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Taking Issue | June 01, 2001

Ain't No Such Thing as a Schizophrenic

Jeffrey L. Geller, M.D., M.P.H.

Psychiatric Services 2001; doi: 10.1176/appi.ps.52.6.715

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Practitioners of all disciplines who provide care and treatment to persons with mental illnesses, along with the recipients of these services and their families, unwittingly contribute to stigmatizing the very individuals we are trying to free from the myths and stereotypes of psychiatric disorders. Like a skin-borne pathogen, stigma passes among us with no more than a handshake, a hug, or a graze. We all keep this stigma alive by using the names of disorders to designate people.

Let me give you some examples. In June 1999 at the White House Conference on Mental Health—a remarkable event focused in part on ending stigma—a person with bipolar affective disorder was referred to as "a manic depressive." In an article in the New York Times magazine on May 23, 1999—an exposé focused on inadequate care of people with serious mental illness—Michael Winerip, an insightful and careful writer, labeled an individual with a diagnosis of schizophrenia as "a schizophrenic." Officially distributed materials for intensive training in dialectical behavior therapy refer to patients with diagnoses of borderline personality disorder as "borderlines."

Among physicians, psychiatrists are unique in their use of such terminology. Whereas referring to a person with a psychiatric disorder by the name of the disorder is common in psychiatry, it is uncommon in other branches of medicine. How often do you hear an individual being called "a lymphoma," "a fibroid uterus," or "an AIDS"? (Of course, a patient may be referred to as "a pain in the neck," but still this term does not refer to the individual's pain but to the effect of that individual on others!)

Medicine does have some significant exceptions, such as "she's a diabetic" and "he's a hypertensive." But even in these cases, the label does not refer to the person in the same way that "he's a schizophrenic" does. "Schizophrenic" provides the necessary structure from which to hang stigmatized images of a person—a lonely person with inadequate social skills and poor hygiene in one language, and a person who is bizarre, grubby, smelly, a street person, or a zombie in another language.

If we want to end stigma we need to start with ourselves. That's not to say that we should be quiet about the visual and verbal misrepresentations of persons with mental illnesses in highly visible media, such as cinema, advertisements, comic books, and video games. But others won't hear what we say until we ourselves hear it. Ain't no such thing as a schizophrenic.

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Jeffrey L. Geller; Ain't No Such Thing as a Schizophrenic. Psychiatric Services. 2001 Jun;52(6):715-715.

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