An alert student forwarded me a rather bizarre report from MSNBC about a discussion among British psychiatrists about the use of the label “schizophrenia.” According to these psychiatrists, schizophrenia “has no scientific validity, is imprecise and stigmatizing.”
Labeling is always an issue in psychopathology. We have to have some agreement that a particular disorder exists and is characterized by certain symptoms in order to provide appropriate treatment. Yes, labels can become stigmatizing, and there is a long history of label changes designed to reduce stigma. We have developmental delays instead of mental retardation, and autism spectrum disorders instead of autism. But labels work positively when they allow researchers and practioners to “speak the same language” when discussing disorders.
The opinions expressed by the psychiatrists interviewed in this article surprised me quite a bit. I am not a clinician, so profess no expertise here, but I always thought of schizophrenia as being one of the more reliable, valid categories of psychopathology. I feel quite differently about AD/HD, for instance, which seems to me to be very loosely defined.
What might we use instead of schizophrenia? One psychiatrist suggested “dopamine dysregulation disorder.” Good grief. For starters, there are a large number of conditions (e.g. Parkinson’s disease) that involve problems with dopamine. Second, we are not all that convinced that dopamine abnormalities are the main causal factor in schizophrenia. Yes, the classic antipsychotic medications are dopamine antagonists, but these tend to leave negative symptoms (social withdrawal, flat affect, etc.) untouched. In addition, many researchers are interested in a role for glutamate in schizophrenia, too. A search on PubMed using “glutamate and schizophrenia” returns nearly 1000 articles.
So I think I’ll pass on the DDD label for now, unless somebody has a good defense to offer for it.
In the meantime, Paul Thompson of UCLA is doing some interesting imaging work looking at the differences in brain development between healthy teens and teens with schizophrenia.