In my experience, the world of ‘mental health’ is absolutely overloaded with what I like to call ‘false arguments.’ Literally every day, people are engaged in debates without ever questioning the premises upon which those debates are founded. It’s akin to my husband approaching me and inquiring, “Hey, should we fill our one-year-old daughter’s sippy cup with Pepsi or Coca Cola today?” followed by us arguing out the various virtues of the dueling soft drinks without ever bothering to wonder why on earth we’d even offer soda to our sweetly innocent and unsuspecting toddler in the first place. In other words, sometimes the biggest problems can be found not in the best arguments of opposing sides, but in the assumptions of the questions themselves.
What would happen if we simply started asking ‘Why?’ more often? WHY do we believe what we believe? WHAT would happen if we dug beneath the most typical arguments and looked for a different starting point? HOW did we get to this point, and is it the right one? And of course, WHO was it that led us here and how precisely did they come by that power?
Part 1: Don’t Call me Consumer (I won’t Answer)
“What should we call them,” someone asks.
“Just ask them what they want to be called,” another answers.
“Haven’t we been through this before?” A voice calls out. “Won’t whatever word we choose just become the wrong word in a year or two?”
“Yes, but we need to call them something,” goes the retort.
One-word labels abound within the mental health system, and the question ‘What do we call them?’ (sometimes offered in a more subtle format) yields a seemingly forever conversation. ‘Patient’ was a starting point for many, ‘client’ a slightly more recent option. Then, of course, there is ‘consumer,’ ‘member,’ and ‘participant,’ each one having taken its turn in the lead and remaining at varying levels of popularity. We also have our one-word labels masquerading as two words in ‘person served,’ ‘service recipient,’ and ‘service user’ (sometimes restored to the true and fabulous one-word term, ‘user’). The real charmers in the crowd dispense with all the efforts toward gentleness and cut right to calling people by their diagnoses (‘Schizophrenics,’ ‘Borderlines,’ and such) or group them all together amongst ‘the mentally ill’ (my personal favorite). I’ve even heard of some particularly creative groups combining labels to form the endearing term ‘consumer clients,’ or turning ‘individual’ into a bad word by using it so ritualistically only to refer to those receiving services that it became synonymous with the ‘client’ it was trying to escape. And then there’s the decidedly creepy ‘guest’ and the latest favorite, ‘peer.’ (We’ll come back to that one another time.)
I could spend many hours arguing the merits of these various words within the context of the system. ‘Consumer’ beckons images of a relentless beast inhaling everything in its path, or of prospective shoppers perusing a ‘Consumer’s Choice’ magazine evaluating which car to buy. ‘Client’ calls up the idea of voluntary relationships with other professionals – such as lawyers – whom the ‘client’ might reasonably fire should they not do their job well. Yet, these arguments miss the point entirely. The point is that all the squabbling over ‘What to call them now?’ is quite simply a false argument. I call this particular one the ‘myth of the one right word.’
Plainly put, there will never be one right word to describe all the people who are receiving or have received some sort of service from within the mental health system. N-E-V-E-R. Never. Any one word – even if it seems momentarily better or somehow ‘empowering’– that becomes systematized and used routinely to refer to those who that system regards as ‘the mentally ill’ might as well just start off being called ‘the mentally ill’ in the first place. That’s how the word will come to be understood. Just give it time. So, the questions then become: who came up with this idea that there needs to be one word, and why are we following along so blindly?
Without ascribing good intentions or bad, it strikes me as undeniable that the system conceived of the need for the binary of ‘client’ versus ‘staff,’ and the clear purpose served is to separate those who ‘need’ help from those who ‘give’ it. More simply put, it separates ‘us’ and ‘them.’ Were that linguistic division held only in the context of a short-term or occasional connection such as that between a divorce lawyer and his ‘client’ or a ‘consumer’ and a car salesmen, there’d be no harm done. However, the reality of the system is that many people spend days, months, or years contained within its stark white and green-tiled walls, and so those labels become identities. And, once those labels become identities, we don invisible shackles to the system and the cloak of invisibility makes them that much harder to break.
Imagine for a moment that you had to spend the next year being called primarily one thing. Are you a parent? A teacher? A friend? A spouse? An artist? Which of these would you choose, and which would you be prepared to give up? Now, what if someone else was choosing for you? And, what if that same person decided he or she was going to switch out that strengths-based label and choose a deficit based one on your behalf? One year later, how might you think of yourself differently? Introduce yourself differently? See your future differently? There is tremendous privilege in being able to walk so freely between different parts of who we are, and deep loss when we cannot.
Once, during a group conversation on language, someone said to me, “I have to use these words to be taken seriously in my work setting, but if a client flinches when I use a particular word, I stop.” I wanted to grasp him firmly by the shoulders and shake him until he understood that it’s the ones who don’t flinch about whom he needs to worry the very most. It seems to me that those who are still flinching have managed to retain some spark of sense of self about them. They have not yet fully given themselves over to be re-birthed into a mold made by someone else. We need to worry about the ones who have acquiesced, who walk into a room and introduce themselves as a ‘consumer’ or by their diagnosis without any prompting from the wings. These are the lost souls of our brothers and sisters. These are the ones we need to work hardest to free.
I’ll never forget one woman who told me, “Initially, the labels meant something to me. They helped put all my confusing experiences into a framework. But those labels objectified me, and so when they started to talk to me about ‘recovering’ I was at a loss. How does an object ‘recover’?” So much of this talk of language is written off as ‘political correctness’ or the onslaught of the ‘language police,’ but that accomplishes little more than the devaluation of this woman’s story and the journeys of so many others. There is no doubting that this is a complex conversation made only more so by the fact that so many in our movement have also assimilated themselves into the language constructs of the system. That assimilation is common in any situation where there has been historic oppression, and I’ve always found it funny (in a very unfunny sort of way) when providers have attempted to bypass this whole conversation by stating, “We asked them what they wanted to be called, and they said they wanted to be called [insert whatever label here].” So often, you can literally hear the subtext, the “So, since we’ve addressed that, can we please just move on now?” dripping in their tone. But the reality is it makes sense that when a person has his/her agency taken away, is exposed to a particular set of limited options for a lengthy period of time, and is then asked, “Now, what do you want?”, that silence or a regurgitation of all they’ve repeatedly been fed is often the response. So, no, I’m afraid we can’t move on. Not yet.
This brings me to the biggest ‘rub’ in the vast abstraction that is this conversation. We can’t move on to other issues, because with so many identities still tied to this one, moving on would necessitate leaving those people behind. Many of us are crying out for a true human rights perspective of our movement. (What movement, you say? The consumer movement? The recovery movement? The peer movement? I don’t even know anymore, but let there continue to be movement nevertheless!) This perspective demands that we stop saying, “That group over there has rights,” and start saying, “We all have rights, and they happen to be the same ones: human.”
One’s rights should not be defined by a certain status of personhood or change based on labels received. But how on earth can we have that conversation, if we’re too busy figuring out what to call ‘them’? People’s minds will always jump to different rights – or at least different interpretations of those rights – as long as we see people who have been given psychiatric labels as a group separate from ‘the rest of us.’
So, the real question we should be asking is how do we talk with one another about these difficult experiences and the fact that we sometimes need support without dehumanizing each other in the process? How do we hold onto each of our respective personhoods with an inalienable fierceness? How do we talk about our needs and rights not as particular groups but as one group altogether called ‘human beings’? As long as we keep separating ourselves into these boxes, rights violations will continue and healing on a broader scheme will elude us. We must find a way – in language and in practice – to move beyond the fragmentation of our understanding of human experience. After all, only then does ‘us’ and ‘them’ become ‘us’ is ‘them.’
As I conclude Part I, I continue to be plagued by the image of so many of us shackled to a system through the very words we choose and so I leave you with this poem from an anonymous source:
Tools are Shackles
Tools are shackles.
Shackles are tools.
I was taught early on to follow the rules.
Listen to your elders. Respect authority.
Be sure to go along with the majority.
As I grew up, I followed rules less and less.
I didn’t give authority much respect.
Unbeknownst to me, I was headed in the wrong direction.
Living by my own rules, I lost my human connection.
It didn’t take long until I was far off course.
Roaming the wilderness of the mind, I encountered a powerful force.
I thought I was free in the bush because I had a wide range,
But I was trapped by the vastness. Isn’t that strange?
Tranquilizer dart pierced my rear, and I was introduced to psychiatry.
No more running away from authority.
I don’t know the institution’s intentions. It wasn’t all bad.
It took away every last bit of sanity that I had.
Tools are shackles.
Shackles are tools.
I was forced to follow a new set of rules.
They said your mind is sick, and how do we know?
It’s from the odd behaviors that you show.
Luckily, we’ve got a tool to help you out.
It’s called a diagnosis, and it lets us know the type and amount
Of medication needed to restore your health.
All the things you thought you knew about life, you can put on a shelf.
Now medication is our greatest and most revered tool.
Did I mention that it may very well likely cause you to drool?
Every Wednesday we’ll use a tool to give you an injection.
Everything we’re doing is for your and our protection.
You’ve got a bizarre illness. In the olden days, they called it sin.
But our tools have freed you from your boundless prison.
You’ve entered a systematic new world, though it’s a bit smaller than what you’re used to.
We’re all safe now, so be grateful for the subhuman to which we’ve reduced you.
Life may be a little boring. It may be a little dull.
Don’t blame us. Blame that unruly brain in your skull.
In our system, everyone’s got a place but not a direction,
You may not be moving forward, but you agree you required correction.
I agree I needed structure. That I don’t dispute,
But I didn’t need to be made agentially mute.
I guess when you think about it, a shackle is a tool,
But anyone who would try to free someone with a shackle has got to be a fool.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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Wow, what an excellent piece! It reminds me of the discussions of what word to use for the people descended from the people who lived here in the Americas before Europeans arrived to steal their land and livelihoods. Members of the dominant culture make themselves feel better by saying “Native Americans,” but when you talk to those people they are referring to, most would prefer to be identified by their tribe or locality or family name. Lumping them all together and giving them one name is, in itself, a part of the oppression. Might as well stick with “Indians.”
The need for “providers” to distance themselves from “consumers” of “mental health services” is deeply embedded in our culture. Ironically, I have found that the ability to erase or transcend that distance, to create a sense of commonality and mutual experience with those I am trying to help, is the core of what actually leads to a reduction in the person’s suffering, regardless of their “symptoms.”
The one thing the people you are referencing have in common is, perhaps, their experiences in the mental health system. Sometimes I have referred to the group as “those people who have been labeled by the mental health system as having a ‘mental disorder.'” A bit wordy, but a lot more specific. A slightly different group might be “those who are currently experiencing significant mental or emotional distress.” But that pretty much covers everyone at one time or another, doesn’t it? Maybe we should just refer to people as human beings, and recognize that distress and emotional pain is simply part of the human experience.
Thanks for the excellent blog – I am really looking forward to Part 2.
Thanks, Steve! I’m all for wordy! I have that conversation with people all the time (the importance of being wordy, especially when the stakes are so high). I particularly like your last line about human experience. 😉
Excellent blog and excellent response. I might add, just to be fussy, that the word America comes from some Spanish dude name Amerigos who came to “America” and decided it should be called after him. This is after Columbus “discovered” America. So, “native American,” is a term that kind of is more mumby jumbo about giving something a name, as if that does it.
You might call “consumers” um…. “Native Bleulerists: since Bleuler “discovered” schizophrenia; or one could just stick with “Yankee Doodle…”
They haven’t had an DSM meeting about whose name should be used to claim the territory?
I am actually averse to calling the rather confusing unsubstantiated medley of contradictory jargon that spews out of the mouths of those diagnosing people a sign of psychosis. I think psychosis is something that’s spiritual. Diagnosis isn’t. Maybe Native American stands for: “I’m a native of the land Amerigos stole…”
You totally cracked me up, Najinsky! A classic reply!
I’m with Steve. A great reply! 🙂 Thanks for reading.
Thanks Sera for this! Recently a friend of mine posted a comment about the ways we teach our children whether it be in the school system or at home, as to teach younger people to use more critical thinking. We are taught from a young age not to ask why and challenge the people who are supposed to hold all the answers. This probably isn’t true in all children, but how many times have you heard the phrase “don’t ask why because I said so” used. Children are taught from a young age in traditional school settings to just do what is asked and not to question authority. In some instances children have been raised in households were they are taught and praised for asking why. It almost seems to me that we are conditioning people at a young age not to question authority, but then as they go into some form of secondary education we are asked to gain critical thinking skills. Change is what is needed and probably not going to come outside of the home to start, but if more families and communities start asking why we might stand a chance for change.
At a young age I was labeled and separated in school systems and as an adult wonder sometimes if things would of been different if I wasn’t given that label. The one thing I know I gained from receiving that label at a young age is the ability to teach my children not to use them and have tons of conversations about it with them. I also can understand how the relief of receiving a label can feel for people who have struggled for sometime.
Again Sera thanks for sharing with me some of your feelings with us, they gave been so inspiring to me and others.
Thanks for reading, Currie. I’ve thought a lot about what you brought up: How to teach kids to question, question, question and think critically while also giving them some structure within which to accomplish that in those early years.. Something our school system does indeed fail at, most of the time.
This was so FANASTIC. Things I’ve sensed and thought, in a wordless sort of way, but couldn’t quite articulate. Things I’ve been grappling with for years.
What it all boils down to is that EACH AND EVERY ONE OF US is a human being. It’s a human rights movement. Put another way, it is a struggle against DEHUMANIZATION, in all it’s many forms…
But that’s just my way of saying it. Likely there are better words out there!
Thanks for reading and for the positive feedback! 🙂 Yes, absolutely, a struggle against dehumanization…!
Very valuable conversation. Recent calls for draconian laws to further shackle us, following the recent tragedy in Conn. point out just how othered we are. It seems our society needs some group to scapegoat and we seem to be it. All the fears and alienation people feel, end up heaped upon us. Then I agree with Sera, it doesn’t matter what name we are called, the main thing is we are the ultimate other. We are each person’s shadow, their most unexplored unknown. The words stigma and discrimination do not come close to describing the devaluing, disrespecting, and dehumanizing that we are subjected to. Small wonder few people want to declare they recovered, for to do so means they have to admit they also were part of the other.
Sera really knows how to look beyond the initial hype for the deeper messages at stake in today’s mental health messages. I deeply appreciate her writing.
If you are interested in your NEC to redirect narratives away from illness management towards recovery, meaning, and living well despite events of adversity, have you considered expanding your database of recovery stories to including the deceased as potential role models?
I haven’t read any of his books yet because I was just turned on to him, but Anton Boisen had extensive psychotic episodes in his life… but he also had good careers and extensive scholarship on a range of disciplines. http://en.wikipedia.org/wiki/Anton_Boisen
Stephen, if you read this, you probably know of Anton, because of his great contributions to the field of hospital chaplaincy.
Thank you for reading, Emily! I’ll be curious to look up the person you mentioned, too, as he’s not someone I know yet! 🙂 Thanks for sharing!
Good points, Dan. There’s also some issues with the implications of the word ‘recover’ itself, but that’s a conversation for another time 😉
I agree that we are seen as the shadow and the ultimate other. I think the reason that we are ostracized is that we bring people in touch with the shadow/other within themselves.
Well done, Sera. Thanks for this.
When a person is reduced to a diagnosis her humanity is lost, even though I think SOMETIMES labels are useful ways of describing something that happens sometimes to some people. They might be a helpful starting point in some cases but never an end point. And no label COMPLETELY explains the subjective experience of an individual.
I’m a mental health clinicians and I hate the new DSM coming out, in which the APA has invented more ways than ever to pathologize human experience. And I bet Big Pharma can’t wait for the new DSM to be released. I can already envision the commercials for meds to “treat” *normal* grief, for example.
Your piece reminds of the words of Harry Stack Sullivan: “We are all more simply human than otherwise.”
Christina Emanuel, MFT, PsyD
Love that quote, Christina! Thank you! 🙂
By the way, most tribal names that indigenous groups have given themselves usually just mean “the People.” Today, many of us who are of tribal origin here in America and Canada refer to ourselves as First Nation peoples.
You raise very important issues. It’s interesting that the various names given to us are usually created by the system. No one asked me what I referred to myself as while I was in the hospital. It really grates on me when we’re referred to as “consumers.” Working in that same hospital now I refuse to use titles like consumer, client, or patient. The best I’ve been able to come up with is residents but I’m not satisfied with that either. I like your point that we’re all just human beings in the end. I’m interested in what you will share aabout the title peer.
Thanks for reading, Stephen! Yes, I agree that ‘residents’ – though better in its literal definition than many of the other one-worders – is still a one-word label by nature. In the end, it’s that wordy approach that Steve mentioned that I believe to be the answer… In other words, referring to people by their names or by neutral terms like ‘someone’ a ‘person,’ etc. and then if you need to define who that person is, doing so AFTER that word, and never ever allowing any one word to be used systemically to refer to ‘them.’ Any one word could start out as positive or neutral.. take ‘apple’ for instance… but used systemically it just becomes the next term for ‘them.’ No way around it…
Dear Sera, thank you for this insightful post. It reminds me of something my favorite professor used to tell students in our intro to Sociology classes. To understand human nature and culture you always need to start with one basic question, “Why is that?”
Questioning our assumptions, filters, language and labels is a gateway to freedom. I think we should be cautious and resistant to all labels, even seemingly positive or culturally valued ones. And especially ones used to disempower and marginalize. All labels ultimately segregate us from others and from other aspects of ourselves. Making artificially concrete that which is fluid and ever changing if we don’t cling (and even when we do).
Your blog reminds me of a passage from Richard Bach’s “Illusions,” which I’ll paraphrase as best as I can recall
“To define the Truth is to Limit it.” (or perhaps it was to destroy it).
Thank you for questioning the many illusions in mental health, and encouraging us to drop all labels in favor of our shared humanity. We could even take it a step further, we are more than human beings, we are divine. And that birthright connects us with all life human and not, sentient and not. *Stardust* as someone so beautifully pointed out.
I am grateful to know you are safeguarding all of our human rights.
Thank you for your heart and voice.
Thanks, Jen! 🙂 Your reflections and your eloquence are much appreciated 🙂
It takes yours to bring mine out 😉 I appreciate your leadership and heart and questioning…
Mentalism in Language
“Decompensating” is an us-them term; under stress “we” may not do well; “we” may cocoon, take to bed, get bummed out, get burned out, get a short fuse, throw plates, scream, call in sick, or need a leave of absence. “They” decompensate.
Part of the demotion from “us” to “them” is a loss of one’s designation as a person. One is suddenly no longer a person with a diagnosis, but “a schizophrenic” or “a bipolar… “a mental patient” or “a CMI” or “SPMI.”
Medical illnesses are not associated with the negative assumptions and prejudices that are inferred from a psychiatric label. A “diabetic” is not assumed to be violent, unpredictable, or incompetent.
Associate the term “patient” with discrimination, coercion, and oppression.
Psychiatric personnel have continued to justify the use of the term “patient” because they see it as simply technical.
Mentalist power dynamic: professionals are generally accustomed to being in charge and, as a professional once said, they’re “not about to be dictated to by a bunch of patients.”
The power-up group is comfortable with the existing terminology and that comfort takes precedence over the feelings, wellbeing, and dignity of those who are power-down.
If a diagnosis helps a person to understand her/his experiences and gain control over her/his life, it is a useful tool. If it stigmatizes, communicates contempt, and excludes the person from services, it is a weapon.
If I describe someone as “a borderline with intense dependency,” “a non-compliant schizophrenic,” “an oppositional patient,” “a typical drug-seeking antisocial personality disorder,” “a manipulative, gamey manic,” am I seeking to understand, respect, and help, or merely pass judgment, feel superior, and assert my professional dominance?
I hate that word “treatment.” It’s been twisted by the system and perverted beyond recognition. If they lock you up against your will, strip you literally and figuratively (of your rights) and force you into bondage and solitary confinement and then inject you with powerful and painful drugs, they call it “treatment.” In every other possible realm on earth, this is torture and not “treatment.” If they set a fifteen minute appointment for you to renew your drugs every two weeks or month, they call that “treatment” and they can bill your insurance for payment. I consider it fraud.” -P.R.
“To be a mental patient is to participate in stupid groups that call themselves therapy — music isn’t music, it’s therapy; volleyball isn’t a sport, it’s therapy; sewing is therapy; washing dishes is therapy. Even the air that we breathe is therapy — called milieu. ” -Rae Unzicker
“Normal behaviors are NOT symptoms. Normal people can have a bad day, an “off” week and even a “down” month. However, if we exhibit those normal behaviors on the job, we get labeled and we are asked if we took our medications or if someone needs to call our shrink.” -P.R.
“There is no such thing as a ‘side-effect.’ There are only ‘effects’ from taking drugs. Some effects are desired and others are undesirable. Calling something a “side-effect” obscures and minimizes the resultant pain, suffering and misery that can be caused by psychoactive drugs and in doing so, it discounts our experiences and perceptions and thus sets us up as less than we are. It denies our reality. “Hey doctor, my eyes fell out and I’ve got big purple splotches all over.” “That’s okay, it’s just a side-effect.” -P.R.
Psychiatric facilities are not “hospitals.” Hospitals are those places with oxygen coming from the walls, with private television, with beds that bend up and down, where folks bring your meals to you, where nurses deliver the medicine and accept if you refuse, where a nurse will give you a back rub to avoid bedsores. Psychiatric facilities are places of holding and containment that want to fool folks into thinking they have any medical purpose other than oppression and suppression. The quiet mental patient who causes no community disturbance is considered “cured” or “recovered,” no matter how miserable or incapacitated he or she may be.
Interesting story, Sera. As for me, as a person who receive her mental health treatment at the VA, my label as a “consumer” of mental health care is “vet”. I’d rather be called a patient though than a consumer,client or any other euphemism that’s politically correct. I think the most important thing to remember is never to refer to a person by his or her illness.
Sera, thank you for your continuing insightful writing on the significance of the language and labels applied to us. My latest pet peeve is the way “peer” has come to be the system’s new euphemism for “mental patient.” It doesn’t even make grammatical sense, let alone any other kind of sense. I truly believe that if everyone decided that people with psychiatric histories should suddenly be referred to as “pinecones,” within days, “pinecone” would become a dirty word.
I think we can get even more clever, people with psychiatric histories should now be called “psychiatrists” That would be fun!
Sera, I loved your post, and most of the comments above.
In describing our unwellness to a psychiatrist, it is expected, nay demanded of us that we must describe our symptoms using the jargon of psychiatry. And implicit in using that jargon is accepting all the falsehoods that underpin it. But yet, to describe your unwellness in straightforward language, as you actually experience it, is to invite further unwanted labelling…
So Catch-22. The best I can manage is say as little as possible.
There are so many important points in this article, but I just have to share that, “there’s the decidedly creepy ‘guest,’” immediately made me think of how Belle was considered both a “guest” and a prisoner in the beast’s castle in “Beauty and the Beast.” Sounds awfully familiar to “guests” in psych lockups, doesn’t it?
I hadn’t thought of that, but it’s an excellent point. 😉 Thank you for reading and commenting! -Sera
There are many things that bother me. It seems there are not enough fingers to plug the dehumanization pouring upon us from the man made dike . Maybe we need Ronald Reagan to tell us we are an evil empire and to tear down that wall. Or Pink Floyd to sing us “It’s just another brick in the wall.” Or Lenard Cohen singing ” Democracy Is Coming To The USA ”
In any case Sera your posts and the comments they bring out are somehow moving us toward freedom. Thank You , Fred
Great read! Powerful questions in the last paragraph, and the poem was outstanding! The self proclaimed “experts” need to figure it out to reduce the divide and end the oppression! Thanks for writing this, I can’t wait to read the next two!