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What Schizophrenia Isn't

This should be easy.

What schizophrenia is not: A state of being multiple contradictory things at once.

Feel free to chase the etymology of "schizo" all the way to its Greek origins as a prefix meaning roughly "split" or "divided." And feel free to argue that said roots justify a billion hacky music writers calling songs and albums and bands "schizo" when what they really mean is "different things together." (Which they will continue to do because they will continue to not have anything better to say than "this song or album or artist has 'different things together.'") Send me your dictionary links and examples of historical usages of the non-psychiatric definition of schizo and schism. What about schizocarp and schizogenesis? Surely psychiatry can't take away my ancient Greek-derived deprecated slang?

No—no it can't. But understand that by calling the new Kanye West track a "schizophrenic monster" or that Kate Nash album "thrillingly schizophrenic" or some Eminem verse "full schizo Slim Shady mode" you do nothing but hurt and obfuscate. Your misuse of "schizo" and "schizoid" and schizophrenic has only the effect of perpetuating misinformation and stigmatization. And for what?

A shitty metaphor.

A survey conducted in 2007 found that about a third of total uses of "schizophrenic" in the US press involved the metaphorical two-things-at-once slang definition rather a reference to what schizophrenia actually is (or what it is to be schizophrenic). In the German press, that share jumped to nearly 60 percent. And among music reviews, my own unscientific research suggests that the percentage of metaphorical misuse is pretty much 100 percent.

"Schizophrenia is not some unexpected polarity, nor is it a disease of fugue-like dissonance or a Jekyll-and-Hyde struggle for control."

The "schiz" in schizophrenia indeed derives from schism, but not in the classic modern interpretation of cleaving between two oppositional concepts. The schism of schizophrenia is detachment—schizophrenia is very broadly characterized by an inability to correctly interpret sensory input and, in some part, to make sense of the real-world. This has a lot of seemingly disparate manifestations—delusions, hallucinations, extreme social detachment and self-isolation—but it's basically like being forced to live in the world one step removed. This is the schism.

Patrick House, a neuroscientist at Stanford University, got this exactly right a couple of years ago in a piece for Slate called "Schizophrenic Is the New Retarded." "The metaphorical use of schizophrenic suggests a rapid and unexpected switch from one extreme state to another, something like an embattled other self breaking through and taking over," he wrote. "But schizophrenia is not some unexpected polarity, nor is it a disease of fugue-like dissonance or a Jekyll-and-Hyde struggle for control."

If the whole Jekyll-and-Hyde psychiatric fiction corresponds to anything, it'd be multiple-personality disorder or dissociative identity disorder, a diagnosis that remains (justifiably) controversial. Schizophrenia is really nothing like that—in the canonical sense, it's a disease of disordered thinking, a partial inability to separate the signals of the everyday lived world from its noise. If anything, it's more like being trapped in personality solitary confinement than it is sharing different personalities. A profound and profoundly disabling unrelatability.

Of course, schizophrenia is hardly alone in this problem. See also: Oh I'm just so OCD about my Gmail inbox or I'm just so bipolar! I like junk food and vegetables. Or whatever. These are like the classic tools of cheap hyperbole.

"What we want people to understand is how serious and debilitating OCD can be," Joel Rose, director of OCD Action, told the BBC. "We're talking about people who might clean a floor repeatedly for eight hours or someone who can't leave the house. It's not having a tidy house or arranging the tins of food in your cupboard. We also want to get across that it is treatable."

This stuff is everywhere. "Psychotic" is another one. The condition is nothing like the stark-raving, dangerously "mad" caricature and, more likely, indicates a patient that, like the schizophrenia sufferer, has lost the full connection with reality that most of us take for granted. It could be hallucinations (voices, mostly) or delusions, and if you were to ever encounter the crushing sadness of a real-life patient with psychosis—who just as likely is completely or partially catatonic and unresponsive or has lost the ability to express themselves in writing or verbally—you would never use the term metaphorically again. You would have seen that using it is cruel.

The Oxford dictionary includes the metaphorical popular misuse of schizophrenia in its definition with no caveats (though the metaphorical usage of "retarded" is deemed offensive), as do several others, including Merriam-Webster. The Cambridge dictionary excludes it, while Wiktionary offers the hyperbolic metaphorical definition with the note that it's deprecated slang. Which is better than no note at all, I suppose.

Anyhow, it's easy to stop doing this and you're certain to wind up a better writer or thinker or conversationalist for having done so. You'll stop hurting people, for one thing, but it may also force you think about what you're even trying to say about that Kate Nash album so that maybe you can say it better. Or come up with a better, deeper thing to say.

Right now, about two-thirds of Americans think that schizophrenia is having "split or multiple personalities," which is a misconception that precisely no one just pulled out of thin air. As far as barriers to empathy, that's a wall so tall I can't even see the top of it. And so the world is a worse place for many millions of people.

Because of what schizophrenia isn't.