Stretching Terms and Missing the Mark in our Mental Health Discourse

The expansion of mental health and illness concepts strains an already saturated and under-resourced mental healthcare system, neglecting those most in need.

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In our current era of social media, celebrity and athlete influence, and a booming wellness industry, mainstream discourse on mental health has become the new normal. In some ways, this is beneficial – public awareness can promote recognition, reduce stigma, and normalize help-seeking. However, psychologists warn that current trends in public discourse also degrade concepts of mental health and illness, marginalizing those with more severe conditions.

In an article published in Australasian Psychiatry, Henry J. Jackson and Nick Haslam describe concept creep, the rise of broad umbrella terms, and the conflation of mental health with well-being as trends that broaden, loosen, and make mental health concepts more benign.

“Popular concepts of mental health and illness are being degraded,” Jackson and Haslam write. “Some are stretching their meanings to breaking point, some are replacing fine-grained ideas with broad and indistinct alternatives, and others draw away from serious forms of psychiatric suffering.” 

To illustrate their argument, they examined mental health language and concepts used in large government reports created by the Royal Commission into Victoria’s Mental Health System.

Concept Creep

With each additional revision of the Diagnostic Statistical Manual (DSM), diagnostic criteria have loosened, blurring our understanding of “normality” and allowing more people to qualify as mentally ill. This professional process contributes to what Haslam terms Concept Creep, a process where concepts of harm and pathology expand to include a broader range of other less severe experiences.

For example, the concept of depression was once referred to as clinical depression and was “grounded in assessments of severity, duration, and significant functional impairment.” In contrast, depression is now widely used outside of the clinical context, portrayed in media, and commonly used in conversation to describe everyday sadness.

Other scholars also warn that the progressive loosening of mental health concepts in the DSM and in public discourse has and will continuously lead to diagnostic inflation, making it more difficult to differentiate between everyday unhappiness and clinical symptoms. This not only fuels a lucrative drug industry but also drains already scarce mental healthcare resources, leaving those with more severe mental health conditions with unmet needs.

The Rise of Broad Umbrella Terms 

The rise of broad umbrella terms replaces specific diagnoses with broad concepts. For instance, terms such as “mental health,” “mental illness,” or “distress” are used in lieu of specific mental health problems such as specific mood disorders (e.g. bipolar disorder). Jackson and Haslam found that in the Royal Commission Report, generic terms were widely used, but policy recommendations for specific mental health conditions were almost entirely absent.

“Discourse that prioritizes vaguely defined, undifferentiated concepts falsely implies that all conditions within a broad category are the same, need the same treatment, and require the same level of expertise to treat,” they warn. “Such undifferentiated understandings of mental health and illness leave us less capable of addressing the complexities of systemic and personal mental health challenges.”
The Conflation of Mental Health with Well-being

In tandem with the rise of broad umbrella terms and catalyzed by the success of wellness industries is the public popularity of health and wellbeing. This conflation, or combining, of specific definitions of mental illness into the broad categories of health and well-being further obscures the meaning of specific diagnoses.

Jackson and Haslam argue that mental health professionals also contribute to this conflation because their “growing endorsement of dimensional models of mental disorders has enabled the loosening of diagnostic criteria to encompass relatively mild spectrum disorders.”

Although centering general well-being can be useful for public mental health, the broadening, loosening, and conflation of mental health concepts leads to diagnostic inflation, strains an already saturated and under-resourced mental healthcare system, and marginalizes and neglects people experiencing serious mental illness.

To reduce the harm associated with these trends, below is a summary of their suggestions for mental health professionals:

  • Be intentional about language –  “When communicating with patients, colleagues, and the public, recognize duration and functional impairment as crucial considerations for diagnosing mental illness and for treatment by specialist mental health services.” Also, when discussing mental health concepts with the public, avoid generic terms when there are more specific ones available.
  • Think critically about diagnostic procedures – “Especially in primary care settings, do not accept self-report single-domain symptom measures as transparent indicators of diagnosis for treatment.”
  • Avoid a one-size-fits-all treatment model – “Strengthen the triage function of clinical practice to ensure mental health plans fit the severity of presenting problems.”
  • Advocate for those most in need – “Advocate for allocating attention, resources, and services to serious mental illness in the face of growing emphasis on the other end of the spectrum.”

Although this research was completed in an Australian context, in Western society, media continues to play an increasing role in public mental health, and psychiatric discourse has become hegemonic – showing up in our daily lives and shaping how we interact with the world.

To prioritize mental health equity and social justice must focus greater attention on the implications of changes in professional and public discourse and ensure suffering individuals have adequate support.

 

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Jackson, H. J., & Haslam, N. (2022). Ill-defined: Concepts of mental health and illness are becoming broader, looser, and more benign. Australasian Psychiatry, 30(4), 490–493. (Link)

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Tiffani Elliott
Tiffani is a doctoral student and researcher in the Sociology department at Northeastern University - Boston. Through her research, she advocates for a mental healthcare system that moves beyond pathologizing mental distress that is rooted in the lived experiences of social injustice and inequality. In doing so, Tiffani aims to promote a person-centered mental healthcare system that respects treatment preferences, adequately addresses social and structural determinants of mental health, and provides comprehensive and continuous care.

8 COMMENTS

  1. I agree that there is “overdiagnosis” and blah blah blah, the problem I see in these proposals is that they aren’t based in some valid disease model for “mental” disorders/diseases whatever.

    It reproduces the unjustified expectations that everyone has do to something in a “normal” way. Pilgrim homeless monks that try not to teach the way are excluded from “normality”, even if they are/could be ahead of the curve. Not belittling nor minimizing.

    Severity, impairment, need, specificity, tailoring, are words that fly in unanchored ground to a valid disease model.

    Although different those words are used in a very similar context to: a woman must scrub the potatoes, a man should be courteous and chilvalrich, a man should provide to the family, you must praise the one only god, caring should be done trough charity, everyone is supposed to “work”, everyone should get married and have a ton of kids, you should have “experience” at the prom, etc.

    It bears no attachement to what disease models are in medicine. Nearing them to psychology obviates the fact that even if psychology is experimental it is still part of the humanities, not a real unpinocchio science.

    These proposals to me try to be “liberal” and end up being oppresive and prosystem with all it involves but in a “cancel culture” kind of way…

    But!, they are positive, just still running in circles around the mainstream course of what society expects unjustifiably from its members. After all, as Cantiflas said, paraphrasing: the rich do not hoard work… nor civil courtesy, heck! they live on loans and rarely pay taxes beyond consumption tax, where there is any. And apparently these proposers are OK with that.

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  2. Respectfully…..Ms. Elliott’s reporting and observations seem jejune and very, very late to the reality. The horse escaped the barn decades ago.
    Lamenting the language surrounding psychiatry is and has been declared dangerously co-ercive…EXPLOITIVE…for decades..

    For Pharma/oops, Psychiatry…the eagerness that Gen-whatevers have adopted & embraced the spoon-fed vocabulary of “mental illness” to include ANY moment that doesn’t result in a smiley-face sticker, AND to be medicated, is an ECONOMIC RENAISSANCE.

    ECONOMICS….It’s entirely the point…when a manufacturer has folks demanding their product as a necessity for the purpose of day-to-day survival. A GROWTH INDUSTRY….VICTORY!

    I posted articles here & elsewhere regarding the language of psychiatry in 2018 & 2019 following my 15-year entombment by the industry. DSM-IV’s written expansion of bipolar ‘symptoms’ tripled adult ‘diagnoses’ and 40X pediatric conscription…”for life”….a
    CONSUMER of GOODS & SERVICES’ till death…because they said so.
    No.

    After I self-rescued/forcing a ‘change’ of that absolute condemnation-in writing-“life-time SMI”, now NOS ANXIETY (no sh*t)-the following 9 years of research always pointed at the language of COMMERCE-SIMPLE RETAIL…CREATING an unchallenged customer base, flexing culturally-supported ‘trust’ (in the medical community) by Pharma-cash-propelled diagnoses (see Open Data.gov).

    The flaw was assuming that psychiatry had an unquestioned relationship with medical science (legitimacy!)..oops…hence this website & others.

    This topic is about ‘Medical’ vs Commerce…SELLING OUT…and how effective Pharma & their field-reps, the APA, & satellite support orgs (NAMI, MHA, etc) are in SACRIFICING the vulnerable, messaging the media, & owning Congress. The answer is…VERY effective.

    Try to keep up…and help us. It’s critical to inform regarding the dangerously flawed, long-time existing status quo…and warning about specific marketing/recruitment tactics today & tomorrow.

    When a population is persuaded that ‘mental health’ is (easily!) achieved by a life-time prescription(s) of simple & complex sedation…and socially/culturally acceptable…well-Orwell.
    Ex #1-Alcohol has a tragic, massively expensive history…& will never be banished as the addictive poison it is…but…Yay-Margaritaville!…(even Buffett, a great poet- had to quit)

    A sedated population is far more malleable by commerce and government. Shiny objects may seem larger thru that lens…distraction from the dangers of exploitation is the goal.

    And Commerce/PHARMA pays for government-literally the #3 ‘donor’ on the Hill for decades.

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    • Also respectfully, trying to interpret my own thoughts, it might seem that clinical psychology has fallen prey to institutional capture:

      — They will stay on course, rather than get down of the waggon wherever it leads. In appearance searching for new ways to do things without addressing the fatal epistemic flaws that predate any apparent instead of real change of course. And the relative lack of accomplishments that even if controllably measssured can’t be claimed as even modest victories, they are IMO at beast anecdotals collected under the umbrella of a controlled study.

      Profits aside which provides more incentive to stay on course, just like psychiatry. Just like astrology, palm reading, divination, etc. Even IQ tests, GRE exams, personality tests, etc., have been proven to be not good enough, or not at all, predictive, particularly about the future.

      Even if divination saved the greeks from the second? persian invasion, which of course I am not questioning…

      Heck! Mexico has had 3 major earthquakes every 19 sept since 1985!. And experts say confidently that they are just coincidences!.

      I knock on wood, the 19th is around the corner, and Apollo has not spoken to me 🙂

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