Should the term “thought disorder” be revised?

Abstract

The term “thought disorder” is widely used in American and British psychiatry to describe the cognitive and linguistic abnormalities which occur in schizophrenia. Both the term itself and the emphasis on its importance in the diagnosis of schizophrenia derive from Bleuler, who regarded it as pathognomonic. 1 During more recent years some investigators have questioned both its value and its specificity. 2–6 Diagnostic systems have been developed which emphasize the importance of other symptoms, such as specific types of delusions and hallucinations or poor premorbid personality and social adjustment. 7–10 Further, various types of thought disorder have also been observed in other illnesses, such as mania or depression. 11–13 Yet another objection to the term thought disorder, perhaps even more salient and compelling than those mentioned, is that the term has come to be used so broadly and imprecisely that it has become nearly meaningless. Wittgenstein has warned us that we cannot assume that because there is only one word, there is only one thing. The single term thought disorder has grown pregnant with a variety of meanings over the years. If the language of medicine and science relied on connotative richness and ambiguity, the value of the term would be thereby increased. Since science and medicine instead demand denotative sparseness and precision, the term has in fact become prostituted. Current usage of the term “thought disorder” varies so widely that it may mean anything from delusional thinking to memory impairment to a cognitive set predisposing to low self-esteem. A reevaluation of the terminology used to describe the psychopathology of cognition and self-espression is long overdue.