Joanna Moncrieff1, Hugh Middleton. 1. aDivision of Psychiatry, University College London, London bUniversity of Nottingham, Nottingham, UK.
Abstract
PURPOSE OF REVIEW: The term 'schizophrenia' has been hotly contested over recent years. The current review explores the meanings of the term, whether it is valid and helpful and how alternative conceptions of severe mental disturbance would shape clinical practice. RECENT FINDINGS: Schizophrenia is a label that implies the presence of a biological disease, but no specific bodily disorder has been demonstrated, and the language of 'illness' and 'disease' is ill-suited to the complexities of mental health problems. Neither does the concept of schizophrenia delineate a group of people with similar patterns of behaviour and outcome trajectories. This is not to deny that some people show disordered speech and behaviour and associated mental suffering, but more generic terms, such as 'psychosis' or just 'madness', would be preferable because they are less strongly associated with the disease model, and enable the uniqueness of each individual's situation to be recognized. SUMMARY: The disease model implicit in current conceptions of schizophrenia obscures the underlying functions of the mental health system: the care and containment of people who behave in distressing and disturbing ways. A new social framework is required that makes mental health services transparent, fair and open to democratic scrutiny.
PURPOSE OF REVIEW: The term 'schizophrenia' has been hotly contested over recent years. The current review explores the meanings of the term, whether it is valid and helpful and how alternative conceptions of severe mental disturbance would shape clinical practice. RECENT FINDINGS:Schizophrenia is a label that implies the presence of a biological disease, but no specific bodily disorder has been demonstrated, and the language of 'illness' and 'disease' is ill-suited to the complexities of mental health problems. Neither does the concept of schizophrenia delineate a group of people with similar patterns of behaviour and outcome trajectories. This is not to deny that some people show disordered speech and behaviour and associated mental suffering, but more generic terms, such as 'psychosis' or just 'madness', would be preferable because they are less strongly associated with the disease model, and enable the uniqueness of each individual's situation to be recognized. SUMMARY: The disease model implicit in current conceptions of schizophrenia obscures the underlying functions of the mental health system: the care and containment of people who behave in distressing and disturbing ways. A new social framework is required that makes mental health services transparent, fair and open to democratic scrutiny.