The language people use when it comes to mental health matters. A lot of words are 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.
Role identities
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’s 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’s completely okay; however, I don’t think that others should try to impose an illness identity upon us.
Are we patients? Consumers?
Then there’s the question of what terminology we use to refer to our relationship with mental health service providers. 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”; to me, it sounds like an economic term. It’s also based on service use rather than personal experience (I also dislike “service user” for that reason). While we’re certainly survivors, the term psychiatric survivor suggests a very antagonistic relationship with the mental health care system. That’s certainly the case sometimes, but it doesn’t seem like a particularly productive way of defining ourselves.
I actually like the term patient in certain contexts. It’s mostly fallen out of favour, 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, but 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 it’s inaccurate. Physical health and physical illness don’t seem to be difficult to grasp, and I’m just not sure why the whole thing seems to fall apart when you substitute the word mental for physical.
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 (and accuracy).
Vague language
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 are clueless enough about mental illness without muddying the water with amorphous terminology.
Derogatory terms
There are plenty 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 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 working with 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).
A lot of the issues around labelling and mental illness come 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.
Diagnostic labels
That brings me to diagnostic labelling and mental illness, with those labels being applied by the medical profession to people who have a 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. Others might find a psychiatric diagnosis liberating if 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?
There’s more on language issues and mental illness stigma in the post The Problem with Language Policing.
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
I tend to say that I have “mental health issues”. I like that it sounds serious without going into details. Somehow it’s easier than listing all my issues individually, especially as there’s a mixture of stuff I’ve been diagnosed with and stuff I’ve self-diagnosed, plus there’s the borderline autism aspect, which technically isn’t mental health, but interacts with my mental health issues (e.g. social anxiety). Also, I worry about the stigma that can come with depression, that it isn’t seen as being as ‘real’ or serious as some other mental health issues. That said, I can see it can be problematic; my Mum thinks it’s too vague and that people might assume I have schizophrenia or something.
The colloquial use of terms like ‘depression’ and ‘OCD’ really bothers me, but I don’t have the confidence to call it out.
Yes mental health issues works well in that sense. I also struggle with calling out colloquial misuse of terms like depression; online is fairly easy, but in person not so much.
This is such a broad and very interesting topic. As for my own preferences, if I am open with people about my mental illness, I don’t mind them describing me as for example dysthymic and I have no issues with referring to myself as dysthymic or mentally ill, or living with mental illness, when I feel like this aspect of my identity is important. It’s the same as with describing myself as blind, it’s certainly not something about me that I’d mention at first place, but it is important and it is a huge part of me, so I just describe it as it is, not running away from it into terms that don’t really cover it.
When I’ve become a part of some English language mental health communities it was also a bit surprising for me when people used mental health as sort of synonym for mental illness. I would rather say “I have a mental illness” instead of “mental health issues” if I wanted to disclose it, so at the beginning it sounded even a bit weird for me, ’cause it’s like your mental health is an issue for you, or like you desperately don’t want people to think you’re ill. However, with time I realised that sometimes such euphemistic approach is better when you need to be a bit more diplomatic or when you talk not only to other people with mental illnesses but also those who haven’t ever experienced it to not scare them at the beginning. Also there may be situations when I don’t want to fully describe all my illnesses like – I have this, this, and that. – In some contexts, imo, it’s not necessary and may look egotistic for some so you can just use mental health issues to make it more intelligible and maybe less overwhelming for some. But in all the other aspects I prefer either saying I have mental illness(es) or naming them, it depends on the environment i’m in, I think.
I have nothing against derogatory terms in reference to myself, like I often call myself crazy or freaky or insane or nutty, or whatever else interesting there might be in other languages, and although I get it might feel offensive for some people, I feel like not being always deadly serious about your issues can give you a bit more healthy approach to them. In some cases, I’d even rather say I’m fucking crazy than I’m mentally ill.
although in most situations I would rather go with living because suffering can sound a bit pathetic, but maybe it’s just my not liking to be too emotional and draw too much attention.
All very interesting points. I agree that being able to use humour and make fun of ourselves once in a while is very healthy.
Goodness me, where to start!
Service user, yuck! In the service I used to work for all of the paperwork (and there was a lot!) was based on the “Service User” and it used to irk me. When I have used other services I have been called “the client” which I wouldn’t think I am particularly.
Then again, labels have always bothered me. I’m just me. I’m made up of all of these different parts, but they are all just part of the amazing person that I am. (I must be in a good place, calling myself amazing with no prompting from anyone else.)
The derogatory terms that I may occasionally use about myself do not relate to my mental wellbeing. I recently had a task to do, and by the end of the task it was sending me absolutely “batshit crazy” but that wasn’t in a negative way at all, achieving the task gave me a boost though, because it was such a challenge!
Finally, I used to work with a lady who would introduce herself by saying “Hi, my name is …… and I’m Schizophrenic” This was holding her back in her recovery, and over the time I was with her she worked really hard to change that and realise that she is …….. and the illness doesn’t define her or what she is capable of.
Yes the language we use should empower us rather than hold us back.
I use the terms mental illness and mental health problems interchangeably but mainly because some people dislike the former term. Personally I would rather be described as having (or living with) depression and PTSD than to be called mentally ill. Having problems or issues with my mental health makes it sound like a minor blip. It’s difficult.
Patient wins over service user, client, consumer etc. I’m happy with doctors having patients, to me it makes the most sense!
As an aside, many people I know object to the term survivor in relation to cancer, personally I view that I’m a cancer survivor for every day that it hasn’t killed me! Embrace survivorship!
Yay for survivorship!
Oooo this is an interesting one! I think my previous role as “psychology student” has a piqued interest here. You are totally right about the derogatory terms and connotations when it comes to mental health, but also how they can be used in a more light-hearted or even positive way (I also use “crazy” in a positive sense). I think my peeve is probably in terms of people using a term as though they experience it to the full degree – “ugh insomnia is awful” (says the person who slept a whole seven hours when I struggle to get 2) or various comments about anxiety / depression when those individuals probably can’t even comprehend what it’s like to experience such things for an hour let alone every damn day. I think it’s the generalisation, the downplaying of such terms that are used very widely and under-appreciated. This is certainly a post that’s got me thinking, and a little revved up… Very good points indeed!
Caz x
Thanks! I completely agree with you about people using terms when they have no idea what the full extent of the problem actually feels like. It’s so frustrating.
My biggest pet peeve is when someone says the weather is bipolar. Idk why but it really irks me!
Yes that’s definitely annoying!
Oh, I 100% would agree with “psychiatric survivor.” I basically have a either an antagonistic or fear based response to the crap we call mental health “care” in the U.S. Especially in Red States and especially for those who can’t speak for themselves. I’ve seen too much abuse – including reckless and dangerous use of meds with horrible and lasting consequences – to ever trust the system. Yeah, ok, this response got angry quickly, but that’s because I’m dealing with that shit – with some garden variety neglect and abuse thrown in for good measure – as something I have to testify against again this week. My only quibble about psychiatric “survivor” might be I can only hope everyone truly does ‘survive’ it. My nightmare scenarios are that my story becomes one of the ones I’ve read about where the patient didn’t…
P.S. – I probably should explicitly say I’m not including you in my dark assessment of earlier. I’m not in a good situation right now, and it is because of a system that harms where it should protect. I can’t really keep the fear and anger – clearly – out of even my random comments right now because of how bad this week is for me. I also didn’t want you think it was aimed at you. I appreciate that you are trying to honestly point out inequalities, stigma and other problems in the system on this blog. 🙂
No worries, it’s totally ok. I think how we identify is very much shaped by the experiences we’ve had. There are far too many people having negative experiences in the mental health “care” system, and that absolutely need to be addressed. It’s bad enough that there’s stigma from the world in general, but when it’s coming from the very people that are supposed to be helping it’s even worse.
That’s true, and even sadder when I just remembered you are in Canada. I think people are shocked at just how bad my Red State homeland is, but not surprised. Then maybe both shocked and surprised even more when I tell them “yeah, it’s bad there, but there was also an abuse scandal at the inpatient hospital of the very first outpatient clinic my insurance referred me to.” It was with their most in need patients, who again because of their illness couldn’t advocate or even necessarily voice they were being abused. I’d still move to Canada in a heartbeat so at least I didn’t have to pay so damn much out of pocket for the lousy “care” – especially for someone else so medically fragile – but it kind of saddens – but not shocks – me that Canada has all the same stigma.
Yes the system in Canada is far from perfect, but at least having a public system we escape some of the problems that go along with privatized health care.
The whole box thing has always annoyed me. My friends do it all the time to me. It’s like talking about a diagnosis immediately directs to me succumbing to some greater force. Saying it’s a box, to me personally, reduces a diagnosis to a mere social branding like ‘Goth’, ‘Jock’ etc. I mean,its like getting diagnosed with appendicitis after having symptoms for a while. Symptoms that happen to overlap with so many other medicinal complications. To finally be able to narrow it down means you can get help specific for appendicitis. Idk it’s annoying to me. I can see how it wouldn’t annoy others, though.
I agree. Diagnosis that helps you someone get the right treatment is liberating, not confining.
Thank God you don’t think I’m being delirious! Such a relief, really <3