Impact of changing the Japanese term for “schizophrenia” for reasons of stereotypical beliefs of schizophrenia in Japanese youth

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Abstract

The old term for schizophrenia, “Seishin-Bunretsu-Byo” (Mind-Split Disease), has been replaced by “Togo-Shitcho-Sho” (Integration Disorder) in Japan. Stigma research requiring individuals to report personal beliefs is useful but is subject to social desirability bias. Using the Implicit Association Test, a measurement designed to minimize this bias, we assessed the impact of this renaming on the stereotype of schizophrenia held by a younger generation. The old term was strongly associated with “criminal”, and this association became significantly weaker with the new term. The strategy of renaming holds considerable promise for tempering negative bias toward this disorder in Japan.

Introduction

The stigma of mental disorders stands in the way of improving the quality of life of people with disorders as well as their families. The stigma leads to discriminations in education, employment, personal relationships, marriage and housing. To reduce mental illness-related stigma (particularly regarding schizophrenia), various programs are underway internationally (Sartorius, 2007, Thornicroft et al., 2007). In Japan as well, a strategy to change the term for schizophrenia was introduced. Since each Chinese character conveys its own meaning, and the old term for schizophrenia, “Seishin-Bunretsu-Byo”, explicitly translates as “Mind-Split-Disease”, the Japanese Society of Psychiatry and Neurology approved replacing the old term with “Togo-Shitcho-Sho”, literally meaning “Integration Disorder”. The former term has been said to lead the public to misunderstand and stigmatize individuals with schizophrenia.

In western society, the term also implies “split” and is frequently misunderstood as “split personality” (Chopra and Doody, 2007) or inappropriately metaphorized (Geller, 2001). In fact, even in a renowned scientific journal, “schizophrenia” was recently misused as “split personality” (May, 2008, Pfleiderer and Hackl, 2007). Thus, movements to rename schizophrenia are gaining momentum in western society as well (Kingdon et al., 2007). Most stigma research relies on questionnaires that require individuals to report their personal attitude (Greenwald and Banaji, 1995, Hinshaw and Stier, 2008). This information is useful but is subject to response bias due to social desirability (Dovidio et al., 1997, Gaebel et al., 2002, Griffiths et al., 2006, Hinshaw and Stier, 2008). One measure designed to minimize response bias is the Implicit Association Test (IAT) (Greenwald et al., 1998). IAT assesses associations that exist beyond conscious evaluation, allowing a measurement of automatic biases even if people are unaware or unwilling to report them. This method has been widely used to assess implicit attitudes and stereotypes associated with many characteristics, including age, race and gender (Greenwald et al., 2002). Recently, IAT has been applied to the assessment of negative attitude toward mental illness (Teachman et al., 2006). Using IAT, we assessed the impact of renaming on the implicit stigma associated with this disorder in Japan. The most prevalently held stereotype is that of people with mental illness being unpredictable and dangerous (Angermeyer and Matschinger, 2004). The media are an important source of public information on mental illness (Stark et al., 2004), and negative depictions (criminality and dangerousness) of mental illness predominate (Coverdale et al., 2002). The media tend to present sensationalized and stereotypic depictions of mental illness and emphasize propensities toward violence and crime (Hinshaw and Stier, 2008). However, previous studies have revealed that people with mental illness are far more likely to be victims of crime than perpetrators (Hinshaw and Stier, 2008, Teplin et al., 2005). We assessed the association between schizophrenia and criminal versus victim. We hypothesized that the new term would have less automatic association with criminal.

Section snippets

Participants

Sixty-eight non-medical undergraduate students (28 males and 40 females, mean age 21.5 years, S.D. = 1.4) participated. All were Japanese. They were asked if they were aware of the replacement of the term for schizophrenia. They were further asked about their knowledge of schizophrenia using a 7-point scale (1= none, 7= very much). The average score of knowledge was 3.5, indicating that the participants did not have enough or accurate knowledge of schizophrenia, although the majority (88%) knew

Results

The average total score of Link's devaluation–discrimination-scale was 31.9 (S.D. = 5.5). This was in very good agreement with the study of reliability and validity of the Japanese translated version, in which the average total scores for males and females were 31.6 and 31.9, respectively (Shimotsu et al., 2006).

For the “Seishin-Bunretsu-Byo” version, average response latency for CC and IC was 844 ms (SEM = 21) and 927 ms (SEM = 25), respectively, yielding an 84-ms averaged IAT effect. For the

Discussion

The current study demonstrated that the old term “Seishin-Bunretsu-Byo” (Mind-Split Disease) was more incongruent with victims than the new term “Togo-Shitcho-Sho” (Integration Disorder), suggesting that the old term was strongly associated with “criminal” vs. “victims”, while the automatic association between the new term and criminal was not strong. There was no positive significant correlation between the explicit Link's scale and IAT measures. On the contrary, a loose negative correlation

Role of funding source

Funding for this study was provided by a Health and Labor Sciences Research Grant for Comprehensive Research on Disability Health and Welfare (H20-SYOGAI-011) from the Japanese Ministry of Health, Labor and Welfare; the sponsor had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Contributors

Author Takahashi and Ideno designed the study and wrote the protocol. Author Takahashi and Ideno managed the literature searches and analyses. Authors Ideno, Okubo S. and Matsui undertook the statistical analysis, and author Takahashi wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflicts of interest

The authors have no conflict of interest.

Acknowledgment

Emi Yaoita is gratefully acknowledged for data collection.

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