Academic journal article The Israel Journal of Psychiatry and Related Sciences

What Is in a Name? Professionals and Service Users' Opinions of the Hebrew Terms Used to Name Psychiatric Disorders and Disability

Academic journal article The Israel Journal of Psychiatry and Related Sciences

What Is in a Name? Professionals and Service Users' Opinions of the Hebrew Terms Used to Name Psychiatric Disorders and Disability

Article excerpt

Abstract: Objectives: Stigma constitutes the hidden burden of mental disorders. Its ubiquitous presence may be reinforced by iatrogenic factors, such as the terms used to name mental disorders and disability. This preliminary study examines opinions with regard to the use of these terms in Hebrew. Methods: Two samples of convenience, mental health professionals (n=330) and service users (n=75), were asked to complete a self-administered questionnaire about their respective acceptance of the current term in use to name psychiatric disorders and disability, as well as their preference for alternative terms that may carry a lesser degree of stigma. The distribution of responses was compared within and between these two groups. Results: There was consensus in both groups that a substantial proportion of service users reject the current term used to name mental disorder, mahalat nefesh (disease of the soul). Mental health professionals had a statistically significant acceptance of this term compared to service users. The term hafraa nafshit (disorder of the soul) was reported to carry a lesser degree of stigma. No specific term was selected by more than a third of the respondents to best define disability resulting from a psychiatric disorder. Conclusion: A case for study and possible subsequent action was established by this pilot inquiry.

The adverse effect of stigma is known as the hidden burden of mental disorders (1, 2). Stigma towards mental disorders, the affected persons and their families is a powerful factor that, among other consequences, impedes affected persons from seeking care when needed (3) and reintegrating in the community upon discharge from an inpatient service (4). Professionals and other mental health-related stakeholders have launched multiple activities to elicit (5) and reduce stigma worldwide (6), including in Israel, where a major study is being conducted by the Myers-JDC Institute, Jerusalem, and the Ministry of Health (N. Shtruch, personal communication). Strategies to reduce stigma, as its eradication is too illusory an aim, are of multiple types. The World Psychiatric Association delineated these strategies upon launching a major international campaign to fight stigma on account of schizophrenia (6).

This article describes a preliminary inquiry among all major disciplines engaged in the direct care of persons with mental disorders and service users with regard to the currently used Hebrew term for mental disorder, mahalat nefesh (disease of the soul).

The Even-Shoshan Dictionary defines nefesh as "soul, the life spirit of any creature" (7). Such a definition is highly dissonant with current scientific conceptions whereby mental disorders are recognized as bio-psycho-social entities. The current term in use gradually took over the place of mahalat ruach (dis ease of the spirit); conceivably, mahalat nefesh was regarded as a more appropriate name of the construct. (Interestingly, both terms mahalat ruach and mahalat nefesh had been in use for centuries. As an illustration, a rabbi and doctor, Jacob Tzahalon, in his book "Otzar Hahaim" published in Venice, Italy, in 1683, alluded to both terms in the title of a planned chapter he had intended to write (S. Kotek, personal communication). The terms ruach (spirit) and nefesh (soul) have been suggested to be stigmatic insofar as both terms may suggest that the spiritual essence of a person is affected by the psychiatric disorder. In addition, the former term, ruach (spirit), referred to the cause of the condition insofar as an altered spirit entered into the subject (8). The term for disability resulting from a psychiatric disorder may not be free from a similar source of stigma, insofar as neche nefesh (approximately, handicap of the soul) is the current term in use.

An inquiry analogous to ours, but with reference to schizophrenia, was conducted in Japan in 2001 and resulted in a governmental decision to change the term that was in use for this specific disorder. …

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