Conspiracy of silence?

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 (McGory, 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 (Spencer 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.