I would like to draw attention to the inappropriate use of the psychiatric term schizophrenia in the title of the article by Kuldip Nayar ('Schizophrenic Nepal policy', #285). Schizophrenia is commonly used in the media as a metaphor for something that is viewed as being 'split' or a 'split personality'. The term has Greek roots 'schizo' (split, schism, or divided) and 'phrenos' (mind) and was selected by the psychiatrist who coined it at the beginning of the 20th century as he conceived of the disease as a mismatch between mood and thought. This made it vulnerable to misrepresentation as a 'split personality'. Schizophrenia is a serious mental illness that is characterised by disturbances in a person's thoughts, perceptions, emotions and behaviour. It affects approximately one in every hundred people worldwide and its onset is usually in adolescence or early adulthood, although it can also occur later in life. At present, schizophrenia cannot be cured but it can be controlled by medication (and other treatments). Research in the UK and the US has shown that stigmatising references to schizophrenia play a role in discouraging people from seeking treatment and can have a negative impact on the effect of treatment. Such references can invoke negative, disparaging associations and if uncritically and widely accepted can play a role in the social rejection and well-being of people suffering from that illness. In Nepal where mental health problems are highly stigmatised and psychiatric services extremely limited the careless use of the term schizophrenia is regrettable.

Dr Judy Pettigrew,
University of Central Lancashire