Académique Documents
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Culture of Ideograph:
The Japanese Experience
by Yoshiharu Kim and Qerman E. Berrios
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Schizophrenia Bulletin, Vol. 27, No. 2, 2001 Y. Kim and G.E. Berrios
mon daily usage. This is not the case at all in the West, 1999) surveyed the attitudes of Japanese clinicians toward
where schizein, phren, and -ia are not used as independent seishin-bunretsu-byo. Some believed that they should
words. From just glancing at seishin-bunretsu-byo, a continue using the term on the grounds that the term indi-
Japanese speaker will fully grasp the entire "meaning" of cated a coexistence of sanity and insanity that, according
schizophrenia. Connotations also become important at to some, is the central feature of the disease. But it was
this stage: for example, bunretsu ("split") by itself also also alleged that the term remained stigmatizing even
evokes a condition of "catastrophic disorganization." when the patient was in remission, as the potential for
When denotations and connotations are put together, the falling back into "mental disorganization" was ever pres-
result is a powerful and stigmatizing term. ent. This fatalistic view of the disease (which is not pres-
The same is the case in other countries using ideo- ent in Bleuler's original meaning) is likely to have been
graphs. In China the term is perceived by ordinary people encouraged by the semantic idiosyncratic connotation
as meaning "catastrophe of mind." In Korea it has a simi- attached to this disorder by the terms listed above.
Furthermore, in Japanese, pejorative derivatives of the
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At Issue Schizophrenia Bulletin, Vol. 27, No. 2, 2001
ophrenia differs from Bleuler's and does not take into toms are meant to highlight the view that schizophrenia is
account the mechanism of splitting. Its introduction into a "cerebral disease" and that splitting is relevant only to
American psychiatry (by DSM-IH, American Psychiatric secondary symptoms. Thus, it could be said that in etio-
Association 1980) led to a gradual abandonment of the logical terms Bleuler was not fully committed to the con-
Bleulerian view. cept of splitting.
In scientific terms, the concept of splitting is no A third cause of reluctance may be the belief that
longer important in relation to schizophrenia. Of 1,854 renaming will not work because "schizophrenia" is used
articles that had "schizophrenia" in their title and were by many people around the world. This belief may lead to
published between 1997 and 1998 (Medline search, fatalism. This set of arguments would be acceptable if the
September 30, 1999), only 2 use "split" or "splitting" in meaning of the term (i.e., that there is a "catastrophic
the old sense. Five others mention Bleuler but do not splitting of the mind") was in keeping with current sci-
touch upon "splitting," and the same is the case in two ence. One of the counterarguments put forward in this
other papers on "word association" (an experimental article is that the term is not in keeping with current sci-
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Schizophrenia Bulletin, Vol. 27, No. 2, 2001 Y. Kim and G.E. Berrios
Table 1. Diagnoses known by schizophrenia patients and their family members (from five National
Mental Hospitals, Japan)
% patient, % family members,
Diagnosis n=157 n = 109
No knowledge 48.4 50.5
Schizophrenia 16.6 33.9
Affective disorder 8.9 8.3
Manic depressive 3.8 3.7
Depression 4.5 3.7
Mania 0.6 0.9
Neurosis 14.0 2.8
Psychasthenia 2.5 0.9
Anxiety neurosis 1.9 0.0
putative "paternalism" within Japanese psychiatry. It does A new name could be constructed on the basis of (1)
sound very much as if the difference is due to a withhold- a fundamental biological mechanism, (2) a pathogno-
ing of the diagnosis of schizophrenia. Be that as it may, monic clinical feature, (3) a crucial psychological dys-
keeping patients ignorant of their diagnosis and prognosis function, or (4) an eponym. Bleuler wished that it was
has disease management implications and violates their option 1 but in the end settled for 2. The problem today is
rights. To add insult to injury, euphemisms such as that there is not yet a scientific conclusion about either the
"neurasthenia" or "autonomic nervous dysfunction" seem disease's fundamental biological mechanism or its
more common in the case of schizophrenia than with pathognomonic clinical feature. In regard to option 3,
other mental disorders. Euphemisms rarely work in prac- Kraepelin regarded dementia praecox as primarily a disor-
tice; in this case, they lead to disinformation and interfere der of intellectual function (as opposed to manic-depres-
with the right of patients to access the correct information sive illness, which was primarily a disorder of affect), and
about their illness. the field is now going through a "cognitive period" in the
Some Japanese psychiatrists have attempted of late to interpretation of the disease (e.g., Andreasen 1999).
resolve the problem of translational connotations by creat- However, grouping schizophrenia with the many demen-
ing a semantic or phonetic neologism. This solution has tias currently described might be confusing, and a redefin-
worked acceptably in regard to diseases such as dystro- ition of "cognition" in the future might leave many with
phy, whose phonetic transcription in Japanese indicates a egg on their face. It would seem, therefore, that our scien-
place in the classification rather than a specific content. tific ignorance precludes 1, 2, and 3 above.
Still, some psychiatrists feel that this solution is not faith- What about 4? Eponyms are safe in that they are
ful to the truth. proper names and avoid connotations altogether. History
shows that the disease was mainly identified by Kraepelin
and Bleuler. "Kraepelin's disease" already exists to name
Can the Disease Be Renamed? a form of presenile dementia, and "Kraepelin-Morel's dis-
Replacing the term schizophrenia, even at this late stage in ease" and "Bleuler's disease" (Morbus Bleuler is the orig-
the history of psychiatry, is not an altogether nonsensical inal term and is used in some parts of Germany) never
proposition. Arguments in favor of the change have been took off. "Bleuler's syndrome" already exists to name a
made for some time, and in some cases they originate from form of "organic delirious state." Under the circumstances
concerns about the "reality" of schizophrenia (e.g., and provided that we all believe that schizophrenia will
Brockington 1992). The case made in this article is not theo- survive as a unitary disease for the next 50 years, we may
retical and stems from an issue affecting the perception of want to rename schizophrenia "Kraepelin-Bleuler dis-
the disease by a quarter of the world's population. ease," or KBD for short.
184
At Issue Schizophrenia Bulletin, Vol. 27, No. 2, 2001
185