"An almost schizophrenic nature"

This morning, I turned on The Current on CBC Radio to hear guest Peter MacKay, the former Canadian Minister of Foreign Affairs, talking about Donald Trump's post-G7 attacks on Justin Trudeau. MacKay made some good points about Canada-US relations, and included some context on past enmity between presidents and prime ministers. I was impressed.

Then, asked to explain Trump's behaviour, MacKay said this:

I don't think there is any explaining it. This is a product of his combative personality. He prides himself on driving a hard bargain... This is not something you can analyze and come up with any clear answer. There seems to be an almost schizophrenic nature when it comes to what he says one minute and what he says the next.

There was no negative intention behind that turn of phrase. It just slid out naturally. Just like comedian Gad Elmaleh probably meant no harm during the stand-up bit in his Netflix special when he made a joke about being able to get multiple reference signatures from a relative because he has schizophrenia.

But hearing that sentence from Peter MacKay, I felt deflated. Discouraged. It is (or should have been) common knowledge for decades that people with schizophrenia don't have multiple personalities. And calling atrocious behaviour by the President of the United States -- or anyone else "schizophrenic" is not helpful. (As an aside, if you want to feel even more deflated do an image search for "schizophrenia." It's not pretty.)

I am writing a hybrid memoir (part memoir, part literary journalism) about family and mental illness, and one of the things I've thought about is whether there is any other illness that carries as much of a burden as schizophrenia. I know very few people who openly talk about having schizophrenia. Some hide their mental illness altogether, for fear of the consequences of friends or co-workers finding out about it. Some use "psychosis" as a more general term to describe their diagnosis. Strictly speaking, psychosis represents a set of symptoms, not a disorder in itself, but it has come to be used as a blanket term covering some forms of schizophrenia and other psychotic disorders. Some have talked publicly about their diagnosis, but then went back into the closet because of the treatment they received. 

I have heard of psychiatrists who sidestep the issue of diagnosis altogether, especially in the early months of treatment, because it's not relevant to their patients' recovery. And when they do use the word "schizophrenia" it can have a negative impact on their patients. It's a heavy word. Loaded. An incurable illness. For many years, even medical professionals had very little hope people with schizophrenia could lead happy, fulfilling lives.. 

That's changed, now that we have a new understanding of schizophrenia, new medications for treatment, and an understanding of how crucial early intervention and relapse prevention can be. 

But much of society still has to catch up.

In Japan, psychiatrists no longer use schizophrenia as a diagnosis. Instead, they call it "Togo Shitcho Sho" or "integration disorder,." This paper outlines reasons for the change, but notes that one of the most important was

 the deep-rooted negative image of schizophrenia, in part related to the long-term inhumane treatment of most people with the disorder in the past.

Since the change, back in 2002, 

86% of [psychiatrists] found the new term easier to inform patients of the diagnosis as well as to explain the concept of the disorder. Eighty-two percent of them found the new term more suitable to obtain consent to treatment from patients, useful to improve treatment compliance, effective to reduce stigma, and promising for achievement of social integration.

That's the power of changing a word - and it points to why we need to stop tossing out "schizophrenic" to make jokes or to casually describe unstable behaviour.

If you want to learn more, the American Psychiatric Association has a good, concise explanation of schizophrenia here.