Declining use of the terms 'schizophrenia' and 'mental illness'

The Philadelphia Association (PA) (see eg. previous post) was originally founded by R.D. Laing and others in 1965 to relieve "mental illness of all descriptions, particularly schizophrenia". These days, as on its website, the PA tends to talk about challenging "established ways of thinking about and responding to distress" without mentioning 'mental illness' or 'schizophrenia'. People have become far more reluctant since 1965 to use what may be seen as stigmatising terms such as 'mental illness' and 'schizophrenia'. I want to look at what this change in everyday language means and its implications for PA objectives.

Mario Maj also comments in a World Psychiatry editorial on the declining professional use of the term 'schizophrenia' in both clinical work and academic publications. Even psychiatrists now tend to use the term 'psychosis' rather than 'schizophrenia'. A case has been made in the academic literature that there is no specific schizophrenic genetic, brain disease within the psychosis spectrum and the term should be abandoned (see eg. previous post). 

'Mental illness' now tends to be replaced with more general terms such as 'mental health problems' or even 'distress'. Some people want to relinquish the notion of 'mental illness' because they say it implies biological abnormality when it shouldn't (see eg. another previous post). As the remit of psychiatry has broadened over the years, the use of the term 'distress' opens up psychiatry to anyone with mental health problems. Psychotherapy likewise tends to make itself available to people with any psychological difficulty, although people are not always suitable for therapy, for example because of their lack of motivation or other personal factors. As one of the main activities of PA is its psychotherapy training, its use of the phrase 'responding to distress' in its current objectives could indicate that its focus is on psychotherapy. 

By contrast, the original objectives of the PA founders seem broader than just psychotherapy. The use of the term 'schizophrenia', rather than opening up psychiatry to all, focuses psychiatry on those with more severe mental health problems. Schizophrenia has been seen as one of the most serious of mental illnesses, because it reflects a losing of touch with reality and at least potential chronicity. Kingsley Hall, the original PA household (see eg. previous post), tended to function as an alternative to psychiatric admission, and at least some residents would have been diagnosed as schizophrenic. Laing in fact admitted he felt trapped in his psychotherapy training and wanted to pursue his interests with more severely disturbed people in hospital (see my book chapter). I think the emphasis on 'schizophrenia' in the original PA objectives reflects this. 

There is an issue about whether schizophrenic or psychotic people may be eligible for psychotherapy because of their lack of insight and not even necessarily seeing themselves as ill and being motivated for therapy. Laing would have been aware that psychotherapy was not suitable for all mentally ill people. But he wanted to change the way mental health and mental illness are understood. Ironically, despite the general shift away from the use of 'schizophrenia', psychiatry could be said to have become even more dominated by a biomedical perspective on mental illness. This was what Laing wanted to challenge, hoping psychiatry rather would become more existential and social (see eg. previous post). Psychiatry still needs to move on from its outdated physical disease model of mental illness to a more relational mental health practice.