Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands.
Epidemiol Psychiatr Sci. 2019 Jun;28(3):254-257. doi: 10.1017/S2045796018000586. Epub 2018 Oct 18.
There had been a long way to go before we felt comfortable about even discussing the issues revolving around the concept of 'schizophrenia', let alone reckoning on mere semantic revision. In this editorial, we aim to extend our discussion on the reasons behind the slow death of the concept of 'schizophrenia' and the benefits of changing the name and embracing a spectrum approach with an umbrella psychosis spectrum disorder (PSD) category (similar to autism spectrum disorder) that goes further than a mere semantic revision. We attempted to cover the topic of the renaming by providing five most pertinent points categorised under five domains: reasons, signals, challenges, promises and steps for the change. Admittedly, even a modest revision, such as classifying all psychotic disorder categories under an umbrella category of PSD, and abolishing the term schizophrenia requires careful deliberation and some effort in the beginning, but the revision is well worth the effort considering the benefits in the long run. Renaming a particular form of mental suffering should be accompanied by a broader debate of the entire diagnosis-evidence-based-practice (EBP)-symptom-reduction model as the normative factor driving the content and organisation of mental health services that may be detached from patients' needs and reality, overlooks the trans-syndromal structure of mental difficulties, appraises the significance of the technical features over the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalisability. Individuals may make great strides in attaining well-being by accommodating to living with mental vulnerabilities through building resilience in the social and existential domains. Changing the name and the concept of 'schizophrenia', which goes beyond a mere semantic revision, may become the first step that allows catalysation of the process of modernising psychiatric science and services worldwide.
在我们感到舒适地讨论围绕“精神分裂症”概念的问题之前,还有很长的路要走,更不用说仅仅依靠语义修正了。在这篇社论中,我们旨在扩展我们对“精神分裂症”概念缓慢消亡的原因的讨论,并探讨更名为精神障碍谱(PSD)类别下的伞状概念的好处,这种方法比单纯的语义修正更进一步。我们试图通过提供五个最相关的要点来涵盖重命名的主题,这些要点分为五个领域:原因、信号、挑战、承诺和变革步骤。诚然,即使是对所有精神病类别进行分类的适度修正,如将所有精神病类别归入 PSD 伞状类别,并废除“精神分裂症”一词,也需要在开始时进行仔细的考虑和一些努力,但从长远来看,这种修正值得付出努力,因为它带来了好处。为一种特定的精神痛苦重新命名,应该伴随着更广泛的讨论,即整个基于诊断的证据实践(EBP)-症状减轻模型,因为它是驱动心理健康服务内容和组织的规范性因素,可能与患者的需求和现实脱节,忽视了精神困难的跨综合征结构,评估护理的技术特征相对于关系和仪式成分的重要性,并且低估了 EBP 群体到个体的普遍适用性的缺乏。通过在社会和存在领域建立韧性,个体可以通过适应精神脆弱性来实现更大的幸福。超越语义修正的“精神分裂症”的名称和概念的改变,可能成为催化全球精神科学和服务现代化进程的第一步。