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October 18, 2004
Change disease name to decrease stigma?
Can a less pejorative Chinese translation for schizophrenia reduce stigma? A study of adolescents' attitudes toward people with schizophrenia
KA FAI CHUNG AND JOHN HUNG CHAN
The name schizophrenia (from the Greek meaning "split mind") has been in use for decades to describe schizophrenia. While it isn't the original term used for the disorder (Emil Kraepelin first described schizophrenia in modern medical literature and called it dementia praecox) it has come to be the most commonly used term and one that carries with it much information but also the stigma that is often associated with major mental illness. In China, the word schizophrenia was translated to essentially mean "mind-split disease." The authors of this study wanted to determine what the effect would be of re-translating the word for schizophrenia to mean "dys-regulation of thought and perception" which would convey a more clinical/biological connotation than "mind-split disease." The authors gave a survey to 314 10th/11th graders in an average (academically) school in Hong Kong. They gave the students a story that was about someone who met criteria for diagnosis of schizophrenia and used either the common label for the disease, the new term or no word at all for the symptoms that the patient had in the story. Students were then asked to give their impression on various topics including social distance, stereotypes of schizophrenia, and attributions regarding mental illness. Students were also asked if they knew anyone with mental illness, if they were themselves religious and if they had ever received a diagnosis of any kind of mental illness.
The authors found that the use of the more "politically correct" term had little to no impact on how the students rated the various patients in their vignettes. The students tended to show less stigma than the authors anticipated in general, regardless of the label given to the patient in the story. Interestingly, religious students tended to give less attribution to the patients for their disease than did agnostic students.
There have been studies over the years that have shown that patients generally prefer less pejorative ways of describing their conditions. There are many features of mental illness care that are generally stigmatized: speaking with a psychiatrist, taking medication, difficulty with social functioning/hygiene/work. In Hong Kong a recent campaign has tried to teach people of the new terms in an effort to help decrease stigma and barriers to treatment. The effects of this campaign are difficult to evaluate and perhaps it may have been partially responsible for the overall decreased stigma seen regardless of description given that the students were told of the symptoms that the patient was suffering from. It should also be noted that this study only looked at a small, specific population (high school students) and so the general results are difficult if not impossible to generalize to the overall community of Hong Kong, much less to people in the United State or Europe. However it does present a dilemma with respect to how to most effectively decrease stigma. Would changing the name of schizophrenia to something clinical or biological in English (such as dopamine dysregulation or neurobiological disease) actually help? There probably is no way to know for sure, but efforts to help decrease stigma are still definitely needed worldwide as shame and misunderstanding of mental illness still creates a difficulty for many of those affected by schizophrenia whether consumer or family member.Posted by Jacob at October 18, 2004 11:56 PM | TrackBack