Sir: Clafferty et al (Psychiatric Bulletin, September 2001, 25, 336-339) report some very interesting findings. Some of their conclusions urging increased disclosure of the diagnosis of schizophrenia are, however, problematic.

In the course of studying the social correlates of insight in 150 people with schizophrenia (Reference White, Bebbington and PearsonWhite et al, 2000), we found that individuals with poor insight reported, strikingly, that they were rarely able to trust or confide in health professionals.

There is no evidence that telling this surprisingly large group of patients their diagnosis will impact on their poor insight. It is more likely that it will antagonise them, and further damage an already fragile therapeutic relationship.

It would seem much more important in this instance to recommend that doctor and patient develop an understanding of the patient's experiences that is shared by them both, and that can subsequently form the basis of mutually acceptable therapeutic interventions. This principle, which is collaborative rather than didactic, egalitarian rather than authoritarian, underpins much cognitive—behavioural therapy for psychosis and requires the clinician to work more with the patient's existing beliefs. Seen in this light, blanket recommendations regarding the disclosure of diagnosis for the sake of reducing the stigma of schizophrenia lack subtlety, and indeed seem misplaced.