In her introduction to a report on the use of seclusion and restraint in New Zealand psychiatric hospitals, the CEO of our National Centre of Mental Health Research, Information and Workforce Development tells the following story:
I vividly remember delivering the news of the death of a young man to a mother who thought her son was going to come home from the mental health inpatient unit. He died as a result of restraint asphyxia. Restraint asphyxia is rare, but can happen as a result of restraining someone who is highly distressed.
What a nicely sanitized term for killing someone by forcing them into a position that prevents them breathing and holding them there until they die. Note how it is characterized by the victim’s distress, not by the healthcare professional’s incompetence and negligence.
There are numerous studies showing that changing the language people use changes how they think.
A famous example is that of the differences in descriptions of a key by Spanish and German speakers (where key is feminine in Spanish and masculine in German) with the German speakers using phrases like “hard,” “jagged,” “metal,” and “heavy,” while the Spanish speakers used phrases such as “little,” “shiny,” “golden,” “intricate,” “lovely,” and “tiny.” According to the researchers this is evidence that linguistic processes influence fundamental thought processes, unconsciously shaping the way we think and the way we see the world.
Others argue that it is the other way around and that the language we use describes and emerges out of our social reality with sexist language for example arising from, rather than causing, lack of gender equity.
Whether language shapes our perceptions or our social realities give rise to the language we use, there is an argument to be made that the use of language in psychiatry deliberately sets out to influence our perceptions of particular practices and concepts. A term like ‘restraint asphyxia’ serves to minimize the killing of people n psychiatric institutions to something less than the killing of other human beings.
Imagine a situation where a child is throwing a tantrum in a supermarket and the child’s mother wrestles the child to the ground face down, puts their weight on the child’s body so it can’t move and keeps it there until the child stops breathing and dies. How likely is it a court would find the child died from ‘restraint asphyxia’ rather than manslaughter? Why is ‘restraint asphyxia’ the appropriate term for someone who dies being restrained while distressed in a psychiatric hospital, but not for a child who is distressed and restrained by their parent?
Last week I had a long discussion with Leonie Fennell about the extent to which the term ‘antidepressant’ shapes the way we think of these drugs. How it renders the fact that they can worsen depression and cause suicidal thinking and behavior counter-intuitive, and makes people skeptical of claims they don’t work and make distressed people feel worse. We decided not to use this term anymore and Leonie came up with the simple alternative antidepressant.
There are lots of other terms in psychiatry that are designed to render violent and distressing events as benign, and normal human rights, feelings and behaviours as threatening – things I think we need to name for what they are:
Discontinuation syndrome – drug withdrawal
Paraphilic coercive disorder – rape
Sectioned – detained against your will and having your human rights removed
Medication Non-Compliance – exercising your human right to refuse treatment
PTSD – having a normal human response to traumatic events
Side effect – direct effect of a drug that doesn’t fit with the marketing plan
And all the rest.
I’m going to make a real effort not to buy into this alteration of reality by using misleading terms, and to name things for what they are. Except tea and cigarettes… despite all the above, I’m still going to refer to them collectively as breakfast.
L. Boroditsky et al. “Sex, Syntax, and Semantics,” in D. Gentner and S. Goldin-Meadow, eds., Language in Mind: Advances in the Study of Language and Cognition (Cambridge, MA: MIT Press, 2003), 61–79.