DOES COINING A NEW NAME BRING
A NEW THING INTO EXISTENCE?
DOES DELETING A NAME CAUSE THE THING IT NAMES TO GO OUT OF EXISTENCE?
DESCRIBING PHENOMENA WHOSE BOTH NATURE AND CAUSES ARE UNKNOWN, WITH WORDS
WHOSE MEANINGS ARE NOT CLEARLY DEFINED, ISN'T THAT TALKING A LOT OF HOT AIR?
"What's in a name? that which we call a rose
by any other name would smell as sweet."
William Shakespeare: Romeo and Juliet, II, ii, 1-2"Man is by nature a metaphysicist and filled with pride. He could believe that the ideas made up by his mind, which would suit his feelings,would also represent reality. ...
...To sum up, we should realize that the words we use to express the phenomena whose causes we don't know are nothing in themselves, and that from the moment we grant them any value for criticism or in debates, we give up experimental evidence and fall into scholasticism ...
...In science, the word criticism is not synonymous with disparagement; criticising means looking for truth by separating the true from the false, to tell apart good and bad."
Claude Bernard: Introduction to the study of experimental medicine. Paris 1865
The BBC (see news.bbc.co.uk and schizophrenia.com) recently reported that academics, psychologists and psychiatrists in Great Britain had engaged in controversies about the significance and the usefulness of the term "schizophrenia" for the diagnosis of what should be recognized as some rather arbitrary rag-bag of ill-defined psychotic illnesses. Some of them united to launch a campaign to scrap the term "schizophrenia": Campaign to Abolish the Schizophrenia Label (CASTLE). Others think that, although the term is not accurate, it is nevertheless useful and should be retained, at least provisionally until a better name is found.(but why would it be better?).
Such fruitless discussions are far from new, but psychiatrists, psychologists
and psychanalysts from many countries don't seem ever becoming weary
of them.
Among these professionals of mental health are those who favor discarding
the term because "the concept is scientifically meaningless" and
groups together a whole range of different problems under one label, which
may be ultimately damaging to patients: because it may encourage the same
"biomedical" treatments (drugs) for all to the detriment of individualized
psychological help (psychotherapies?).
Some of the experts believe that it should be possible (and more efficient)
to target drugs and psychological treatments on specific signs and symptoms
as they are found in individual patients.
(Convincing evidence in support of this latter claim is still lacking,
however, and, despite frequent statements to the contrary, there aren't yet
any drug nor psychological treatments which would "target specific symptoms"
of schizophrenia, for the quite simple and obvious reason that the causes
and the mechanisms of the symptoms are unknown. Considering for how long such
attempts have been claimed, successful therapeutic results, if there had been
any, surely should have received a lot of enthusiastic publicity! Did we actually
hear of it?)
Other advocates of scrapping the name "schizophrenia" think, falsely,
that this label both is somehow worsening the illness and the source, in the
public at large, of numerous disparaging ideas about the ill persons: ideas
of violence (which are indeed false), of dangerousness (also false), unpredictability
(which is true), inability to recover (which is true when people think that
recovery should mean being cured), a constant and lifelong need of medication
(true), the inability to work (which may be either true or false, depending
on the degree of severity of the illness). They say that the label is stigmatizing.
That is an easy way to distort the truth: that's not the label which is stigmatizing,
that's the behavioral consequences of the illness that are so. Such an ingrained
reproving attitude generally prevails in the public, quite automatically,
also towards people in good health if they happen to behave in the same "unproper"
ways as mentally ill persons may do, but of course, the latter do it unwittingly.
There are also diehard professionals (guess who?) who still stubbornly cling
to the belief that child abuse is the primary cause of schizophrenia, although
this ideology has been disproved since a long time and has nowadays become
rather outmoded.
I find it somewhat difficult to understand how one reasonably might hope
that discarding the term "schizophrenia" should in any way improve
the public's impressions or the professionals' knowledge of these illnesses
regrouped under this label, since neither does it explain anything, nor does
it provide any clue for a more rational treatment. It would not in any way
entail the extinction of the illnesses, and it could not any more ensure a
better health of the ill persons. Contrary to what some so-called experts
seem to believe and to what they seemingly would have us believing, burying
one's head in the sand never was a successful policy, and discarding a name
never abolished its target, nor did the word's deletion change the properties
of the thing it stood for.
Quite obviously, Shakespeare was a much more astute psychologist than many
of our present day mental health professionals seem to be, and in his wake,
today I would like to say: "What's in a name? Those
whom they call schizophrenics, by any other name would not fare any better."
Another bunch of experts would prefer to keep the name of "schizophrenia"
for practical reasons; according to them, the diagnosis of schizophrenia is
at present the only available means to distinguish ill persons afflicted with
this woolly syndrome from those persons afflicted with other psychiatric psychotic
disorders (not less woolly), in order to provide them with the treatments
best suited to their "case", to their "personal needs".
Some of these therapists, however, would readily replace the "unpleasant"
term "schizophrenia" with that of "dopamine dysregulation
disorder" (is it "more pleasant"?) which they believe to
"reflect more accurately" what is happening in the brain when
someone is psychotic (this assertion is debatable, however, and the name
suggested as a suitable alternative for schizophrenia is not less of a rag-bag
than that of schizophrenia itself).
As history has shown, other names (diagnoses) coined long ago by medicine
and psychiatry, such as cretin, schizophrenic, idiot, oligophrenic, etc.,
etc. rather rapidly became insults in everyday lay language. In all likelihood,
"dopamine dysregulation" would soon meet with the same fate.
When you think of it, you can't but wonder about what these hair splitting
discussions may contribute to the knowledge of those mental disorders regrouped
under the umbrella name of "schizophrenia". What does such never
ending quibble actually contribute to the improvement of the treatments and
of the fate of patients afflicted with "schizophrenia"?
Such fruitless discussions keep experts busy and happy, but meanwhile they
forget one of their most important tasks: painstakingly researching the true
biological causes and mechanisms of psychoses, and thus they don't help their
patients as well as should be expected of them (I would like to say to them:
"You are sleeping, Brutus, while Rome is waiting
in fetters"; Voltaire, The
death of Caesar, II, 2).
Moreover, by dint of always relying only on the sole power of words forming
high-sounding sentences (though often devoid of any meaning), many professionals
eventually forget that descriptions of things and phenomena made with these
words are, necessarily, always incomplete and inaccurate. Words don't
convey any idea of a perfume if you did'nt smell it before, because
your nose doesn't use words; you can't "explain" with
words a new perfume to anybody except to perfumers or to persons trained to
the task of smelling (people with a cold or anosmia should abstain!).
Neither do words describe a piece of music to someone who doesn't listen to
it or who never heard it before, and you can't force a person deaf from birth
to imagine it, even by using sign language.
What was said above holds true for psychoses, which you can't describe
nor "explain", except to those who, day in day out, live with
a patient. These persons "understand" descriptions of the illness
because, when they are told them or they read them, they feel themselves treading
on familiar ground.
But some people, who sometimes deem themselves to be professional experts,
do not like the descriptions of the illness made by relatives (since the latter
are not acknowledged experts) and say they are simplistic, incomplete and
inaccurate. Possibly, they get carried away by their hypertrophied imagination
which prevails over their somewhat less well trained critical mind. They thus
don't enough pay attention to the realities of lives which they do not live
through themselves.
As a consequence, descriptions of "schizophrenia" made by others,
which take into account only facts actually observed and sensibly refrain
from unwarranted "psychological" interpretations disappoint the
professionals' imagination. They can't acknowledge their value because they
can't understand them: they listen (do they?) to words with their imagination,
not to odo[u]rs with their nose.
If professionals actually wish to help patients afflicted with schizophrenia,
they should try to live more side by side with them, they also should better
control their own lively imagination and perhaps beware of it.
| First published: 26 October 2006 | (J.D.) | Last modified: 26 October 2006 |