I’ve written about this a few times before, but the language people use when it comes to mental health is so important that I could probably talk about it ad nauseam. There are a lot of words that get tossed around to describe who we are and what we experience, and in this post I’ll consider some of the issues around labelling and mental illness and whether certain words are helpful or harmful.
We all have multiple different role identities; this is a sociological concept that refers to identities that are defined around a certain role. Some of my role identities are daughter, sister, nurse, and person with depression. The weighting placed on the importance of these role identities varies greatly, both by individual and by context.
Mental illness awareness campaigns will often say that we shouldn’t refer to people by an illness identity, e.g. he is a schizophrenic, because it doesn’t define who they are. I believe we all have the right to have control over our identities and those aspects of our identities by which we wish to be known and understood. I know bloggers who describe themselves as being bipolar, for example, and that is completely okay, but I don’t think that others should try to impose an illness identity upon us.
Are we patients? Consumers?
Then there is the question of what terminology to use to refer to those of us living with mental illness and our relationship with mental health services. Consumer, psychiatric survivor, patient, client, person with lived experience… There are lots of terms floating around out there, and everyone seems to have a different preference.
I don’t like consumer, because to me it sounds like an economic term, and one that is based on service use rather than personal experience (I dislike service user for a similar reason). While we are certainly survivors, the term psychiatric survivor seems to suggest a very antagonistic relationship with the mental health care system, and while that’s certainly the case sometimes, it doesn’t seem like a particularly productive way of defining ourselves.
I actually like the term patient in certain contexts. I know it’s fallen out of favour for the most part, but for me it comes back to the idea of role identities. I play the role of patient at certain times and in certain contexts, although it doesn’t define me as a person overall. As a nurse, I talk about my patients because I’m interacting with them as they are engaging in that role, not because I see patient as their defining identity. I often refer to myself online as a person living with mental illness. I know some people use the term “suffering” and others quite dislike it; I don’t have strong feelings either way.
Mental health as a synonym for mental illness
I’ve always been a bit puzzled when I see “mental health” used as a synonym for “mental illness” (e.g. “I have mental health” used as a substitute for “I have a mental illness”). I know it’s reasonably common, but to me it seems like a misnomer. Perhaps it’s sometimes used as a euphemism (somewhat like mental health “issues” or “problems”), but my personal preference is for a bit more specificity.
The problem with nonspecific terms is that vagueness can leave a lot of room for misunderstanding. One of my pet peeves is “nervous breakdown”. It’s not a term that has any psychiatric meaning; it’s just something that’s thrown around haphazardly to describe a random assortment of experiences. The vast majority of people out there in the world are clueless enough about mental illness without muddying the water with amorphous terminology.
There are a lot of derogatory terms that relate to mental illness, including crazy, nutty/nutbar/nutjob, psycho, bonkers, insane, looney tunes, etc. I admit that I use these terms, but not to criticize people with mental illness. If a “normal” person was doing something bizarre (I could insert a Donald Trump reference here but I’ll restrain myself), I might say that person is “batshit fucking crazy”.
Or sometimes I might use the word “crazy” as a good thing; for example, I really like helping patients who are highly psychotic, so I might express my preference as “the crazier the better”. I sometimes describe myself as crazy, and I recently saw another blogger write about being a fruit loop in a positive sense.
I guess what I’m trying to say is a lot of the issues around labelling and mental illness come to down to intent and context. Words like crazy aren’t going anywhere, but I think we can take away some of the power they have to harm, perhaps in the way that members of the LGBTQ community have taken ownership of words that were once used against them.
“She’s so OCD”
We also have “normal” people co-opting mental illness diagnostic labels to refer either to themselves or others. OMG, I can be so OCD sometimes. She is, like, so bipolar! The guy I like didn’t respond to my text and now I’m totally depressed! I tend to consider this use of language to be more harmful than the casual use of derogatory terms, because it significantly minimizes and invalidates the experiences of those who actually have those illnesses. I’m not sure what we can do to change this aside from calling it out when we see it.
That brings me to diagnostic labelling and mental illness, with those labels being applied by the medical profession onto people who have mental illness. For some people, a diagnostic label can feel like an attempt to cram them into a small box that doesn’t have room for individuality, while others might find diagnosis liberating, as it helps them understand what they’re going through and what treatment options are available. For me, it’s been more the latter.
A diagnosis is not who anyone is; it’s a framework that describes certain elements of experience that tend to be shared among people with the same diagnosis. Getting a diagnosis doesn’t change who a person is or what their personal experience is, although unfortunately there are some people who are going to judge us based on that label.
What are your language preferences or pet peeves when it comes to labelling and mental illness?
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other online retailers.