The renaming movement in Japan

In Japan, as a corresponding translation for schizophrenia, Seishin-Bunretsu-Byo (‘mind-splitting disease’) was approved in 1937 by a committee for psychiatric terminology within Japanese Society for Psychiatry and Neurology (JSPN), and it has been used since then. However, The National Federation of Families with Mentally Ill in Japan (NFFMIJ) wrote a letter in 1993 to the President of JSPN, requesting to rename the condition on the ground that ‘the term Seishin-Bunretsu-Byo is humiliating’. In response to this letter, JSPN started to organise a subcommittee and a special committee designated move forward with renaming (Table 1) (Sato, Reference Sato2006, Reference Sato2008).

Table 1. Actions towards renaming the disease

This committee established criteria to use when considering the new name: the new name should (1) not result any social disadvantage to patients, (2) reflect the concept of schizophrenia, (3) not intend to stand for a disease entity but syndrome, (4) be easy to understand and (5) be distinguished from other disorders. This committee met frequently, and they narrowed down the possibilities to three candidates: Togo-Shitcho-Sho (‘disintegration disorder’), Sukizofurenia (‘schizophrenia’ spelled out according to the Japanese writing system) and Bleurer's disease. JSPN members were asked to comment on those three candidates, and at the JSPN General Assembly, Togo-Shitcho-Sho received the final approval. The new term was publicly introduced at the XIIth International Congress of World Psychiatric Association, and a month later, the Japanese government officially endorsed this as well.

However, it took 3 more years to have the Japanese Mental Health and Welfare Law reflect the change. To change the disorder name already used in the laws, it was necessary to demonstrate how much awareness the proposed term has gained and the effects that the new term is expected to have on various departments of the Japanese government. To provide evidence, two research projects were conducted by the Health Labour Sciences Research Grants in Japan (Sato, Reference Sato2004; Ono, Reference Ono2004).

It has come to be widely known that Japan re-named schizophrenia, but less known is the fact that schizophrenia was re-conceptualised. Sato (Sato, Reference Sato2008) reports that, along with the renaming from ‘mind-split disease’ to ‘disintegration disorder’, the following changes were made:

• • Schizophrenia is a syndrome, not a disease (i.e., discontinuation from the conceptualisation of dementia praecox).

• • It is delineated by specific clinical symptoms, rather than vulnerability of brain.

• • The illness and personality are assessed in separate dimensions, rather than in combination.

• • Its aetiology is dysregulation of neurotransmitter system and heterogeneity in heredity is observed, rather than simply ‘unknown’.

• • The overall severity of the condition is milder than before.

• • Its course and outcomes is ‘recovery in more than a half’ instead of ‘progressive and poor’.

• • Informed consent and psychoeducation for the patients are ‘easy’, not ‘difficult’.

• • Recommended treatment is now a combination of medication and psychosocial therapy, rather than medication alone.

The situation in Asian, Europe countries and the USA

Movement of renaming is observed in other Asian countries where Chinese characters are also in use. The Korean term for schizophrenia had been ‘Jeongshin-bunyeol-byung’ (‘mind-split disorder’), which was changed in 2012 to ‘Johyun-byung’ (‘attunement disorder’) by Korea Psychiatric Association (Lee and Kwon, Reference Lee and Kwon2011; Lee et al., Reference Lee, Kim and Kwon2013). Behind this change was discrimination against the affected patients and caregivers and also mental health professionals due to the old term. In addition, the old term was often confused with dissociative identity disorder. Commenting on the new term, Lee et al. (Reference Lee, Kim and Kwon2013) report that ‘Johyeon literally means “to tune a stringed musical instrument”. In the context of schizophrenia, attunement is a metaphor for tuning the strings of the mind.’

In Taiwan, Taiwanese Society of Psychiatry decided to rename the term from ‘Jing Shen Fen Lie Zheng’ (‘mind-split disease’) to ‘Si Jue Shi Tiao Zheng’ (‘dysfunction of thought and perception’).

Hong Kong seems to be entertaining the possibility of renaming; neither China nor Singapore seems to (Sartorius et al., Reference Sartorius, Chiu, Heok, Lee, Ouyang, Sato, Yang and Yu2014).

There are researchers proposing to consider renaming schizophrenia in Europe and America as well, which seems to suggest an increasing interest in renaming. This may be partially motivated by publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association and upcoming publication of the International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) by the World Health Organization. Of note, the ICD-11 is expected to be approved at the World Health Assembly in May 2019, but schizophrenia is not planned to be renamed.

In the Netherland, an organisation called Anoiksis (a completely consumer-run association of people who have chronic psychoses or schizophrenia) is actively promoting renaming of schizophrenia. Information regarding how users are approaching renaming is scant, but it is noteworthy how similar the movement in the Netherland is to the process in which renaming of schizophrenia in Japan started with NFFMIJ, the organisation run by users (George and Klijn, Reference George and Klijn2013a, Reference George and Klijn2013b).

Alternative names for schizophrenia that have been suggested in the process of two research projects conducted by the authors and also additional candidates suggested by others

The authors have conducted two surveys regarding renaming of schizophrenia (Maruta and Iimori, Reference Maruta and Iimori2008; Maruta et al., Reference Maruta, Volpe, Gaebel, Matsumoto and Iimori2014; Maruta and Matsumoto, Reference Maruta, Matsumoto, Gaebel, Roessler and Sartorius2016). These research projects and proposed candidate terms suggested by others are summarised in Table 2.

Table 2. Alternative names for schizophrenia that have been suggested in the process of two research projects conducted by the authors and additional candidates suggested by others