How Using the Right Language Can Destigmatize Mental Illness

Why the language we use to describe mental health matters

How Using the Right Language Can Destigmatize Mental Illness
2 May 2019

It is perhaps not surprising that an area of health that has been so systematically stigmatised for so many decades has historically settled for a discriminatory lexicon. Generations of people have grown up in societies that found terms “psycho”, “schizo”, “loonie” and “crazy” perfectly acceptable.

Stigma is not only an element of mental health of course, but the extent to which it has permeated our language, compared to any other area of ill-health, is astonishing.

Many would argue that it is practice and not language that matters. But words are a barrier to help-seeking and a motivator for making discrimination acceptable.

It can be a provider of a context for many people, which further entraps them in a vicious cycle, of thinking that they’re suffering from “something” that they really shouldn’t be – or worse, that this “something” is somehow defining them as lesser members of their communities.

Words are a barrier to help-seeking and a motivator for making discrimination acceptable.

Why do words matter?

A big body of research from the past few decades has helped better our understanding on how the human brain works and the associations it makes. Psychologists and behavioural economists, among other disciplines, have defined our thinking in terms of two “systems”.

“System 1”

  • Operates automatically and quickly, with little or no effort and no sense of voluntary control.
  • Here, let’s call it our “Feely Brain”. This part of our brain is responsible for most of our day to day actions and has learned how to distinguish between the surprising and the expected. This makes activities such as walking, reading and understanding nuances of social situations effortless.

“System 2”

  • Allocates attention to the effortful mental activities that demand it.
  • Here, we’ll call it our “Thinky Brain”. This part of our brain represents our conscious, reasoning self that makes decisions, solves complex mathematical calculations and helps us complete more complicated tasks parking and writing.

Compared to our Thinky Brain which is relatively young and immature in its development (talking in millennia terms), our Feely Brain has developed over millions of years and includes natural skills that we share with other animals.

In our human context, it completes several highly complex associations every minute that help us lead our normal lives.

Given that our Thinky Brain tends to be lazy and uninvolved unless prompted, our Feely Brain largely guides our thinking. Our rapidly thinking Feely Brain is always looking to make simplistic causal connections (so that we can get the impression that what we first think is also what is true).

This is particularly important when it comes to our language. Evidence shows that our Feely Brain easily and effortlessly takes charge in producing a response to words.

This is called “associative activation” and it is a simple result of seeing or hearing a word. A word brings an idea, and an idea triggers many other ideas.

Our Feely Brain keeps making connections between all those ideas by resurfacing memories, which in turn recall emotions, that then bring other reactions.

It is a cascade of activity in our brain which happens quickly, with no virtual conscious control, and it produces a series, or a pattern, of cognitive, emotional and physical responses. That’s right, we respond to words without even realising it.

That’s right, we respond to words without even realising it.

Types of words

If we understand the important processes that words trigger in our brains, we may decide that it is worth being more thoughtful in the words that we are use to describe mental health.

There are words that are clearly discriminatory and should outright not be used, “nutter” and “mental”.

Then there are words that have originated in different contexts and have evolved over the years in a way that has made them too emotionally charged to use in our modern context.

In a similar way that we would struggle to understand what someone meant by “Inbox”, “Unfollow” and “Selfie” 10 years ago, the use of words “psychotic” and “neurotic” are today outdated and stigmatising. Our language is evolving.

How we talk about mental ill health in our immediate environment is also critical, and evolving. An important example is suicide. We often say that someone has “committed suicide”.

The use of the word “committed” originates when suicide was considered a crime and a sin. You commit a crime or you commit a sin. Suicide is neither.

Thankfully we seem to be slowly getting towards global consensus on this (though not entirely there yet).

Given the impact suicide can have on the bereaved family, friends and colleagues, it would be much more thoughtful to use expressions “took his/her own life”, “ended his/her own life”, or “completed suicide”.

If someone has attempted suicide and survived, sometimes we say they’ve been “unsuccessful” at taking their own life. However, when we say someone has been “unsuccessful” it almost implies that we wanted them to “succeed”.

Our language is emotionally charged.

Our language is emotionally charged.

Being more thoughtful

It is not just how we talk about problems and diagnoses that is important.

Remember that 1 in 6 of us is experiencing high levels of distress or a common mental health problem every week, therefore being respectful and thoughtful in our mental health related language could do wonders for our brain’s “associative activation”, and, hence, the emotions of the people around us.

For example, we should avoid:

  • Describing someone who is organised as “OCD” – being clean, tidy and particular is not the same as living with clinical Obsessive Compulsive Disorder.
  • Talking about being “bipolar” when we experience everyday natural mood swings, is not the same as living with Bipolar Disorder.
  • Saying “I’m depressed” or “that’s depressing” if we feel a bit sad, is not the same as living with Depression.
  • Using very problematic words “psycho” to describe a person we dis or “schizo” to describe a person’s reaction or personality, sitgmatises people living with Schizophrenia.
  • Describing someone who is thin as “anorexic” misunderstands that  Anorexia Nervosa is a mental health condition that is much more complex than just losing weight.
  • Saying “Ugh, I’m going to kill myself” when frustrated, embarrassed or when something is going wrong is insensitive to someone who is Suicidal or someone who has lost a loved one to Suicide.

Our identity

As we’ve covered before in this blog series, mental ill health impacts fundamental parts of our personal identities, our relationships, work performance and educational outcomes.

In the way that we have framed our societies, people living with a long-term mental health problem can struggle to recover their personal identity (as a parent, spouse, co-worker, volunteer, student etc). Therefore, how we talk about this experience of mental illness could play a positive and influential role in the recovery process for millions of our fellow citizens.

Identifying someone as simply a “patient”, “service user” or a “schizophrenic” implies that this is all the person is — that this diagnosis defines them. Instead, describing someone as experiencing mental illness can help to allow for other parts of their identity to still exist.

We often use the word “suffer” when it comes to mental ill health. Whilst it is accurate that we should acknowledge the actual impact and suffering that people experience, we also need to be careful not to imply that a diagnosis equates to a “life sentence” of suffering.

We now know that following a diagnosis, we can engage in positive recovery pathways, thrive in our workplaces and be dependable family members.

So, if we instead use expressions “people who use mental health services”, “people who experience mental health problems”, “people living with depression” we could achieve a more holistic and accurate view of the experience of ill-health.

Contrasting views

For people who have been in contact with mental health services, there may be contrasting views about language that are worthy of reflection.

  • Some people reject the labels of diagnosis, while others find them helpful. For example, someone may find a diagnosis stigmatising, but also essential when accessing benefits in the UK.
  • We often use the phrase “mental illness”. Some people regard this as unhelpful as there is not a consensus on an agreed organic component to distress.
  • People may instead choose to talk about mental ill-health.
  • We at the Foundation often talk about “mental health problems”.
  • The word “recovery” has also been controversial because the term means many different things to different people.

It can be useful to explore what thoughts people have around such terms, to help us reach a shared understanding. As an example, “Mad Pride” has been used to reclaim the language around mental health.

It became a movement involving past and present users of psychiatric services. It seeks to reverse the negativity of experiencing poor mental health and stresses that people should be proud of their «mad identity».

This is further complicated from an evolutionary perspective.

A lot of the activity happening in our Thinky Brain triggers emotions that would have been normal and protective some tens of thousands of years ago (e.g.

our ancestors got angry to protect themselves against a threat and sad to ask for help and treatment). But for our Feely Brain, and our language, negative emotions “have to be” problematic.

It can be useful to explore what thoughts people have around such terms, to help us reach a shared understanding.

How far have we come

It is true that we have come a long way in public mental health in recent years in terms of our attitudes around and our efforts to tackle the stigma of ill-health, but we are not there yet.

It remains true that several thousands of our fellow citizens experiencing symptoms of mental ill health will not seek professional clinical help because of the stigma attached to mental illness and the fear of being misunderstood.

Media, retailers and social media have been playing a role in the persistent use of stigmatising, stereotyping and offensive language:

  • From Brexit being a “collective mental breakdown”
  • To “mental patient” Halloween costumes sold on the high street
  • From documentaries framed around the diagnosis behind homicidal behaviours
  • To Christmas cards highlighting “Obsessive Christmas Disorder”

We are still exposed to unhealthy imaging and expressions. The fact that there is a strong response to such unfortunate uses of words is encouraging.

The potential of humour to help address stigma is welcome, but as a rule of thumb, trivialising or “adjectivizing” diagnostic terms should have no place in our societies.

For too long, most campaigning efforts in psychiatry and public health have focused on increasing the understanding of the biological model of mental illness, i.e. the physical, organic and biological aspects of illness.

We now know that social circumstances play a huge role in the development of mental health problems.

 Research shows that while this increased understanding of the biology leads to greater acceptance of professional help, it hasn’t really changed the attitudes towards people with mental illness.

A greater understanding on the social circumstances that we grow and live in – and that expose us to risk, or gather protection to our mental health – is needed. We cannot change this understanding unless our language evolves.

A collective responsibility

We need more efforts across society for everyone to be the change they’d to see. We don’t need to wait until we get on the other end of the spectrum to change how we talk about mental health. And when it comes to talking, with great power comes great responsibility, so high reach media should come on board this evolution.

Little by little, through citizen activism and a new generation of celebrities willing to open up about their own experience of mental health problems, our language is slowly catching up with the centuries of mystifying mental illness. We are now well beyond the times when we thought that if we locked up people experiencing symptoms that we don’t understand, then maybe they will stop existing.

We know that mental health problems exist in our homes and communities, they are common and they can be addressed through prevention, timely treatment and concentrated societal effort.

Addressing the crisis starts with talking about it … in an appropriate way.

As Antonis says, we can prevent mental health problems and we can create a mentally healthy world. But we can't do it by ourselves. We need your help to move us forward. Please consider a donation today.

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Источник: https://www.mentalhealth.org.uk/blog/why-language-we-use-describe-mental-health-matters

Stigma and Discrimination

How Using the Right Language Can Destigmatize Mental Illness

The lives of people with mental health conditions are often plagued by stigma as well as discrimination.  Stigma is a negative stereotype.  Stigma is a reality for many people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life.

Stigma differs from discrimination.

  Discrimination is unfair treatment due to a person’s identity, which includes race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability, including mental disorder.

  Acts of discrimination can be overt or take the form of systemic (covert) discrimination.  Under the Ontario Human Rights Code, every person has a right to equal treatment with respect to services, goods and facilities, without discrimination due to the identities listed above.

Stigma is the negative stereotype and discrimination is the behaviour that results from this negative stereotype.  Often, individuals with a mental illness are faced with multiple, intersecting layers of discrimination as a result of their mental illness and their identity.

  For example, a woman with a mental illness may experience discrimination due to sexism as well as her illness, and a racialized individual may experience discrimination due to racism in addition to their mental illness.

  In addition,  living with discrimination can have a negative impact on mental health.

Media influence on public attitudes

Many studies have found that media and the entertainment industry play a key role in shaping public opinions about mental health and illness.  People with mental health conditions are often depicted as dangerous, violent and unpredictable.

News stories that sensationalize violent acts by a person with a mental health condition are typically featured as headline news; while there are fewer articles that feature stories of recovery or positive news concerning  similar individuals.

  Entertainment frequently features negative images and stereotypes about mental health conditions, and these portrayals have been strongly linked to the development of fears and misunderstanding.

Impact of negative public attitudes

There are significant consequences to the public misperceptions and fears.  Stereotypes about mental health conditions have been used to justify bullying.  Some individuals have been denied adequate housing, health insurance and jobs due to their history of mental illness.

Due to the stigma associated with the illness, many people have found that they lose their self-esteem and have difficulty making friends. Sometimes, the stigma attached to mental health conditions is so pervasive that people who suspect that they might have a mental health condition are unwilling to seek help for fear of what others may think.

Experiences of stigma and discrimination is one of their greatest barriers to a satisfying life.

What you can do to stop stigma and discrimination

Use person-first language which focuses on the individual, not on the substance use. Language used is an important factor in reducing stigma and breaking down negative stereotypes associated with substance use disorders. By using non-stigmatizing language, those who are experiencing challenges may experience fewer barriers to accessing supports.

The following guide includes some suggestions of person-first language in mental health:

Common / outdated termsPerson-first language
Mental health disorders Mental health issues, conditions or illnesses
Individuals “struggling” or “suffering from”  or having a mental illness, mental health condition or issueIndividuals living with mental illnesses, mental health condition or issue
Committed Suicide, “suicided”, or successful / unsuccessful suicideDied by suicideAttempted suicide
Mental illnesses  A mental illness (or specify specific disorder, rather than generalize by using the term “mental illness” to capture all mental illnesses.)
Mentally ill personSomeone who is bipolarSomeone who has a mental illness.Someone who is living with bipolar disorder.
Patient / Client People with lived experience or individuals we serve
Addict / Substance abuserHe/she has a substance use condition.He/she has lived experience of substance use

CMHA Ontario has also developed a one page primer on talking about substance use to help.

Use the STOP criteria to recognize attitudes and actions that support the stigma of mental health conditions. It’s easy, just ask yourself if what you hear:

  • Stereotypes people with mental health conditions (that is, assumes they are all a rather than individuals)?
  • Trivializes or belittles people with mental health conditions and/or the condition itself?
  • Offends people with mental health conditions by insulting them?
  • Patronizes people with mental health conditions by treating them as if they were not as good as other people?

If you see something in the media which does not pass the STOP criteria, speak up! Call or write to the writer or publisher of the newspaper, magazine or book; the radio, TV or movie producer; or the advertiser who used words which add to the misunderstanding of mental illness. Help them realize how their words affect people with mental health conditions.

Start with yourself. Be thoughtful about your own choice of words. Use accurate and sensitive words when talking about people with mental health conditions.

Источник: https://ontario.cmha.ca/documents/stigma-and-discrimination/

Words Matter — Terms to Use and Avoid When Talking About Addiction | National Institute on Drug Abuse

How Using the Right Language Can Destigmatize Mental Illness

This page offers background information and tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction.

Although some language that may be considered stigmatizing is commonly used within social communities of people who struggle with substance use disorder (SUD), clinicians can show leadership in how language can destigmatize the disease of addiction.

 For similar information for patients, visit NIDA’s Words Matter: Preferred Language for Talking About Addiction.

To learn more about the unique impact of stigma on pregnant women and mothers, visit NIDAMED’s Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder.

How to earn CME/CE credit:

What is stigma?

Stigma is a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with SUD might include inaccurate or unfounded thoughts  they are dangerous, incapable of managing treatment, or at fault for their condition.

Where does stigma come from?

For people with an SUD, stigma may stem from antiquated and inaccurate beliefs that addiction is a moral failing, instead of what we know it to be—a chronic, treatable disease from which patients can recover and continue to lead healthy lives.

How does stigma affect people with SUD?

  • Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.

    1,2

  • Stigmatizing views of people with SUD are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with an SUD.

    2

  • Stigmatizing language can negatively influence health care provider perceptions of people with SUD, which can impact the care they provide.3

How can we change stigmatizing behavior?

  • When talking to people with SUD, their loved ones, and your colleagues, use non-stigmatizing language that reflects an accurate, science-based understanding of SUD and is consistent with your professional role.

  • Because clinicians are typically the first points of contact for a person with an SUD, health professionals should “take all steps necessary to reduce the potential for stigma and negative bias.”3 Take the first step by learning the terms to avoid and use.
  • Use person-first language and let individuals choose how they are described.4 Person-first language maintains the integrity of individuals as whole human beings—by removing language that equates people to their condition or has negative connotations.

    5 For example, “person with a substance use disorder” has a neutral tone and distinguishes the person from his or her diagnosis.6

What else should I keep in mind?

It is recommended that “substance use” be used to describe all substances, including alcohol and other drugs, and that clinicians refer to severity specifiers (e.g., mild, moderate, severe) to indicate the severity of the SUD.

This language also supports documentation of accurate clinical assessment and development of effective treatment plans.

7 When talking about treatment plans with people with SUD and their loved ones, be sure to use evidence-based language instead of referring to treatment as an intervention. 

Terms to avoid, terms to use, and why

Consider using these recommended terms to reduce stigma and negative bias when talking about addiction.

Instead of… Use… Because…
  • Addict
  • User
  • Substance or drug abuser
  • Junkie
  • Alcoholic
  • Drunk
  • Former addict
  • Reformed addict
  • Person with substance use disorder8
  • Person with opioid use disorder (OUD) or person with opioid addiction [when substance in use is opioids]
  • Patient
  • Person with alcohol use disorder
  • Person who misuses alcohol/engages in unhealthy/hazardous alcohol use
     
  • Person in recovery or long-term recovery
  • Person who previously used drugs
  • Person-first language.
  • The change shows that a person “has” a problem, rather than “is” the problem.7
  • The terms avoid eliciting negative associations, punitive attitudes, and individual blame.7
  • Substance use disorder
  • Drug addiction
  • Inaccurately implies that a person is choosing to use substances or can choose to stop.6
  • “Habit” may undermine the seriousness of the disease.
For illicit drugs:For prescription medications:
  • Misuse
  • Used other than prescribed
  • The term “abuse” was found to have a high association with negative judgments and punishment.9
  • Legitimate use of prescription medications is limited to their use as prescribed by the person to whom they are prescribed.  Consumption outside these parameters is misuse. 
  • Opioid substitution replacement therapy
  • Medication-assisted treatment (MAT)
  • Opioid agonist therapy
  • Pharmacotherapy
  • Addiction medication
  • Medication for a substance use disorder
  • Medication for opioid use disorder (MOUD)
  • It is a misconception that medications merely “substitute” one drug or “one addiction” for another.6
  • The term MAT implies that medication should have a supplemental or temporary role in treatment. Using “MOUD” aligns with the way other psychiatric medications are understood (e.g., antidepressants, antipsychotics), as critical tools that are central to a patient’s treatment plan.
For toxicology screen results:For non-toxicology purposes:
  • Being in remission or recovery
  • Abstinent from drugs
  • Not drinking or taking drugs
  • Not currently or actively using drugs
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.10
  • Set an example with your own language when treating patients who might use stigmatizing slang.
  • Use of such terms may evoke negative and punitive implicit cognitions.7
For toxicology screen results:For non-toxicology purposes:
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.9
  • May decrease patients’ sense of hope and self-efficacy for change.7
  • Baby born to mother who used drugs while pregnant
  • Baby with signs of withdrawal from prenatal drug exposure
  • Baby with neonatal opioid withdrawal/neonatal abstinence syndrome
  • Newborn exposed to substances
  • Babies cannot be born with addiction because addiction is a behavioral disorder—they are simply born manifesting a withdrawal syndrome.
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.10
  • Using person-first language can reduce stigma.

References

Источник: https://www.drugabuse.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction

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