Saying ‘person with schizophrenia,’ not ‘schizophrenic,’ can affect clinician beliefs, study finds

Mental health counselors had kinder and less authoritative reactions to statements that used the phrase “person with schizophrenia” instead of “schizophrenic,” a new study finds — an important confirmation of the benefits of person-first language.

The study, published Wednesday in the Journal of Counseling & Development, adds to a broader social conversation but sparse scientific literature supporting person-first language, which is meant to de-stigmatize disabilities, mental health conditions, and other conditions. Patient advocates have pushed for people with diabetes or people with alcoholism to be described as such, for example, and for terms like “diabetic” and “alcoholic” to be avoided.

Darcy Granello, co-author of the study and a professor of counselor education at the Ohio State University, said the new research confirms the importance of those linguistic changes.

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“If we take the time to say ‘person with schizophrenia,’ it actually has real, practical, and significant differences,” she said. “This isn’t just person-first language for the sake of being politically correct.”

Granello said that the inspiration for the research came from observing a shift toward person-first language in the past 40 years that seemed to leave behind case notes, assessment instruments, clinical textbooks, and conversations between care providers. Though clinicians used the person-first language with patients, they didn’t necessarily implement the same changes more broadly. “We know what we mean” was a common refrain she heard among practitioners, she said.

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Because she herself works with people who have schizophrenia, Granello focused the new study on the condition to tease apart the specific effects of language. She sent a survey to a mix of 251 students in counseling and mental health counselors to look at the differences in their responses to the phrases “person with schizophrenia” and “schizophrenic.” Respondents rated their agreement from 1 to 5 with statements such as “Schizophrenics need the same kind of control and discipline as a young child,” and the survey assessed authoritarianism, benevolence, community mental health ideology, and social restrictiveness.

Both students and clinicians scored significantly higher on authoritarianism when given the survey that used the noun “schizophrenic.” They also each scored lower on benevolence, though only current counselors significantly so.

According to the study, a linguistic phenomenon known as the Sapir-Whorf hypothesis could be to blame. In the English language, the theory claims, using premodified nouns in a sentence places greater emphasis on the descriptions they contain than using post-modified nouns does. So, a term like “schizophrenic” emphasizes the condition, while “person with schizophrenia” highlights the person first.

“It seems like a no-brainer to put the term ‘schizophrenic’ into the dustbin of history,” said Joshua Kantrowitz, the director of the Columbia Schizophrenia Research Center, who was not involved in the study. He added that he rarely hears the term anymore among trained scientists, and that the change is in line with others meant to emphasize humanity, such as replacing “subject” with “participant” and “patient” with “client.”

Granello admitted, however, that the study can’t explain whether the counselors’ different attitudes extend to differences in how they treat patients, as the study only looked at beliefs and opinions. She said that future research would have to measure how these types of language differences affect patient care.

Even without a clear understanding of their effects, she argued that counselors should assume that terms they use, even with one another, impact their ability to treat patients, and they should eliminate the use of the term “schizophrenic.”

“When clinicians and counselors receive the instrument that says ‘schizophrenic,’ they score lower on benevolence, on recognizing the basic humanity of the other person. I think when we lose basic humanity of the person sitting across from us, that does have clinical implications,” she said.

Outside of clinical practice, person-first language is not universally accepted for every condition or disability. The American Psychological Association recommends interchanging person-first and identity-first (e.g. disabled person) language unless a community’s preference is known. Advocates in the blind, deaf, and autistic communities, for example, have opted for alternatives.

Still, Granello said that the new study focuses on terminology’s impacts on clinicians, a separate but related topic. Groups that prefer identity-first language may not know that how their conditions are phrased in conversation could itself lead to different treatment.

Source: STAT