ALONG WITH A few other neighboring countries, Japan uses the Chinese writing systems, and our writing system for the nomenclature of mental disorders is no exception. With the aim of reducing the stigma associated with schizophrenia, the Japanese Society for Psychiatry and Neurology (JSPN) played a key role in changing the term for schizophrenia in 2002 and dementia in 2004. Specifically, the equivalent term for schizophrenia was changed from seishinbunretsu-byo (‘split mind disease’) to togoshitcho-sho (‘loss of coordination disorder’), and that for dementia to ninchi-sho (‘cognitive disorder’).
The ICD, which has been published and revised by the World Health Organization (WHO), is closely related to the DSM, issued by the American Psychiatric Association (APA). The 5th edition of the DSM was just released in May, 2013, and the 11th revision of the ICD is to be released in the near future. The new diagnostic categories to appear in these classification systems have been discussed by the JSPN, which had set up two committees with specific topics to discuss, respectively, namely the Committee for the Psychiatric Glossary of DSM/ICD Classification and the ICD-11 committee.
The term ‘disorder’ has turned out to be especially problematic for the Committee for the Psychiatric Glossary, as its equivalent term in Japanese, ‘shougai’, is also an equivalent term for disability (i.e. ‘intellectual disability’). Disorder and disability are two different concepts, and in Japan the question has been raised as to whether we can or should continue to use the same word for both disorder and disability. The implication of this problem is serious, especially for pediatric diagnoses. Children, understandably ignorant of this complex issue in our nomenclature, automatically associate and often equate or confuse ‘disorder’ with ‘disability’ and its resulting handicap. In other words, a child diagnosed with a mental disorder faces a great risk of being seen as disabled, which implies irreversibility and a marked handicap and further subjects the child to teasing and alienation.
Aside from the issues inherent to the nature of translation, there also remains some controversy as to what terms should be used to refer to specific illnesses, that is, disorder, disease or syndrome. One may say that some illnesses are closer in nature to ‘disease’ in that we know their biophysiological mechanism better than others'; in contrast, some illnesses may be more appropriately addressed as syndromes, for our relative lack of knowledge on their cause, heterogeneity of symptom presentations among patients with the same diagnostic label, etc.
The Committee for the Psychiatric Glossary has adapted the following seven criteria for deciding on an official translation of nomenclature. The translation has to: (i) reflect the concept and background of the nomenclature; (ii) reflect the difference from and relevance to the traditional Japanese terminology; (iii) reflect the original meaning in English; (iv) be as concise as possible; (v) be self-explanatory enough for the general public to deduce what symptoms would be manifested; (vi) be unambiguously distinguishable from other disorders and their symptoms; and (vii) not facilitate prejudice against the patients.
Considerable changes can be seen in parts of the classification and nomenclature of the ICD-11 and DSM-5 in comparison to their previous editions. Not all disorder labels used in the previous editions were adapted with much transparency in terms of how the final agreement was reached and for what grounds. For instance, the term ‘somatoform disorders’, which first appeared in the 3rd edition of the DSM, is expected to be replaced with ‘somatic symptom disorders’.
The nomenclature of mental disorders inevitably goes through changes over time and with accumulation of new scientific knowledge. The recent movement toward person-centered medicine is particularly notable, and it has become a critical factor to consider how the nomenclature will be perceived and understood by the patient who receives the diagnosis. In Japan, upon the publication of the DSM-5 in May 2013, the glossary committee is planning to publicize the draft of translated disorder labels and call for public comments on their website.
In Japan, because the ICD is used for the national statistics, the Japanese government launched the Subcommittee of the Classification of Disease and Morbidity and the Statistics Committee of the Social Council of the Ministry of Health, Labor and Welfare from the outset to revise the ICD-11 and smoothly introduce the ICD-11 to established organizations throughout Japan.
The JSPN has established a mechanism to handle translation of the ICD-11 and of material to be used in field trials. Among the key activities that the JSPN has taken a lead in is recruitment for a network called Global Clinical Practice Network (GCPN), which is expected to function as a pool for registrants to participate in web-based field studies. At preset the number of registrants from Japan is more than 700 (as of May, 2013), and it is expected to increase further. In addition, the JSPN has been successful in establishing the Field Studies Center Network, with approximately 30 institutions and organizations nominated nationwide to conduct field studies with real patients. The first face-to-face meeting was held with an attendance of the senior project officer from the WHO in March 2013. With the ICD-11 projected to be published in 2015, a series of web-based studies will be conducted, followed by field trials with real patients.
To the authors' knowledge, in the Asian region it appears that no academic society has made collective efforts of this scale yet, and we hope that the progress that we have made in Japan will serve as a useful example. In particular, our experiences in translation and how we handled difficulties associated with translation may be relevant to China, Taiwan, Korea and Hong Kong, where the Chinese writing system is also used. We believe that the JSPN, in the series of aforementioned activities, contributes not only to the people of Japan, including patients, caregivers and health-care professionals alike, but also to the neighboring countries, by providing a valuable example.