Lee et al (Reference Lee, Lee and Chiu2005) reported that in Hong Kong individuals with schizophrenia experience stigma even from family members. This stigma as well as public attitudes towards mental illnesses are serious issues. Mental health professionals are expected to take a supportive stance against such stigmatisation. However, is this always the case?

Practising clinicians may have unconsciously been partly responsible for assigning prejudice to the condition. The terminology routinely used in Japanese clinical practice to describe the characteristics of schizophrenia is somewhat derogatory, e.g. the term jinkaku suijun no teika (a decline in the level of personality) is often used to describe a feature ascribed to the larger domain of negative symptoms. The symptoms checklist used in the official mandatory evaluation of long-term in-patients includes one item regarding ‘the morbid state of personality’; apathy and abulia are assigned the label of ‘residual personality changes’, and no other items are assigned to the category of negative symptoms. These descriptions imply that the affected person's personality has decayed and, consequently, that the process is irreversible.

There are other expressions often used in Japanese clinical practice that may encourage prejudice: these include jigiteki sokai kan (silly or childish cheerfulness). kekkan jotai (a defective state), hinekure (perverseness) and omoi agari (conceited). The latter two terms were introduced in Japan in 1956 from the original descriptions (Vershrobenheit and Verstiegenheit, respectively) of L. Binswanger (1881-1966) and are still in use.

Demands to eradicate the stigmatisation of people with mental illnesses have never been higher in modern psychiatry (Reference PorterPorter, 1998; Reference Crisp, Gelder and RixCrisp et al, 2000; Reference Corrigan, Edwards and GreenCorrigan et al, 2001). Caregivers need to be alert to the intrinsic problems that may exist in daily practice. The disclosure of medical records is still uncommon in Japan (Reference TakeiTakei, 2001) and standardised diagnostic systems such as the ICD-10 (World Health Organization, 1992) have not been widely used. These practices have fostered reliance on subjective judgement and the use of rather undesirable terminology in clinical practice. Mental health professionals may themselves stigmatise people with schizophrenia and such an unbecoming attitude may not be limited to a particular country.