621942

research-article2015
ISP0010.1177/0020764015621942International Journal of Social PsychiatryAker et al.

E CAMDEN SCHIZOPH

Original Article

International Journal of

Can renaming schizophrenia reduce Social Psychiatry

2016, Vol. 62(4) 311­–315
© The Author(s) 2015
negative attitudes toward patients in Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav

Turkey? DOI: 10.1177/0020764015621942

isp.sagepub.com

Servet Aker1, Ömer Böke2 and Gülay Oğuz3

Abstract
Aim: To determine the perception of the term schizophrenia among university students.
Methods: This cross-sectional study was performed in April 2015 with students from Canik Başarı University (Samsun/
Turkey). A patient history was first established. We then investigated to what extent students agreed with 10 statements
based on that patient history. Three separate questionnaire forms (versions A, B and C), differing only in terms of
the diagnosis in the patient in the history, were prepared. The three diagnoses were ‘Schizophrenia’ (version A),
‘A psychiatric disease by the name of Bleuler’s syndrome’ (version B) and ‘Brain tumor’ (version C). The questionnaires
were administered in a class environment. In all, 771 students participated.
Results: Statistically significant differences between the forms were determined in only two statements (‘A.’s disease will
represent a problem in A.’s future career’ and ‘A. will in all probability have problems with the law in the future’). While
no difference was determined between versions A and B at two-way comparisons, a statistically significant difference was
observed between versions A and B and version C.
Conclusion: No difference was determined between students’ attitudes toward a diagnosis of ‘schizophrenia’ and one
of ‘a psychiatric disease known as Bleuler’s syndrome’. The focus in preventing stigmatization of schizophrenia should
not concentrate on a name change alone. Changing the name schizophrenia may be of no use unless public ignorance
and fear of psychiatric diseases can also be overcome.

Keywords
Schizophrenia, stigma, renaming, Turkey

Introduction
Schizophrenia is a complex psychiatric disorder that can
be seen in all communities and at all socioeconomic levels
and that exhibits variation in terms of diagnosis, clinical
symptoms and course. Schizophrenic disorders are
reported to affect 26 million people worldwide (Lora et al.,
2012). The number of patients with schizophrenia in
Turkey is uncertain. However, according to one systematic
review, the lifetime incidence of schizophrenia in Turkey
is 8.9/1,000 (Binbay, Ulas, Elbi, & Alptekin, 2011).
Due to its high treatment costs, sufferers’ loss of ability
to work and the fact that it causes severe despair and
depression in patients and in families, the costs of schizo-
phrenia to society exceed the material resources spent on
patients. From that perspective, rather than being a ‘dis-
ease’ concerning only patients, their relatives and mental
health workers, schizophrenia is a public health problem.
Various theoretical and practical problems concerning
the early diagnosis, treatment and rehabilitation of schizo-
phrenia are under discussion in the world. One subject of
debate is the stigmatization of schizophrenia patients.
Stigmatization is the negative evaluation of an individual
or group on the basis of characteristics such as mental dis-
ease, ethnic group or physical disability (King et al., 2007).
Although many groups and diseases are exposed to stig-
matization, individuals with any psychological disease are
particularly subjected to branding and labeling (Marshall,
1998).
1Canik Community Health Center, Public Health Directorate, Samsun,
Turkey
2Department of Psychiatry, School of Medicine, Ondokuz Mayıs
University, Samsun, Turkey
3Department of Psychology, Canik Başarı Üniversity, Samsun, Turkey
Corresponding author:
Servet Aker, Canik Community Health Center, Public Health
Directorate, Gaziosmanpaşa Mah. Alaca Sok. No. 31, Canik, Samsun,
Turkey.
Email: servetaker@gmail.com

Downloaded from isp.sagepub.com by Daniel Martinez on June 18, 2016

312 International Journal of Social Psychiatry 62(4)
Negative attitudes toward and branding of psychiatric
patients can have various direct or indirect effects. These
may involve the early diagnosis or treatment of diseases,
the determination with which patients apply to physicians
for treatment, whether they comply with the treatment rec-
ommended, whether they are willing to be hospitalized for
treatment, whether they take part in rehabilitation services
and their ability to resume their former functioning
(Corrigan, 2004; Heginbothom, 1998; Ozmen & Taşkın,
2004; Schomerus & Angermeyer, 2008; Thara & Srinivian,
2000).
The fact that the word schizophrenia means ‘split mind’
leads to fear in society, to various problems associated with
the use of the word and therefore to discrimination against
patients (Van Os, 2009). Some patients, relatives and health
professionals therefore suggest that the name should be
changed (Lasalvia, Penta, Sartorius, & Henderson, 2015).
The first country to change the name of schizophrenia in
that context was Japan. The name change was introduced as
part of a campaign against prejudices attendant on the con-
cept of schizophrenia. A decrease in negative attitudes
toward schizophrenia has been reported following that
campaign and name change (George & Klijn, 2013). There
have been no studies to date of the probable effects of
renaming schizophrenia n Turkey.
The purpose of this study was to determine the percep-
tion of the term ‘schizophrenia’ among university students.
Method
This cross-sectional study was performed between 15 and
30 April 2015, with students from the Canik Başarı
University, Samsun, Turkey. Canik Başarı University ethi-
cal committee approval was obtained before the study
commenced.
A patient history was established based on the authors’
professional experience and real patients.
Patient:
A. is an unmarried, 22-year-old university student liv-
ing with his or her family. A. enjoyed academic success
and a harmonious family/social life until 1 year previ-
ously. Approximately 1 year previously A. began turn-
ing away from his or her family and friends, becoming
introverted and missing school. The subject was reluc-
tant to wash and personal hygiene levels decreased. He
or she began smoking two packs of cigarettes a day. His
or her family noticed this, but assumed he or she had
school-related problems and did not follow it up. Eight
months previously A. began becoming suspicious of
people around him or her and was unwilling to trust
anyone. A. believed that his or her former partner was
checking up on him or her, was aware of everything
happening in the house and was sending him or her
Downloaded from isp.sagepub.com by Daniel Martinez on June 18, 2016
messages via the television. He or she suspected his or
her brother and mother of involvement in this and
attacked his or her brother verbally and physically and
threatened him or her. He or she heard voices giving
him or her orders. He or she sometimes spoke with
these voices and reacted to them. He or she stopped
leaving the house, never spoke with anyone, was unable
to sleep and walked around indoors all night, in a trou-
bled state of mind. Seven months previously A. was
taken to a doctor, who admitted him or her to hospital
with a diagnosis of (Schizophrenia, a psychiatric dis-
ease known as Bleuler’s syndrome or brain tumor). A.
has been using medicinal drugs for 6 months, attends
monthly medical check-ups, appears to have recovered,
attends school and is capable of living without
problems.
No information was provided about the gender of the
patient known as A. out of a concern that specifying a gen-
der might influence attitudes. Three separate questionnaires
were prepared (versions A, B and C). These contained the
same histories and comments regarding the histories and
differed solely in terms of the diagnosis. The three diagno-
ses were ‘Schizophrenia’ (version A), ‘A psychiatric dis-
ease by the name of Bleuler’s syndrome’ (version B) and
‘Brain tumor’ (version C). Bleuler’s syndrome was named
after Eugen Bleuler, the psychiatrist who first described the
concept of schizophrenia. Students were given only one of
the three questionnaire forms containing exactly the same
histories but different diagnoses. The students were asked
to indicate to what extent they agreed or disagreed with
statements concerning the history described and the diag-
nosis reported. The first diagnosis given was ‘schizophre-
nia’. This is a disease of which everyone has heard. The
second diagnosis was a known psychiatric disease, the
cause, treatment and prognosis of which are unknown. The
third diagnosis was brain tumor, an organic disease. The
reason for the inclusion of these three diagnoses in the
study was to determine whether the term schizophrenia has
any further load burden in addition to being a psychiatric
disease and to identify any differences between attitudes
toward diseases of organic and psychiatric origins.
The first part of the question inquired into students’ age,
sex and faculty attended. The second part contained 10
statements used to measure attitudes toward the patient
described in the history. These statements were based on
those used in previous similar studies (Arıkan & Uysal,
1999; Arıkan, Uysal, & Çetin, 1999; Arkar & Eker, 1992;
Tranulis, Lecomte, El-Khoury, Lavarenne & Brodeur-
Cote, 2013). The extent to which students agreed with
these statements was assessed using a 5-point Likert-type
scale. The scale covered a range from strong agreement
(−2) to strong disagreement (+2).
The questionnaires were administered in a class envi-
ronment. Students were informed about the study before
Aker et al. 313

Table 1.  Characteristics of the students in the study.

Diagnosis p Totala

  Schizophrenia Bleuler’s Brain  

syndrome tumor
Sexa
 Male 102/39.5 119/47.4 114/43.5 >.05 335/43.5
 Female 156/60.5 132/52.6 148/56.5 436/56.5
Departmenta
  Faculty of Education 39/15.1 36/14.3 39/14.9 >.05 114/14.8
  Faculty of Arts and Sciences 76/29.5 63/25.1 71/27.1 210/27.2
  Faculty of Administrative Sciences 49/19.0 55/21.9 55/21.0 159/20.2
  Engineering Faculty 94/36.4 97/38.6 97/37.0 288/37.4
Ageb 20.8 ± 0.1 20.8 ± 0.1 20.7 ± 0.1 >.05 20.8 ± 0.1
Totala 258/100.0 251/100.0 262/100.0 771/100.0
aN/percentage.
bMean ± standard error.

the questionnaires were applied, and verbal consent was Discussion

obtained. In all, 771 students participated.
The data from the questionnaires were analyzed on
SPSS for Windows 13.0 software. Responses to the state-
ments were expressed as percentage and mean ± standard
deviation. The chi square test was used to compare grouped
data. Analysis of variance was employed to test whether
responses to statements varied depending on the diagnosis.
The Bonferroni corrected t-test was used in two-way com-
parisons if a difference was observed between the three
groups.
Results
Women constituted 56.5% of the 771 students in the study.
Mean age of students was 20.8 ± 0.1 years. Various charac-
teristics of students are given in Table 1.
The students were given one of the three different ques-
tionnaire forms involving the same history but different
diagnoses. They were then asked to indicate the extent to
which they agreed or disagreed with statements concern-
ing the patient whose history was described. Students’
responses are shown in Table 2.
Students’ levels of agreement with the statements given
were compared. The only statistically significant differ-
ence between the three diagnoses was determined between
the statements ‘A.’s disease will represent a problem in A’s
future career’ and ‘A. will in all probability have problems
with the law in the future’ (p < .05). The three diagnoses
were subsequently compared in a two-way manner in
terms of agreement with these two statements. While no
difference was determined between ‘schizophrenia’ and ‘a
psychiatric disease known as Bleuler’s syndrome’, statisti-
cally significant differences were identified between ‘brain
tumor’ and both schizophrenia’ and ‘a psychiatric disease
known as Bleuler’s syndrome’ (p < .05) (Table 2).
Positive changes in negative attitudes toward patients with
schizophrenia have been reported following a name change
in Japan (Koike et al., 2015; Sato, 2006; Sugiura, Sakamoto,
Tanaka, Tomoda & Kitamura, 2001; Sugihara & Takei,
2013; Takahashi et al., 2009). In addition, several studies
have reported that public education and the renaming of
schizophrenia are effective in overcoming stigma (George
& Klijn, 2013; Kavanagh & Banyard, 2013; Lasalvia et al.,
2015; Van Os, 2009).
Seven of the 10 statements in this study concerned dis-
tance in social environments and work. No statistically
significant difference was determined in these statements
between three diagnoses with the same history. Similarly,
Tranulis et al. (2013) observed no difference in statements
assessing social distance between two distinct diagnoses
(schizophrenia and salience syndrome).
Similar attitudes were determined between all three
diagnoses in terms of the domains of social distance at
work or school and in social interactions (such as house
meetings). In our opinion, this is due to the history being
the same in all three diagnoses and due to the presence in
that history of the patient resorting to violence. We think
that if the clinical picture is poor, then the name of the
patient’s disease is unimportant in attitudes involving areas
requiring social interaction with patients.
In order to account for this, we need to look at the his-
toric origins of stigma. Throughout the course of history,
individuals with inexplicable symptoms have been a cause
of fear. They have therefore been excluded from society in
order to ensure its survival (Arıkan & Akman, 2002). One
of mankind’s most basic instincts is to avoid irregular and
unexpected phenomena, a desire for all things to be known
beforehand and the wish to know what will follow. People
have the same expectations in their relations with other
individuals. No matter what the diagnosis, unpredictable

Downloaded from isp.sagepub.com by Daniel Martinez on June 18, 2016

314 International Journal of Social Psychiatry 62(4)

Table 2.  Distribution of responses to the statements in the questionnaires (mean ± standard error).

Statements Diagnosis p

  Schizophrenia Bleuler’s syndrome Brain tumor  

A.’s disease will represent a problem in his or her future −0.78 ± 0.11 −0.66 ± 0. 11 −0.25 ± 0.12 <.05a
career
I would not wish to be left alone with A. under any 0.06 ± 0.12 0.21 ± 0.13 0.45 ± 1.90 >.05
circumstances
A. will in all probability have problems with the law in the 0.16 ± 0.10 0.23 ± 0.11 0.62 ± 0.11 <.05b
future
I would have nothing to do with A. even if he or she were my 0.58 ± 0.12 0.86 ± 0.12 0.82 ± 0.12 >.05
brother/sister
I would be uneasy if A. were my next-door neighbor in my 0.69 ± 0.12 0.73 ± 0.12 0.74 ± 0.12 >.05
university lodgings
A. should be under constant police surveillance 1.32 ± 0.10 1.49 ± 1.55 1.53 ± 0.10 >.05
I would be uneasy at taking part in a house meeting if A. were 1.34 ± 0.11 1.17 ± 0.10 1.23 ± 0.11 >.05
present
I would not talk to A. if I met him or her in the school canteen 1.54 ± 0.10 1.56 ± 0.09 1.59 ± 0.09 >05
I would be uneasy at attending the same school as A. 1.55 ± 0.10 1.60 ± 0.10 1.64 ± 1.46 >.05
I would not buy anything from A. if he or she ran a sandwich 1.82 ± 0.10 1.68 ± 0.10 1.73 ± 0.10 >.05
and coffee stall opposite my school or lodgings

0 is neutral, negative scores ‘likely’ and positive scores ‘unlikely’.

Two-way comparisons:
aA–B p > .05; A–C p < .05; B–C p < .05.
bA–B p > .05; A–C p < .05; B–C p < .05.

behaviors damage the perception of order in society and
give rise to anxiety. That anxiety then triggers a process of
exclusion and alienation of the patient in order for socie-
ty’s need for order to be re-established.
Three of the statements put to the students investigated
attitudes to the history without involving social interac-
tions. A statistically significant difference between the
groups was determined in two of these. No difference was
determined at two-way comparison between ‘schizophre-
nia’ and ‘a psychiatric disease known as Bleuler’s syn-
drome’ (p > .05), but a difference was observed between
these two diagnoses and ‘brain tumor’. One study in which
the same statements were put to students observed no dif-
ference between ‘schizophrenia’ and ‘salience syndrome’
(Tranulis et al., 2013).
In a study performed in China, Found and Duarte (2011)
observed that negative attitudes toward the labels ‘Jing-
shen-bin’ (mental illness) and ‘Jing-shen-fen-lie-zheng’
(schizophrenia) differed significantly compared to the
label ‘illness’ but determined no difference between the
labels ‘Jing-shen-bin’ (mental illness) and ‘Jing-shen-fen-
lie-zheng’ (schizophrenia).
We observed greater agreement with statements con-
cerning ‘schizophrenia’ compared to ‘Bleuler’s syndrome’,
although the difference was not statistically significant.
We think that so long as the individual’s clinical picture is
the same, the diagnosis is not particularly important.
Bleuler’s syndrome was a diagnosis that students were
hearing for the first time, and we simply described it as a
psychiatric disease. On the basis of our findings, we think
that stigmatization revolves around the concept of psychi-
atric diseases. Found and Duarte’s (2011) study supports
that idea.
The absence of any difference between the three diag-
nosis in terms of the statement ‘A. should be under con-
stant police surveillance’, an expression of social isolation,
one of the most severe forms of stigmatization, is very
important. The fact that this stage has not yet been reached
in the stigmatization of psychiatric disease is grounds for
optimism.
Schizophrenia patients and their families favor the
renaming of the disease (Tranulis et al., 2013). However,
we think that a name change alone should not be the sole
focus in the prevention of stigmatization of psychiatric dis-
eases, and schizophrenia in particular. Unfortunately,
renaming schizophrenia may not be useful in overcoming
popular ignorance and fear of psychiatric diseases (Chung
& Chan, 2004; Lieberman & First, 2007). Therefore,
unless renaming schizophrenia is supported by other meas-
ures, such as psychoeducation, any new name may also be
employed as a term of stigma.
Conclusion
No difference was determined in this study between
university students’ attitudes toward diagnoses of
‘schizophrenia’ and ‘a psychiatric disease known as
Bleuler’s syndrome’. In order for stigmatization of sub-
jects with psychiatric disease, and particularly schizo-
phrenia, to be eliminated, we think that wide-ranging

Downloaded from isp.sagepub.com by Daniel Martinez on June 18, 2016

Aker et al. 315
education programs are needed and that these should be
supported through the media.
Limitations of the study
The study may not reflect the general population since it
involved only young university students.
Acknowledgements
We are very grateful to İremnaz Kırım and Dilşad Bektaş, stu-
dents from the Canik Başarı University Psychology
Department, for all their assistance with the collection of data
for this study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Ethical approval
Ethics committee approval was received for his study.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
Arıkan, K., & Akman, B. (2002). Akıl hastası karşısında
kullanılan savunma mekanizmaları ve stigmatizasyon. In
9th National Congress of Social Psychiatry Conference
Proceedings (pp. 212–217). Malatya, Turkey: Turkish
Association of Social Psychiatry.
Arıkan, K., & Uysal, O. (1999). Emotional reactions to the men-
tally ill are positively influenced by personal acquaintance.
Israel Journal of Psychiatry and Related Sciences, 36,
100–104.
Arıkan, K., Uysal, O., & Çetin, G. (1999). Public awareness
of the effectiveness of psychiatric treatment may reduce
stigma. Israel Journal of Psychiatry and Related Sciences,
36, 95–99.
Arkar, H., & Eker, D. (1992). Influence of having a hospitalized
mentally ill member in the family on attitudes toward men-
tal patients in Turkey. Social Psychiatry and Psychiatric
Epidemiology, 27, 151–155.
Binbay, T., Ulas, H., Elbi, H., & Alptekin, K. (2011). The psy-
chosis epidemiology in Turkey: A systematic review on
prevalence estimates and admission rates. Turkish Journal
of Psychiatry, 21, 40–52.
Chung, K. F., & Chan, J. H. (2004). Can a less pejorative Chinese
translation for schizophrenia reduce stigma? A study of
adolescents’ attitudes toward people with schizophrenia.
Psychiatry and Clinical Neurosciences, 58, 507–515.
Corrigan, P. W. (2004). How stigma interferes with mental
healthcare. American Psychologist, 59, 614–625.
Found, A., & Duarte, C. (2011). Attitudes to mental illness: The
effects of labels and symptoms. East Asian Archives of
Psychiatry, 21, 91–98.
George, B., & Klijn, A. (2013). A modern name for schizophrenia
(PSS) would diminish self-stigma. Psychological Medicine,
43, 1555–1557. doi:10.1017/S0033291713000895
Downloaded from isp.sagepub.com by Daniel Martinez on June 18, 2016
Heginbothom, C. (1998). UK mental health policy can alter the
stigma of mental illness. The Lancet, 352, 1052–1053.
Kavanagh, M., & Banyard, P. (2013). The effect of an alternative
term for schizophrenia in reducing discriminatory attitudes
of the English-speaking lay public. International Journal
of Mental Health, 42(4), 3–33. doi:10.2753/IMH0020-
7411420401
King, M., Dinos, S., Shaw, J., Watson, R., Stevens, S., Passetti,
F., ... Serfaty, M. (2007). The stigma scale: Development
of a standardised measure of the stigma of mental illness.
British Journal of Psychiatry, 190, 248–254.
Koike, S., Yamaguchi, S., Ojio, Y., Shimada, T., Watanabe, K.,
& Ando, S. (2015). Long-term effect of a name change
for schizophrenia on reducing stigma. Social Psychiatry
Psychiatric Epidemiology, 50, 1519–1526.
Lasalvia, A., Penta, E., Sartorius, N., & Henderson, S.
(2015). Should the label ‘schizophrenia’ be abandoned?
Schizophrenia Research, 162, 276–284. doi:10.1016/j.
schres.2015.01.031
Lieberman, J. A., & First, M. (2007). Renaming schizophrenia,
diagnosis and treatment are more important than semantics.
British Medical Journal, 334, 108.
Lora, A., Kohn, R., Levav, I., Mc Bain, R., Morris, J., & Saxena,
S. (2012). Service availability and utilization and treatment
gap for schizophrenic disorders: A survey in 50 low-and
middle-income countries. Bulletin of the World Health
Organization, 90, 47–54. doi:10.2471/BLT.11.089284
Marshall, G. (1998). A dictionary of sociology (2nd ed.). New
York, NY: Oxford University Press.
Ozmen, T., & Taşkın, O. (2004). The influence of attitudes
toward mental disorders to mental health services. Journal
of Psychiatry Psychology Psychopharmacology, 12(3), 5–12.
Sato, M. (2006). Renaming schizophrenia: A Japanese perspec-
tive. World Psychiatry, 5, 53–55.
Schomerus, G., & Angermeyer, M. C. (2008). Stigma and its
impact on help-seeking for mental disorders: What do we
know? Epidemiologia e Psichiatria Sociale, 17, 31–37.
Sugihara, G., & Takei, N. (2013). Renaming schizophrenia
coupled with proper public education is an optimal way to
overcome stigma. Psychological Medicine, 43, 1557–1558.
doi:10.1017/S0033291713000901
Sugiura, T., Sakamoto, S., Tanaka, E., Tomoda, A., & Kitamura,
T. (2001). Labeling effect of Seishin-bunretsu-byou, the
Japanese translation for schizophrenia: An argument for rela-
beling. International Journal of Social Psychiatry, 47, 43–51.
Takahashi, H., Ideno, T., Okubo, S., Matsui, H., Takemura,
K., Matsuura, M., ... Okubo, Y. (2009). Impact of chang-
ing the Japanese term for ‘schizophrenia’ for reasons of
stereotypical beliefs of schizophrenia in Japanese youth.
Schizophrenia Research, 112, 149–152. doi:10.1016/j.
schres.2009.03.037
Thara, R., & Srinivian, T. N. (2000). How stigmatising in schizo-
phrenia in India? International Journal of Social Psychiatry,
46, 135–141.
Tranulis, C., Lecomte, T., El-Khoury, B., Lavarenne, A., &
Brodeur-Cote, D. (2013). Changing the name of schizophre-
nia: Patient perspectives and implications for DSM-V. PLoS
ONE, 8(2), e55998. doi:10.1371/journal.pone.0055998
Van Os, J. (2009). ‘Salience syndrome’ replaces ‘Schizophrenia’
in DSM-V and ICD-11: Psychiatry’s evidence-based entry
into the 21st century? Acta Psychiatrica Scandinavica, 120,
363–372. doi:10.1111/j.1600-0447.2009.01456.x