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Conspiracy of silence?

Published online by Cambridge University Press:  02 January 2018

Andy Owen*
Affiliation:
South Warwickshire Combined Care NHS Trust
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Abstract

Type
The Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2001. The Royal College of Psychiatrists

Sir: The finding of Clafferty et al (Psychiatric Bulletin, September 2001, 25, 336-339) that only 59% of consultant psychiatrists told people their diagnosis of schizophrenia at the time of the first “established episode” raises a number of interesting issues that deserve further discussion and debate. The conclusion that failure to disclose such a diagnosis constitutes a “conspiracy of silence”, contributing to the stigma of mental illness, is highly questionable. Even with operationalised diagnostic criteria, the diagnosis of schizophrenia is often highly unreliable and premature diagnosis may lead to considerable negative effects for the individual concerned and his/her family (Reference McGoryMcGory, 1995).

The finding that large numbers of consultant psychiatrists use the term psychosis may reflect an increasing trend away from the use of a diagnosis of schizophrenia that has low reliability and questionable validity. There is a growing voice of opinion in favour of the use of the term psychosis, which seems to be meaningful and acceptable to patients (Reference Spencer, Birchwood and McGovernSpencer et al, 2001).

Perhaps there is a need for greater consensus between psychiatrists about how best to give helpful and honest diagnostic information to patients and their families.

References

McGory, P. D. (1995) Psychoeducation in first episode psychosis: a therapeutic process. Psychiatry, 58, 313328.Google Scholar
Spencer, E., Birchwood, M., McGovern, D. (2001) Management of first-episode psychosis. Advances in Psychiatric Treatment, 7, 133142.Google Scholar
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