I appreciate the discussion on dropping the term schizophrenia as a scientifically suspect term-it may be more variable in its etiology, course and outcome than most medical disorders which, of course, can also be variable in expression and etiology. It is a "traumatic" term, from the last century, and there are far too many myths embedded in it. Partly for this reason, the Japanese Psychiatric Association dropped it from their lexicon. I really do not think we can rehabilitate the term-therefore, I am in favor of changing it to something else-something which reflects what current research and clinical experience reveals. Some more reductionistically oriented researchers have proposed the term "dopamine dysregulating disorder." The problem with this, is that this is non-specific and can also apply to many other mental disorders (DA upregulation in the limbic-mesolimbic-areas and concomitant downregulation in prefrontal-mesocortical-areas, the crux of the current dual dopamine hypothesis of so called schizophrenia-is exactly what those of us who study the neuroendocrinology and molecular biology of "stress" see).A colleague of mine in the Office of Mental Health of NY State proposed the term "recurrent psychotic disorder" and then specify the parameters. I also strongly believe that if the mutiaxial approach remains-there should be a more clearly defined and mandatory axis (in the spirit of what Les Havens has been calling for for decades) on strengths and resiliencies-this would require clinicians to take a deeper history than what is currently practiced-including mandatory trauma histories. Here here!

Brian Koehler
New York University