In summary

Mental health terminology is constantly evolving; however, the names used to define conditions such as schizophrenia, borderline personality disorder (BPD), and posttraumatic stress disorder (PTSD) have remained the same
Language and terminology are catalysts for understanding mental health and can help in shaping perceptions, empowering individuals and reducing stigma to build inclusive communities
The key challenge is reaching an agreement amongst psychiatrists on what inclusive terms to use in the future, and ensuring that the preferences and perspectives of patients are put at the center

Where does the nomenclature come from?

The names of chronic and complex mental health conditions such as schizophrenia, BPD and PTSD have evolved over time, reflecting our understanding of these conditions and the cultural context in which they were named.

Schizophrenia, for instance, was named dementia praecox in 1893 by Emil Kraepelin¹ and was later renamed to schizophrenia, the term we know it by now, by the Swiss psychiatrist Eugene Bleuler in the early 20th century.¹ According to Bleuler, schizophrenia is a disturbed thought process characterized by associative splitting.¹ Similarly, BPD was named to reflect the borderline between psychoneurosis and psychosis. The term was first used by Adolph Stern in 1938 to describe individuals who displayed symptoms that did not fit neatly into existing diagnostic categories.²

PTSD emerged as a diagnostic category following increased awareness of the psychological impact of traumatic events, particularly among veterans.³ In the British military, patients presenting with various mental health conditions caused by combat stress were initially identified as having shell shock before this diagnosis was discouraged in an attempt to limit the number of cases.³ The term PTSD only became a household name after its first appearance in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published by the American Psychiatric Association.³ PTSD was also previously named soldier’s heart and war neurosis.³ The names reflect the lasting effects that traumatic experiences can have on an individual's mental well-being.

Language matters: How does it shape perception in mental health?

The current nomenclature used to describe mental health conditions often falls short in capturing the full complexity and individuality of each person's experiences. For example, due to its meaning of ‘split mind’, the term schizophrenia can cause negative connotations to arise from the underlying or subsumed sickness notion and its predicted practical repercussions, rather than the correct meaning of its name, which the general public is unlikely to know.⁴ Bleuler coined the term to describe what he believed was the most prominent characteristic of schizophrenia, which is an apparent disconnect between psychic functions such as personality, thinking, memory and perception.⁴

As such, the language and terminology used in mental health care should encourage empathy, fairness, honesty, humility and respect.⁵ One of the key ways to accomplish this is to use person-centered terminology in mental health care, which incorporates the use of first-person language. This concept prioritizes the person over the condition or disability, facilitating the transition from deficit-based to strength- and resilience-based language.⁵

The stigma connected with mental health condition labels is one of the key concerns associated with the use of broad language. The use of labels can perpetuate fear and misunderstanding about these conditions.^2,4 This fear can then lead to discrimination and prejudice against individuals who are dealing with mental health challenges.⁴ The impact of this stigma can be profound. It can prevent people from seeking help and can hinder access to appropriate support and treatment.²

Should we adopt new terminology?

It is crucial to address the limitations and challenges imposed by language to create a more inclusive and understanding society by adopting language that acknowledges the diversity of experiences and avoids stigmatizing labels.

The impact of renaming mental health conditions is two-fold. First, it can help to eliminate negative connotations and stereotypes that are often associated with these conditions.⁴ In 2002, Japan was the first country to formally change the term for schizophrenia from seishin-bunretsu-byo (mind-split disease) to togo-shiccho-sho (integration disorder) at the national level, and several reports published after the terminology changes have suggested that renaming schizophrenia may be a strategy to reduce stigma.⁴ Furthermore, a study conducted in Taiwan evaluating the effect of renaming schizophrenia on medical students' attitudes towards the condition showed that renaming might reduce stigma.⁶

Second, renaming mental health conditions can also contribute to reducing the barriers that individuals face in seeking help and support. Many people may avoid seeking treatment due to fear of being labeled or judged based on their diagnosis.² By using more neutral or descriptive terms, we can create an environment that encourages individuals to seek assistance without fear of discrimination.

However, it is important to note that renaming alone is not a solution for addressing the complex issues surrounding mental health.⁴ Renaming an established and widely used term is a lengthy and complex process with unknown long-term consequences.⁴ So far, the scientific community has not agreed on any alternative names for conditions such as schizophrenia.⁴ Mental health destigmatization should be accompanied by education, positive advocacy and efforts to ensure that all members of society, including people with mental health conditions, are treated respectfully and have equal rights.⁴

In conclusion, renaming mental conditions has the potential to challenge societal prejudices and reduce stigma surrounding mental health. However, changing names will not necessarily eliminate the stigma problem; what needs to be altered is how the public perceives mental health. It is also important to note that these names are not fixed or definitive. As our understanding of these conditions continues to evolve, so too should their names. It is crucial to approach these terms with sensitivity and respect for those who live with these conditions.