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The struggle for mental health reform (II): The importance of language in preventing the neutralisation of innovative ideas.

Courtesy of David Castillo Domininci at FreeDigitalPhotos.net

 

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, might wish to reconsider the use of phrases such as:
An illness like any other
Brain disease
Biochemical imbalance
Serotonin deficiency
Broken brain
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:
Symptoms
Treatments
Disorders
Diagnosis
Relapse
Cure
Remission
Syndromes

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’.

 
Self-assessment
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.

 

 

Photo courtesy of David Castillo Domininci at FreeDigitalPhotos.net

15 thoughts on “The struggle for mental health reform (II): The importance of language in preventing the neutralisation of innovative ideas.

  1. S. Randolph Kretchmar / Reply 21st December 2016 at 4:23 pm

    Excellent points, Gary! It’s really quite easy to just put quotation marks around medically-oriented words. I agree that it’s important to at least indicate some awareness of the arbitrary framework, which can so often be harmful and victimizing. We must resist the ongoing push to make psychiatrists into some black parody of philosopher-kings.

    • Gary Sidley / Reply 23rd December 2016 at 9:31 am

      I’m totally with you Randolph. As you say, the minimum requirement is to highlight that the medical paradigm is just one way of trying to make sense of mental health (and one associated with many disadvantages). I appreciate your interest, support and taking the time to comment.

  2. Pamela soucy / Reply 21st December 2016 at 6:07 pm

    Activity is key to recovery not isolation /seclusion

    • Gary Sidley / Reply 23rd December 2016 at 9:35 am

      I agree, Pamela, that activity in the broadest sense of the word is vital for recovery. Involvement in groups, feeling part of something, engaging in a task that you’re good at, and exercise can all be key elements in enabling someone to achieve a rewarding life.

  3. Dr Suzanne Covich / Reply 21st December 2016 at 7:39 pm

    This is excellent! For the past 20 years I’ve depised jargon associated with the psychiatric industry and made every effort not to use it, especially when referring to a loved one labelled ‘bipolar’. Because of this I’ve repeatedly been told I’m in denial. I refuse to accept the ‘disease’ biochemical model, the belief that leads people into the hands of psychiatry — seeing people as if they are walking heads without a body or socio-cultural context.

    To use the jargon associated with any form of discrimination, hence oppression is to reinforce the status quo. To use a label is to shut down enquiry, settle for whatever hegemony is attached to that label. And yet, all people I personally know, friends and family are only too happy to embrace it. To question and explore takes time and research. On the whole, people are too busy to do that, too busy to even care. They like simple ‘solutions’.

  4. Julie Leonovs / Reply 23rd December 2016 at 4:13 pm

    Well said Gary. As usual, coudn’t agree more.

    • Gary Sidley / Reply 24th December 2016 at 10:35 am

      Thanks for the positive feedback, Julie – we seem to be on the same page in most things.

  5. george / Reply 27th December 2016 at 10:48 am

    Fantastic blog. It is very true that western ‘ideals’ and the language we use surrounding mental health is innapropriate in many cases.

    Check out my page for links to my blog where you will find a petition surrounding he current dwp assessment procedures towards mental health survivors’ and sign to make a difference.

    Thanks

    George

    • Gary Sidley / Reply 29th December 2016 at 10:52 am

      George – I appreciate you taking the time to read my post, along with your supportive comments. I will indeed check out your page. Best wishes.

  6. Jo / Reply 27th December 2016 at 11:09 am

    Really excellent blog. This has really made me think about the language I use with other service users.Even though I was really interested in the anti psychiatry movement at university, it’s so easy to slip into medicalised language when you’re constantly surrounded by it.And there seems to be an increasing tendency to pathologise normal emotional responses to life. Great for big pharma , not so good for society.

    • Gary Sidley / Reply 29th December 2016 at 10:51 am

      Jo – thank you for your positive feedback and supportive comments. I totally agree that our medical culture is so deeply embedded in Western society that it is often difficult to avoid using these terms. And you are spot on with your premise that more and more normal emotional responses are becoming pathologised – the DSM publications have a lot to answer for in this regard.

  7. Tony Goodchild / Reply 27th December 2016 at 2:31 pm

    You may be right to disparage the medical model, but I certainly have not benefitted from the usual alternative: counselling/psychotherapy. I have walked away several times from therapists in disappointment because they seemed to be trying to turn me into someone foreign to my ethical beliefs, and/or they were being of no help at all!
    The example given above of problems being caused by “childhood abuse” is hardly an improvement on the medical model, if all it does is to encourage blame-shifting and belief in one’s victimhood. I believe that the best therapy to “help” someone with non-neurological “problems” is to encourage the person to accept that their different way of thinking is basically valid, provided that they forgive their own resentments (of self or others) and be proud of their potential to “do/be different” in society.
    (Apologies: “help” and “problems” can be used to stigmatise… but what other words can we use?).

    • Gary Sidley / Reply 29th December 2016 at 10:47 am

      Tony – I share your dislike for psychological therapies that strive to ‘mend’ people and mould them into their assumed version of what is normal. And psychologists can sometimes adhere to medical-model thinking as much as psychiatrists; those expressing criticism of traditional psychiatry are not engaging in some form of turf war (although some psychiatrists claim this as a way of avoiding having to address the issues raised).

      With regards to childhood abuse as a major contributor to subsequent mental health problems, I’d suggest for many people (not all) such an explanation makes sense and does not encourage passive acceptance of the victim role. Indeed, for most people I’d argue that construing one’s current distress as the understandable consequence of life experiences is rather more enabling than accepting traditional psychiatry’s ‘broken brain’ messages.

      I totally agree with your point about the importance of validating each person’s view of the world even if it is often different to the majority. Indeed, I’d never try and dissuade someone from construing his/her current view of their distressing experiences if it makes sense/is helpful for that individual. My beef comes with people, usually professionals and so-called psychiatric ‘experts’, who put forward a view of human suffering as ‘the way it is’, a universal truth, rather than one approach in a contested area.

      And as for ‘help’ and ‘problems’, they seems like mainstream descriptive words to me and I have – excuse the pun – no problems using them.

      Thanks for taking the time to read and comment.

  8. Pingback: National Survivor User Network (NSUN) Bulletin - 27 December 2016 - Altering Images of Mentality

    • Gary Sidley / Reply 4th January 2017 at 8:33 am

      Greatly appreciative of the opportunity to publish in the NSUN Bulletin – thank you.

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