact that they constitute 70 percent of psychotic illnesses.

It’s time to forget about “devastating” schizophrenia as the only category that matters, says Os, and "and start doing justice to the broad and heterogeneous psychosis spectrum syndrome that really exists."

Os isn’t the first to highlight the problems with the term “schizophrenia,” and in his paper, published in the British Medical Journal, he argues that “schizophrenia” should be dropped from ICD-11, which is due by 2018.

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