Patrick Corrigan has been my research crush for a number of years now. And what is a research crush, you might ask? I like how his mind works. He’s a psychologist and stigma researcher, with lived experience to boot. He’s one of the most prolific publishers in academic journals that I’ve ever come across. His perspective on stigma is focused on what actually works, and language policing is one of the topics he’s researched. All of the quotes in this post come from his article that’s cited below.
Where things get really interesting is that he’s shown that what actually works isn’t necessarily what makes people feel good in their advocacy. This particular article is a commentary rather than a research article, but he’s done the background work.
Language is a common focus point for anti-stigma campaigning, and it seems like it should be an obvious target. But we’re preaching to the choir when talking to each other; to effectively reduce stigma, it’s not about what feels right for us. It’s about what’s most likely to get that message received and internalized on the receiving end.
The issue of reactance
If you come across as nagging, the message likely won’t get internalized in a constructive way. In fact, it can lead to psychological reactance; the more you tell someone not to do something, the more likely they are to do the opposite.
Corrigan acknowledges that the use of words that are blatantly stigmatized, like “schizo” and “psycho,” is clearly problematic. However, he writes that trying to “fix” the issue by focusing on words is:
…fraught with unintended consequences caused by “word police”—advocates who identify the inappropriate use of terms related to mental illness and scold those who utter them in an effort to stop stigma.
Is it the words or the attitudes?
What’s really missing with a focus on words is the deep, persistent attitudes that underlie those words. It’s hard to suppress language, but even when it can be suppressed in controlled settings, that doesn’t necessarily extrapolate to changes in beliefs. Corrigan cautions that:
Instead, this policing of words might foster an incorrect sense of the ease with which stigma can be erased: that changing the words is enough. Unfortunately, changing stigma is a much more protracted and difficult task.
This is particularly relevant with structural stigma in large organizations, as token changes in language use may be seen as simple and sufficient. They may not realize, though, that there hasn’t been any actual change in attitudes as a result, which means nothing actually changes for people with mental illness within that organization.
While words can absolutely cause harm, prejudiced attitudes and discriminatory behaviour don’t come from words; they come from stigmatized attitudes that are at a much deeper level than words that are used, and the words are chosen based on that.
Telling people what not to say can actually make them think more about that very thing you told them not to say, much like if I tell you not to think about a white bear, you’re far more likely to think about said bear than if I’d said nothing in the first place.
Language policing also runs the risk of people writing it off as political correctness. I wrote last week about the euphemism treadmill, and political correctness just keeps the treadmill spinning without doing anything to address actual problems that exist. My guess would be that the people who are the most anti-PC are also relatively more likely to have stigmatized attitudes about mental illness, and turning off the target audience isn’t likely to help matters.
Alienating the choir
There’s also the risk of alienating people who might otherwise support anti-stigma effort by shutting down conversation rather than promoting it. Sometimes zealous anti-stigma campaigners start venturing into the territory of telling other people with mental illness what to say, but that’s not the target audience whose attitudes we actually want to change.
Apparently, some anti-stigma advocates have taken issue with the word “stigma,” although I hadn’t come across or noticed before. The argument is that it’s a form of labelling that blames the person who has been labelled. The Substance Abuse and Mental Health Services Administration (SAMHSA) has jumped onto this particular bandwagon, preferring the terms prejudice and discrimination.
Mental illness is another term that some people don’t want you to say, but when you start to get that ridiculous, you risk swinging the arrow the other way over to the “just depression,” “everyone’s a little adhd,” and “he’s so OCD” area of minimizing actual illness.
So what can we do?
Just because word policing doesn’t work very well doesn’t mean we shouldn’t be active in speaking up against stigma. But perhaps rather than focusing on words, we would accomplish more by addressing attitudes.
If someone uses the term “commit suicide,” for example, but the stigmatized belief they have about suicide is that it’s selfish, would it be more useful to target the language or to share a firsthand story of a suicide attempt that demonstrates that it’s actually not selfish at all?
I wanted to write about this because challenging language seems like a good idea on an intuitive level. But since language policing doesn’t appear to be a particularly effective way to get the anti-stigma message out into the world, perhaps we need to be more flexible and targeted in our approach. Because really, regardless of how satisfying an approach feels to the messenger, if it’s not sinking in on the other end, then we’re not really accomplishing a whole heck of a lot.
Source: Corrigan, P. W. (2019). Beware the Word Police. Psychiatric Services, 70(3), 234-236.
You can find more on mental illness stigma on the Stop the Stigma page.
A Brief History of Stigma is the upcoming new release from Mental Health @ Home Books. It looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
Visit the book page for tips on how to be an effective advocate.