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Conspiracy of silence?

Camden and Islington Community Health Services NHS Trust

Sir: Clafferty et al (Psychiatric Bulletin, September 2001, 25, 336-339) report some very interesting findings. Some of their conclusions urging increased disclosure of the diagnosis of schizophrenia are, however, problematic.

In the course of studying the social correlates of insight in 150 people with schizophrenia (White et al, 2000), we found that individuals with poor insight reported, strikingly, that they were rarely able to trust or confide in health professionals.

There is no evidence that telling this surprisingly large group of patients their diagnosis will impact on their poor insight. It is more likely that it will antagonise them, and further damage an already fragile therapeutic relationship.

It would seem much more important in this instance to recommend that doctor and patient develop an understanding of the patient's experiences that is shared by them both, and that can subsequently form the basis of mutually acceptable therapeutic interventions. This principle, which is collaborative rather than didactic, egalitarian rather than authoritarian, underpins much cognitive—behavioural therapy for psychosis and requires the clinician to work more with the patient's existing beliefs. Seen in this light, blanket recommendations regarding the disclosure of diagnosis for the sake of reducing the stigma of schizophrenia lack subtlety, and indeed seem misplaced.

References

WHITE, R., BEBBINGTON, P., PEARSON, J., et al (2000) The social context of insight in schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 35, 500-507.[CrossRef][Medline]

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by White, R. Search for Related Content PubMed Articles by White, R.