Imagine you are meeting Hiromi, a 22-year-old Japanese man. He has integration disorder, which can affect his thoughts and perceptions. Sometimes, what he experiences does not reflect reality. But with the right help, he can recover and lead a normal life.
What is your first impression of Hiromi? Would you be open to being friends with him?
Would your view of him change if you knew he actually had schizophrenia?
This thought experiment is the reality in Japan. In 2002, the Japanese medical system changed Seishin-Bunretsu-Byo – which translates to “mind-split disease” – to Togo-Shitcho-Sho or integration disorder. Mind-split disease is the same diagnosis as schizophrenia, which comes from the Greek words for “split” and “mind.”
Along with the name change, Japanese psychiatrists created new associations for integration disorder. It is no longer a debilitating and hopeless disease leading to decline and discrimination. Under a vulnerability-stress model, they rebranded it as a disorder where recovery is possible with the right medication and support.
If you hear “schizophrenia” and think of threat and aggression, you are not alone. A 2001 study of Quebecois individuals found that 54 per cent of respondents considered people with schizophrenia dangerous and violent.
However, people with schizophrenia are 14 times more likely to be victims of violence than perpetrators of it. Reports also indicate that 99.97 per cent of people with schizophrenia are not convicted of serious violence in a year.
Our public perceptions of schizophrenia are not just wrong; they are actively harmful. A 2014 study examined how changing the name of schizophrenia could change perception. The study found that treatment outcomes for schizophrenia are poorer in the Western world – where only one in three people with schizophrenia recover – than in Nairobi, Kenya, where one in two people recover. One of the main reasons for this is said to be the stigma associated with schizophrenia in the Western world.
In a different survey, two-thirds of people with schizophrenia did not pursue treatment because of the anticipated stigma. Another survey cited in the study found that the majority of Western people with schizophrenia view the discrimination that comes from having schizophrenia more negatively than the symptoms of the disorder itself.
In Japan, before the name of the diagnosis changed, there were similar associations between schizophrenia, unpredictability, and violence. Many doctors would not inform people of their diagnosis for fear of inflicting stigma and discrimination, which would affect their treatment.
Since the name change, the diagnosis is viewed as less stigmatizing. Within two years, 33 per cent more people were informed of their diagnosis, and 86 per cent of psychiatrists surveyed said the change made it easier to tell family and friends about the diagnosis and helped introduce education and treatment. The new name and concept have also reduced associations with violence and increased the number of people who would have a relationship with someone with schizophrenia.
But what about the West? Could we change the name and understanding of schizophrenia as Japan did? Initial studies with people from the United Kingdom and Ireland show that it could have positive effects. The name “integration disorder” decreases the discriminatory attitudes toward someone who has recovered from the acute phase of illness. With the new name, participants were more likely to say they would employ, work with, rent to, or become friends with the person.
A name change would not be an automatic win. It would have to accompany correct information about integration disorder, instead of perpetuating the same stereotypes of danger and violence that come with schizophrenia.
Some critics of a prospective name change in the West say that we need to address the root cause of the issue, rather than a mere symptom. It would not change the larger stigma against mental illness in our society. But it would be an opportunity to correct the concept of the disorder, like Japan did. As other researchers say, a name change is not just a new label but “an entirely different way of thinking about people with schizophrenia.”
When we have miscast them as violent criminals, despite evidence to the contrary, and impeded their recovery, don’t we owe them that?