Jim van Os has done us a service in bringing to attention the unsatisfactory nature of the concept of schizophrenia. ^{Reference van Os1} He argues that the scientific evidence for the category is weak and that the present label is highly stigmatised. He suggests that a new concept – salience dysregulation syndrome – be assessed with regard to its clinical utility and patient acceptability. (Compare with Sato. ^{Reference Sato2} )

The term ‘syndrome’ is understandable as a constellation of symptoms rather than just one symptom. For example, I am susceptible to schizophrenia but have never heard voices and never hallucinated. That does not mean I cannot be diagnosed as having schizophrenia. ^{Reference George3} My problem as a patient is that the terms ‘salience’ and ‘dysregulation’ are unfamiliar medical jargon.

If an alternative concept is to replace the construct ‘schizophrenia’, it needs to be acceptable to patients; that, van Os and I agree on. It needs to be understandable, neutral in tone, and without any misleading negative associations. Salience dysregulation syndrome meets the latter two criteria, but not the first. To me and other patients with whom I have discussed van Os's proposal, the suggested terminology is obscure.