About the Inquiry
Many people are aware that ‘schizophrenia’ is a controversial diagnosis and its usefulness has been questioned from scientific, cultural, ethical and social perspectives. Western psychiatry has used it as a diagnostic label for 100 years. It is now being spread across the globe.
Whatever the scientific and/or clinical usefulness of ‘schizophrenia’ as a medical diagnosis, we know from many service user/survivor/experts by lived experience accounts that a diagnosis of ‘schizophrenia’ (or ‘psychosis’) has serious social implications and consequences for people given the label. This is why we undertook this Inquiry.
The terms of reference of the 'Schizophrenia Commission', launched in 2011 by Rethink, assumed that ‘schizophrenia’ is a valid diagnosis and so considers it from a medical and psychiatric system perspective. Our Inquiry took a service user/survivor perspective and focused on the experience of people given the label and, especially, the consequences of this.
The use of ‘schizophrenia’ to describe problems of living is problematic for several reasons:
- ‘Schizophrenia’ does not seem to mean much (as an explanation for mental health problems) to many service users/survivors or their carers, relatives and friends.
- There are historical problems with the diagnosis, which originated 100 years ago at a time when psychiatry was dominated by racist thought, even more than it is today. It grew out of the 19th century idea of ‘degeneration’ which influenced eugenic theory and practice.
- The diagnosis of ‘schizophrenia’ has not proved useful as a basis for research into understanding mental health problems from a biological viewpoint. Its use in international study has confused rather than clarified issues around therapy for, and outcome of, mental health problems.
- In psychiatry, the use of powerful medication is not necessarily related to a diagnosis of ‘schizophrenia’. So the separation of the ‘schizophrenia’ diagnosis from drug treatment would make the use of medication more transparent, thus reducing its abuse.
- When looked at transculturally, ‘schizophrenia’ does not stand up as a useful way of identifying people with problems of living even when these are conceptualised as ‘mental’ ill health. For example, the experience of hearing voices is widely considered to be a symptom of ‘schizophrenia’, but many cultures see it differently, sometimes as a spiritual experience.
- When ‘schizophrenia’ as a diagnostic concept is used in a multi-ethnic setting, many problems emerge; in Britain it has become conflated with racist oppression, raising questions about the racist nature of the diagnosis itself along with psychiatric stigma.
The use of the label ‘schizophrenia’ carries on in psychiatric research, as well as in clinical practice and guidelines, such as those issued by NICE. It thus continues to have a great deal of influence. In view of the problems with the label, psychiatrists have come under pressure to abandon its use as a diagnosis, with the result that ‘psychosis’ is being used more generally to label the people who would otherwise be labelled with ‘schizophrenia’. Hence the Inquiry will include the label ‘psychosis’ as implying ‘schizophrenia’.