In the first part of this blog, I provided an overview of how innovative ideas in mental health are typically nullified by advocates of the dominant bio-medical paradigm. As a consequence, change in Western psychiatry is painfully slow and people continue to be offered the traditional ‘medicate and monitor’ approach when they present to services in a distressed state.
So how can we prevent the neutralisation of initiatives that strive to change the bio-medical skew of current mental health provision? I suggest one important move towards achieving this aim would start by us all reflecting on the words we use.
Language is important
The terms we use when talking about mental health conveys our central assumptions about the causes of, and solutions to, human suffering. Thus, when our discourse routinely includes medical terms we are colluding with the dominant paradigm and rendering it more difficult for alternative approaches to be adopted.
All of us are complicit to some extent; the ‘illness like any other’ approach to emotional problems is so deeply embedded in our Western culture that it is often near impossible to avoid medical jargon. Nonetheless, I would suggest that each individual (service user or provider) could helpfully become more aware of the words they deploy, and the implicit messages they convey.
A reflective exercise
To what degree do your day-to-day utterances contribute – intentionally or otherwise – to the perpetuation of the bio-medical approach to human suffering? Three useful questions to encourage reflection are:
a) Do I attempt to explain mental health problems as if they are a consequence of a brain disorder?
In the Western world, many thousands of people present to psychiatric services each day seeking help for their distress and suffering. The large majority of these service users will be tagged with a formal psychiatric diagnosis, such as ‘major depression’, ‘schizophrenia’ or ‘anxiety disorder’. Yet there is no evidence that the distress suffered by those so labelled is primarily caused by a brain aberration; indeed, if a brain scan illustrated such a biological deficit the person would immediately be referred to another branch of medicine, such as the neurological department or specialist dementia services.
In light of the above, it is inappropriate and unhelpful to talk about mainstream mental health problems as if each is a consequence of a brain disorder. Each of us – professional, service user, journalist, documentary maker – when describing the basis of human suffering, should veto phrases such as:
An illness like any other
Misfiring of neurones
In addition to tightening the grip that the bio-medical approach already enjoys within the field of mental health, other important consequences of deployment of such phrases include: more stigma; less hope; greater passivity and an overuse of psychotropic drugs. Instead of resorting to descriptors that imply spurious brain defects, it would be much more useful for us all to strive to unravel the unique personal story behind each instance of human suffering, the complex web of life experiences that will have shaped that person’s perception of the world.
b) Do I use diagnostic terms in my conversations?
Regrettably, diagnostic terms have leached into our everyday lexicon so that, at times, it can seem almost impossible to avoid them without rendering oneself incomprehensible. Nonetheless, we should keep in mind that diagnostic labels like ‘schizophrenia’, ‘depression’, ‘bipolar disorder’ and ‘schizo-affective’ are lacking validity; they neither predict the course of mental health problems nor effectively provide guidance as to the specific responses that will be helpful.
Despite diagnostic classification in psychiatry being virtually meaningless, they offer a veneer of scientific respectability and their simplicity is seductive. As a direct extrapolation from general medicine, they also misleadingly suggest that a specific biological deficit underpins each label, thereby colluding with, and strengthening, the ‘illness like any other’ approach to human distress.
In requiring a deeper understanding of each sufferer’s life story, it is infinitely more helpful to describe – in everyday language – a person’s presentation along with the milieu from which it has emerged, rather than resorting to simplistic diagnostic labels. So, for example, rather than ‘Jenny is suffering with major depression’, it would be much better to say that ‘Jenny repeatedly feels waves of despair and self-loathing in the context of having been sexually abused as a child’.
c) Do I use medical terms when talking about human misery and suffering?
Diagnostic labels are not the only medical terms that help protect the enduring dominance of the bio-medical paradigm in mental health. When we talk about people who are experiencing distress and overwhelm, it is common for us all (professionals, service users and laypeople) to adopt a raft of words more fitting for the general medical arena.
Examples of such terms include:
To enable the desired shift towards a more psycho-socially informed approach to human suffering, we could aim to replace these medical terms with neutral language. For example, rather than, ‘She has been diagnosed with schizoaffective disorder in which auditory hallucinations are a common symptom’, we might more helpfully say, ‘She is hearing voices condemning her as dirty and worthless’.
In some circumstances, resort to medical language might be unavoidable – perhaps where a diagnosis is required to gain access to services and benefits. In these situations, it is desirable to qualify the statement so as to emphasise that it represents just one perspective, perhaps by adding ‘What some professionals might view as symptoms of depression’.
So how do you fare in your use of language? On reflection, to what extent do your words – during face-to-face interactions and on social media – collude with a biomedical approach to mental health?
I believe we are all culpable to some degree. In the preface to my recent book, ‘Tales from the Madhouse: An insider critique of psychiatric services’, I apologised for the frequent use of some medical terms in the body of the text, having found them impossible to avoid without my arguments losing coherence and clarity. Nonetheless, I believe it is important that we all strive to enhance our awareness of the words we choose when expressing our thoughts and ideas; our utterances might be inadvertently tightening the stranglehold that biological psychiatry holds on Western society, a grip that many of us are fighting to loosen.
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