Psych Concepts Creep Into Our Everyday Experiences: An Interview with Nicholas Haslam

Nicholas Haslam is a Professor of Psychology at the University of Melbourne. He is a prolific writer with nine books and around 270 articles to his name and is well-renowned for his work on dehumanization and concept creep.

He received his PhD at the University of Pennsylvania and taught at the New School for Social Research in New York City before returning to Australia. His books include Psychology in the Bathroom, Introduction to Personality and Intelligence, Yearning to Breathe Free: Seeking Asylum in Australia, and Introduction to the Taxometric Method.

In addition to his academic writing, Nick regularly contributes to The Conversation, Inside Story, and Australian Book Review. He has also written for TIME, The Monthly, The Guardian, The Washington Post, The Australian, and two Best Australian Science Writing anthologies. Nick is a Fellow of the Academy of the Social Sciences in Australia, the Society for Personality and Social Psychology, and the Association for Psychological Science.

In this interview, he discusses inflating concepts around harm and their effects on ourselves, our experience, and society at large. He also talks about his work on stigma and biogenetic explanations of mental disorders, calling it a mixed blessing.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Ayurdhi Dhar: You are most well-known for your work on “Concept Creep.” Could you tell us what it is and how you ended up interested in this?

Nicholas Haslam: Concept Creep is the tendency for concepts around harm, suffering, maltreatment, and things to expand their meanings over time. Over a period of decades, some of the concepts we use now to refer to a wider range of things. For example, 40 or 50 years ago, bullying referred only to peer aggression carried out by children. It was intentional behavior repeated multiple times and done in the context of a power imbalance.

People now use bullying to refer to a much wider range of phenomena such as bad behavior at workplaces among adults, behavior that isn’t repeated, intentional, and isn’t even carried out in a power hierarchy – now you can bully people above you.

I’m not sure when I discovered this idea. You start noticing patterns, especially if you’re marinating in ideas for a living, which is what I do. Everyone’s aware that mental disorder or illness concepts have broadened over time. But concepts of prejudice, bullying, abuse, addiction, and trauma have also broadened. So I was trying to identify a pattern of conceptual inflation occurring across various concepts.

 

Dhar: You refer to harm inflation which is related to concept creep. Why is this happening?

Haslam: Concepts to do with harm like bullying, abuse, illness, violence, hate, etc., tend to broaden. What might be causing that is rising sensitivity to harm or inflating our understandings of what harm is. So, harm inflation is a potential cause or way of making sense of this phenomenon of Concept Creep.

 

Dhar: What are some of the consequences of harm inflation and Concept Creep? For example, you write about polarization. I know that you have said repeatedly that Concept Creep is a descriptive category and not something that is good or bad.

Haslam: You’re right. I’m at real pains to point out that this phenomenon has mixed blessings. It has some good and bad aspects. If you broaden the definition of bullying, you identify people who have been maltreated. If you expand the concept of sexual harassment, you identify bad behavior that previously was tolerated or neglected. If you broaden the diagnostic criteria in the mental health domain, people who were suffering previously but weren’t taken seriously can receive treatment.

But there are downsides. You can become overly sensitive; you can dilute concepts of harm so that people trivialize them. You can leave people who’ve experienced severe versions of the harm to feel that their problems are being diluted or trivialized by these promiscuous uses of concepts in looser ways.

There’s an array of potential implications for defining what harm is. For example, if you lower the threshold too far in deciding what a mental health problem is, it might lead to overdiagnosis, overtreatment, and other consequences.

Concept Creep is a descriptive phenomenon. It’s happening. And whether its benefits or its costs are greater is an open question.

 

Dhar: If you had to pick, when it comes to mental health, do you see more dangers or positives of inflating concepts?

Haslam: I honestly think it depends on the case. There are good things and bad things. This is not the idea that people are whining too much or are too fragile. It’s just a statement that maybe we should be suspicious of narratives that say it’s all good, it’s just progressive enlightenment, or it’s all bad.

It’s a surprise to have your ideas taken seriously at all. But, on the other hand, it’s been frustrating to see that some ways people are taking up this idea are to castigate liberals (in the American sense), which it wasn’t intended to be.

I got a lot of commentaries from scholars. People my age and older tended to like the idea, and younger people tended not to like the idea. So this is not a reactionary idea; it’s a descriptive idea of something going on that might have ambivalent consequences.

 

Dhar: One of the consequences of harm inflation concerns mental disorders and diagnosis. I’m specifically interested in how these changing concepts of harm and widening diagnosis can change our self-concept and social identities. Can you tell us a little bit more about that?

Haslam: Indeed, there can be negative implications, but there also can be positive implications. For instance, if the concept of the diagnostic entity broadens its definition around trauma, more people will see themselves as being disordered, as being traumatized, and that can be a good thing. If you identify with a group, that can give you a positive identity, a community of people to relate to, a way to understand your experiences — identities are valuable.

But it can be a bad thing in particular cases like if the identity you take up implies that it’s a permanent part of who you are. It can be bad if it’s limiting your scope for behaving and your sense of recovering in your future. If you take on a particular identity as being disordered, people can take that as the essence of who they are and will always be, including a view of oneself as being permanently damaged, which could be problematic.

People can have a good sense of personal meaning, security, and familiarity in a particular disorder-based identity. But it can also lead to this self-limiting which can be problematic.

A terrific study done by Payton Jones and Richard McNally at Harvard showed that people who had a broader concept of trauma responded more severely to a mildly traumatic film and developed more post-traumatic symptoms simply due to having broadened concepts. So broadened concepts can have problematic implications if they become part of your identity. Then even if you have an extremely mild case of it, it may have both benefits and limiting costs.

 

Dhar: Dana Becker recently said when “trauma” was being broadened, as a feminist therapist, she was excited about it. But the way it got co-opted was quite horrifying to see. You write that some of the significant consequences of this can be overtreatment, overdiagnosis, and the stigma that comes with this kind of self-concept and identity.

Haslam: All of those things can happen. If you’re broadening what counts as disordered, then you are not escaping the negative perception others may have and the implications for your own personal identity. You are more likely to draw stigma from others in that case.

Dhar: Sometimes, my students enter classrooms with this idea that trauma is a thing that happens and stays with you for life. If you have trauma, then you automatically have PTSD. You write that it was specifically in the 1980s and 90s that “trauma” started shifting shape significantly. Could you tell us more?

Haslam: You’re describing something that many of us have come across. There’s been not just a broadening of the meaning of trauma but also the saturation of our culture with it — everyone is talking about it, in part that’s a good thing because our discipline has ignored how bad things that happen impact us, that our environments, hardship, and social position are powerful in deciding mental health.

But if you’re using trauma to refer to everything from being assaulted or raped down to relatively minor interpersonal difficulties, which are just part of everyday life, then it becomes this blunt instrument. Trauma has undergone the steepest increase in usage over time.

Through successive editions of the DSM, the definition of a traumatic event was broadened. For example, in DSM-III, a traumatic event was one that you personally experienced, was outside the range of normal human experiences, and was severe and life-threatening. Over time the criterion was loosened to allow indirect experiences where you witnessed someone else experiencing something or were just made aware of it. In addition, it was loosened to include events that weren’t necessarily life-threatening but might be developmentally inappropriate.

DSM V drew it back, but there has been this widening of what a traumatic event is within organized psychiatry. Languages evolve. Words will change their meanings, but those changes might have ill effects. If you’re referring to everything as a trauma, what does the concept mean?

 

Dhar: Again, I have witnessed the ill effects of that with my students who think PTSD is the normal response to trauma. It makes me worry about them.

Haslam: That’s exactly why this matters. There is slippage between a general concept like trauma to a purely psychiatric understanding of it in terms of Post-Traumatic Stress Disorder. People have this unwarranted assumption that because you’ve experienced trauma, you will have its repercussions for life; it’s a scar that you’ll never get rid of; it’s indelible. So there are assumptions attached to those words about the lingering, life-limiting, permanent implications of what’s happened.

 

Dhar: It changes your experience of yourself. You have written that mental health and illness concepts have recently become degraded and ill-defined and talked about three ways this has happened. Could you say more?

Haslam: Henry Jackson and I say that some of these concepts have changed in problematic ways in three directions, and one is this Concept Creep, this expansion of diagnostic concepts.

Another is the rising popularity of broad umbrella concepts to try to understand everything, like ‘mental illnesses’ as if they are a singular thing or ‘mental stress’ as if it was a useful concept. They’re using these broad umbrella concepts instead of more differentiated, more detailed ones. And I think you lose a lot of the specificity of people’s experiences if you use these extremely broad umbrella concepts.

The third problem is confusion about the concept of well-being and mental health. People use these terms as if they’re synonyms. Of course, there’s a relationship, but it’s possible to have high levels of meaning, well-being, satisfaction, and fulfillment while having a mental health condition.

Framing mental health as well-being leads people, if they experience a dip in their well-being, as we all do from time to time, to wrongly interpret it only through a mental illness lens. It’s a problem if we think that the absence of well-being is an illness. Losing clarity in our language around these things can lead us to pathologize ordinary experiences of unhappiness. Also, if you start to see anything less than perfect happiness as a disorder, then people suffering from serious mental illnesses will be sidelined. All attention will be paid to those on the milder end of the spectrum.

 

Dhar: Do you have any suggestions of how we can resist the degradation of these concepts?

Haslam: Let’s not use our words as loosely as we do. Let’s not assume that broad umbrella concepts capture the detail of people’s experiences. Not everyone likes to use diagnostic language, but there are real differences between anxiety and psychosis and depression and mania, and everything else.

 

Dhar: Why has this been happening? What are the causes behind these changes in definitions of bullying, prejudice, mental disorders, abuse, etc.? I know you’ve talked about cultural, political, and societal factors.

Haslam: Any cultural trend is likely to have multiple intersecting causes. At the core is an underlying shift in the culture towards a greater sensitivity to harm. Rising awareness and concern about harm could be a good thing. As you become more concerned about harm, you identify milder harms as being harmful — the broadening of the concept is just a manifestation of this rising sensitivity.

What’s causing that rising sensitivity? There are few potential contributors. One is shifting values over time. We have entered a period in many Western societies where post-materialist values are dominant over materialist ones, meaning people, on average, are not as concerned just about survival but also about self-expression, general well-being, and not just material well-being. This focus on personal suffering becomes more prominent in that context.

Maybe it reflects shifts in the degree of exposure people have to adversity. Adversity is very unevenly distributed in our society. Compared to our lives 100 years ago, most people have less exposure to serious adversity. So, it makes sense that we’ve become sensitized to less severe ones. Broadened concepts of harm reflect that severe harms have become rarer on average.

Some examples of Concept Creep are actually deliberately caused and promoted by people for activist reasons, often good activist reasons, or caused by institutions that have official definitions of concepts, like DSM definitions. For instance, you can use a concept like violence not just as physical hostility but also as something that can be done to people through words. The expansion of the concept is done to problematize things that people want to have problematized.

Some of our research shows that there really have been shifts in how much people care about harm. For example, since the 1980s, there has been a steep rise in how harm language has been prominent in English. The more a concept gets used, the more its meaning broadens. So popular concepts tend to broaden their meanings and then tend to be used in more contexts.

 

Dhar: Fewer severe adversities compared to 100 years ago (in certain cultures) would explain the vulnerability paradox. People in areas with more adversities tend to report fewer cases of PTSD. Also, the saturation of some of the concepts reminds me of the work of Ashley Frawley, who writes about psychological fads — these psychological ideas that bust into our collective consciousness, and then they whisper away after a few decades, like self-esteem.

Haslam: Certain ideas do catch on and get used in broadened ways, which is actually their death knell because when the content gets overused, you start realizing that it has lost meaning. But this goes beyond one or two verbal fads because there is a pattern of lots of harm concepts, all broadening around the same time.

 

Dhar: Let’s talk about your work on stigma and biogenetic explanations of “mental illnesses” with John Read. You call it a mixed blessing. Could you tell us more?

Haslam: We were looking at whether this very popular idea that accounting for mental health problems in terms of brain dysfunction, chemical imbalance, hereditary influences — whether that was overall a good thing. We explored the implications of holding biogenetic explanations, especially for stigma. Stigma has different dimensions. One can be how much you blame and hold someone responsible. One can be about how dangerous or unpredictable you think the person with the condition is. One can be how pessimistic you are about your chances of recovery.

We called it the mixed blessings model because studies showed that people who endorsed biogenetic explanations for mental disorders tend to blame those people less, which is a good thing. They’re not being held responsible for the problems. But regrettably, they also tended to see these folk as more dangerous, more unpredictable, and more hopeless.

If you do experiments where you lead people to believe that the cause of some problems is a chemical imbalance, they become pessimistic and averse to the person experiencing it. We’re not saying all biogenetic explanations are bad, but here’s why it hasn’t been the panacea for stigma. It may have a beneficial effect in reducing moralistic anger and blame. Nevertheless, it has a significant downside in promoting pessimism and fear.

 

Dhar: Did you find anything about what it does to people themselves, using biogenetic explanations?

Haslam: No, we didn’t do that in our work, but other people have. Some evidence suggests that when people with depression are led to believe that it has a biochemical cause, they feel less capable of overcoming it. They feel that the only solution is medication. As a result, they become pessimistic about their outcomes.

The clinicians who endorse biogenetic explanations were less empathic towards the people they were treating. This can have implications, not just in terms of public stigma but also in terms of a person’s self-stigma and understanding of who they are and what the future might hold. It can also shift the expectations of the people charged with treating them.

 

Dhar: You said there had been repeated studies that have found that biogenetic explanations increase distance, pessimism, ideas of dangerousness, and social distance. Despite these findings, why are these explanations still so popular in the general public and even amongst clinicians?

Haslam: Culturally, it’s a common way of thinking about people in general. The rise of medical understanding of a range of phenomena has been dominant. One is the massive amount of research they’ve done and the media attention given to the latest biogenetic discovery. You don’t see that when there’s a promising psychotherapy trial.

It’s also because this idea of reducing blame is powerful. If you can say that a chemical imbalance causes your problem, that is a nice simplifying story.

 

Dhar: You have written about psychiatric dehumanizing terms. Could you tell us what these are and what they do to people?

Haslam: Some people find ‘service user’ as dehumanizing. Others think it’s an appropriate description. Some think ‘patient’ is dehumanizing. Others hate the word ‘case’ as they think it reduces someone to a diagnostic category and avoids their individuality. ‘Treatment resistant’ is one I hate, that in most cases is picturing the person as being a deliberate problem when it just means that what you’ve tried so far hasn’t been successful.

It’s not about particular words we shouldn’t use. Humans are very good at seeing other humans as not fully human. It’s not necessarily in the words they use. It’s generally stereotypes of people as being brutish or bestial or infantilized. It’s seeing people as lacking emotional depth and individuality; this happens in many spheres of life. It’s not always revealed in language, and many people will experience dehumanizing treatments, even among people who use the latest approved terminology.

Social psychologists study dehumanization primarily in relation to race, gender, to a lesser extent, class. They haven’t done much research on mental health, disability, or other important forms of human diversity because I think there are many dehumanizing perceptions out there. Dehumanization is a dimension of the stigma that hasn’t been focused on.

People used to think dehumanization is calling people apes or vermin, but it isn’t nearly so blatant and explicit within psychology. There can be subtle, non-conscious ways of seeing people as less of humans. And if you have that broadened concept of dehumanization, you can see it everywhere. There are ways, subtle and otherwise, in which people don’t acknowledge the full humanness of the people they deal with them.

 

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MIA Reports are supported, in part, by a grant from the Open Society Foundations