Words Matter: The Importance of Language Choice in Mental Health Care

The language used in mental health care has significant effects on perceptions, treatment, and informed consent

Shannon Peters
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In a recent commentary in Lancet Psychiatry, Veryan Richards, member of the Royal College of Psychiatrists Patient and Carer Committee, discusses the importance of language in mental health care. Richards argues that language has a powerful impact and therefore more efforts should be made to use language that is destigmatizing and accurately descriptive. Richards writes:

“In the context of mental illness, mental health, and wellbeing, negative words can be experienced as condescending, isolating, and stigmatizing, whereas positive words can convey dignity, empathy, and hope.”

Photo Credit: Pixabay

In 2017, The Royal College of Psychiatrists outlined eight core attributes of good psychiatrists, which include communication, humility, respect, and trust. According to Richards, this “reinforces a stronger, values-based climate which should influence the principles that shape the language and terminology used in person-centered mental health care.” Richards is a proponent of first-person language, which first acknowledges a person and then identifies a condition (e.g., ‘a person with psychosis’ versus ‘a psychotic person’).

Richards argues that the phrase ‘mental health problems’ is often too vague. She suggests this phrase could be problematic when used for common experiences, stating “we should remain alert to overmedicalizing experiences and challenges that would be better understood as a response to social or economic factors and normal human experiences.”

At the same time, she proposes that using ‘mental health problems’ as a euphemism for more serious illness or crisis is also unhelpful. She writes, “some current terminology should be adjusted if parity is to be achieved within the language used in health care.” Richards gives the example of times when ‘patient’ may be the preferred language over ‘service user’ in medical settings.

Richards believes that a language shift can improve shared decision making. She states, “the quality of communication can facilitate a ‘doing with, not doing to’ clinical approach.” She also cites the 2015 UK Supreme Court judgment, Montgomery v Lanarkshire Health Board, which “raises the status of shared decision making from guidance to a legal requirement and concludes that all doctors need the communication skills required to support this process.” Therefore, she recommends medical schools require students to be trained in communication skills.

In a recent BMJ commentary, Richard Smith called for more straightforward, precise language to be used in medical academic writing so it would be more accessible to the general public. Medicalized language has become part of everyday conversation, and this language impacts how people think about mental health, mental ‘illness’ and recovery.

Richards concludes, “It would enhance the quality of care, at no extra financial cost, if everyone engaged in mental health policy and service delivery were to commit to shaping and influencing a culture and standard of communication which diminishes stigma and promotes language that is appropriate, respectful, and empowering.”

 

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Richards, V. (2018). The importance of language in mental health care. Lancet Psychiatry. Advance online publication. http://dx.doi.org/10.1016/S2215-0366(18)30042-7 (Link)

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Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.

18 COMMENTS

  1. The problem is that words used to often lose meaning or people become cynical

    I keep thinking of a dictionary of mental terms

    To identify those who interact with the system
    Patient – totally appropriate when the person is dealing with a doctor or nurse
    Client – totally appropriate for allied health professions
    Service user – for those who attend recreation of psycho education programs
    consumers – only appropriate when you eat chocolate cake. This is the one I would like to see eliminated

  2. Words are a reflection of intent. The author wants to move the words around without changing the intent. Is the purpose of “mental health treatment” to engage with and empower the client, or to make uncomfortable people stop acting the way they do? Is it about encouraging perspective or enforcing social norms? If the intent is different, the words will follow.

  3. Words are often used for social control purposes. (Witness newspeak in Orwell’s 1984). I think jargon (specialist [one could say specialized] language) provides much of the same sort of thing in many instances.

    If a person is “out of control” in somebody’s estimation, what do folks tend to do? Call for the “mental health” authorities, that is, today’s agents, and therefore, technicians and engineers, of “social control”.

    Psychiatry is predominately about “medicalization”, and the people subjected to it, if they don’t have a true medical condition to begin with (usually the case), given enough “treatment” and the time to administer it, certainly will have a real medical condition eventually.

    • Exactly Frank. Well said.

      I just have to point out that this is one of the most ridiculous articles that MIA has published in a while. Psychiatry is inherently a system of slavery, torture, and abuse that uses false diagnoses and harmful labels to stigmatize and ostracize its victims. Psycho-babble, or psychiatric doublespeak, is used to reinforce every insidious practice in psychiatry, thus involuntary incarceration becomes “hospitalization,” unwanted behavior becomes “mental illness,” neurotoxic drugs become “medications,” and stigmatizing labels become “diagnoses.” We’ve even heard of suicide called “emotional lability.”

      I realize that this article is meant to report on the Lancet article. The Lancet article is obviously ridiculous. Psychiatry cannot be made better by improving the language. Psychiatry is the CAUSE of the problems that it pretends to cure. Terms such as “mental illness,” “psychosis,” and even the term “patient” are inherently condescending and abusive. Psychiatry cannot be fixed. It must be abolished. Slay the Dragon of Psychiatry.

  4. Words are important but the concepts are the bigger problem. Whether you’re called a ‘person with depression’ or a ‘depressed person’ or a ‘depressive’, the implication is the same – you’re thought to have something wrong with your brain, you will be given drugs, and the real problems which made you hopelessly sad in the first place will often be ignored.

  5. Propagandists know the enormous power of words, and the current occupant of the White House focuses like a laser on labelling, never missing a chance to drive home the image he wants burned in his supporters’ minds: 30 to 40 percent of voters automatically disregard anything he calls “fake news,” no matter what the evidence shows. Ditto “lying Hillary,” “lock her up,” “the deep state.”

    Same thing with psychiatry. Thomas Insel, then head of NIMH, says the DSM is invalid, but psychiatry’s (and PhARMA’s) decades-long treating DSM as its scientific “bible” of “disorders” and “illnesses just like heart disease” makes all media and even writers at this site talk as though this reified BS is real.

    This article is just nibbling around the edges, kind of like being a “nice” doctor who nonetheless regularly prescribes Haldol. Establishment psychiatry can pose as enlightened and still do what it has always done.

    The starting point needs to be dumping the heading “mental health.” As long as the whole subject refers to the medical-friendly word “health,” it just a short hop for psychiatry and PhARMA to slide right into the same old schtick about synapses and circuitry. Ditto “biopsychosocial” – there is overwhelming evidence that psychosocial factors are enormously important, and hardly any evidence that bio factors actually cause or fix mental problems (beyond sound nutrition and healthful lifestyle). Saying “bio” is primary simply because bodies and brains are necessary for our having behavior or emotions makes as much sense as saying defective celluloid is the primary cause of bad movies.

    As Steve Scharfstien, former head of the APA observed, “biopsychosocial” long ago came to stand for “bio-bio-bio.”

    We need to refer to diagnoses as “so-called depression,” “so-called bi-polar”; “diagnosis” needs to be seen as simply acquiring a label. We need to change “mental health” to something with a basis in fact – “feeling overwhelmed by sadness, isolation, fear, unusual thoughts” etc. Others can figure out more elegant ways of putting it – just don’t use terms that are based on fraudulent science and unsupported supposition.

    The British Psychological Society has made a promising start of ending diagnosis and substituting a profound process of supporting “patients” in constructing answers to questions about the power has shaped their lives and how they can see themselves taking back the power to lead the lives they want to lead.

    • “… even writers at this site talk as though this reified BS [the DSM] is real.” This is a problem, I agree. If the “mental health professionals” want to actually “use language that is destigmatizing and accurately descriptive,” they need to stop using the DSM stigmatizations.

      And Red Squirrel is right, psychiatry is all about making sure you are so sick from the psychiatric drugs that “the real problems which made you hopelessly sad in the first place will often be ignored.”

      And the elephant in the room, according to the mental health industry’s own medical literature, is that today’s psychiatric industry’s primary actual function in our society is DSM stigmatizing child abuse victims as ‘crazy,’ then massively poisoning these child abuse victims.

      Today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

      And here’s the medical proof that the “treatments” for those massive percentages of DSM stigmatized child abuse victims can create both the negative and positive symptoms of the so called “schizophrenia” disorder.

      https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
      https://en.wikipedia.org/wiki/Toxidrome

      We need a “mental health” industry that allows payment to therapists for helping child abuse victims, without first misdiagnosing the child abuse victims with a billable DSM disorder. The current “mental health system” does NOT allow payment to therapists for aiding child abuse victims because child abuse is a “V Code.”

      http://valueoptions.com/providers/Handbook/PDFs/Treatment_Guidelines/V_CODES_RELATIONAL_PROBLEMS.pdf

      And V codes are not generally reimbursable by the insurance companies.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      This flaw in the “mental health” insurance reimbursement laws needs to be corrected. We need a “mental health profession” that actually helps child abuse victims, as opposed to one which continues to defame and torture child abuse victims on the massive scale you have been doing for decades.

      Changing just the “words” you use is far from all that needs changing, in today’s “mental health system.”

  6. Something I left out: psychiatry has sold to the public and professionals that the disease model of “mental illness”reduces stigma. That mantra is so pervasive that you almost never see it challenged. Yet studies consistently show that attributing mental problems to genetics and/or disease actually increases stigma. People tend to avoid those branded with permanent biological labels; and have more empathy when mental problems are described as deriving from life experience.

    • Your comment on stigma caused by psychiatrists labeling people via “medical” diagnoses reminded me of the time I rejected someone because a non-medical professional disclosed their mental illness to me. Instead of opening my heart, I kindly exchanged pleasantries and left. Fast forward to the present, I am dealing with the same stigma from others that clouded my own soul all those years ago. We even share the same diagnosis! When I think about what I did to that person, I feel incredibly horrible, but only because I discovered what psychiatry truly was:social control.

      Mother karma always wins in the end.