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Mental Health

Why Reclassifying Schizophrenia is Necessary

While most mental illnesses carry some measure of stigma, many people — including high-profile celebrities and other public figures — speak openly about depression, bipolar, anxiety, substance use and other disorders. The same cannot be said for schizophrenia, a brain illness that remains firmly in the closet.

People with schizophrenia experience enormous discrimination based on misunderstanding. The thought processes experienced by someone with schizophrenia are not elective, but instead are due to changes in the neurocircuits in the brain. Thus, schizophrenia is a physiological, medical illness that is treatable by medication and evidence-based therapies and support.

While some headway has been made to educate legislators, insurance companies and the public, the negative associations with schizophrenia dominate popular discourse, greatly affecting people diagnosed and their loved ones. Discrimination leading to self-stigmatization, lack of treatment and rejection in turn cause abuse, homelessness, incarceration, misunderstanding, persistent fear and pain. Less than 50 percent of the more than 3 million Americans living with schizophrenia are fortunate enough to receive treatment. Those who do receive appropriate treatment can hold meaningful positions, have fulfilling interpersonal relationships and raise families. But the discrimination attached to it is so great that disclosure about the illness is rare.

Defining schizophrenia

Neuroimaging, genetic studies, neuropathological and longitudinal studies support the neurodevelopmental and neurodegenerative hypotheses. In fact, schizophrenia is a neurocircuitry disorder of the brain with genetic and progressive implications.

Mary Palafox, R.N. and SARDAA board member asks, “Why, then, has this illness not been reclassified as a neurological or neuropsychiatric brain illness?” The social and legal movement surrounding autism (once known as childhood schizophrenia) succeeded in breaking the myth that it was based on poor parenting. Now autism is identified as a neurodevelopmental disorder and is receiving better coverage.

People are treated both socially and medically depending on classification. For instance, the neurotransmitter dopamine (DA) and dopaminergic neurons play an important role in both schizophrenia and Parkinson’s disease (PD). A decrease in DA is implicated in PD, and an excess of DA is implicated in schizophrenia. Both illnesses can manifest dystonia and psychosis, but schizophrenia is labeled as psychiatric and is thus subject to mental health laws and behavioral health care standards. In contrast, Parkinson’s is neurological and under medical standards of care. There are significant differences in resources and supportive care for illnesses labeled neurological. Parkinson’s patients are not homeless, incarcerated or abused because of their symptoms. Mental health laws often usurp medical advice and care. Through no fault of their own, many with schizophrenia go untreated, are criminalized and are judged as deserving the fate their illness has bestowed upon them.

Impact of reclassification

The longer the duration of untreated psychosis the poorer the prognosis. Society must be re-educated about the fact schizophrenia is a progressive yet treatable neurological brain disease. People diagnosed deserve the same respect, empathy, clinical treatment, resources and protection afforded autism, Alzheimer’s and Parkinson’s patients. It’s not imagined, it’s not behavioral, and it’s not elective.  

Reclassification will lead to patients who are properly educated, protected, and comprehensively assessed and treated (medically, neurologically and psychiatrically). This will not only lessen the long-term chronic burden on society and families, but restore the lives of some creative, gifted and highly intelligent human beings. Holding off on reclassification because neurology and psychiatry aren’t ready to merge and the “timing isn’t right” would be a very poor excuse considering the millions of patients abused, left homeless and punished within our judicial system. It’s time.

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