Is there a “right” way to talk about illness and disability? The current popular favourite is person-first language. It really got going in the 1990s, with the American Psychological Association leading the charge. Instead of talking about a “disabled person”, person-first language literally puts the person first, as in “person with a disability.” This has become the generally accepted practice, and the standard in journalistic and academic writing.
Not everyone likes it, though. Sometimes, people with a particular condition are all for identity-first language, while their supporters prefer person-first language. Autism is a good example of this split, with autistic people talking about being #actuallyautistic, while parents and service providers tend to favour talking about people with autism.
A war on adjectives
I figure people should be able to call themselves whatever they want, but the hard push for person-first language feels to me like a war on adjectives. Somehow, if I say that I’m mentally ill, that becomes who I am and all I am from now until the end of time. Yet no one would bat an eye if I were to use all kinds of other adjectives to describe myself, such as tall, brown-haired, brown-eyed, female, Caucasian, educated, intelligent, introverted, Canadian, etc. None of those adjectives define me as a whole person, nor is anyone else likely to think that they do, so why is it that as soon as you start talking about illness or disability, the English language stops behaving in its usual manner?
Other adjectives that we don’t use in a person-first manner: beautiful, creative, special, beloved, compassionate, brilliant, wonderful, kind, ambidextrous, bilingual, pregnant, and on and on. Why are we being told to talk one way about things that are positive or neutral, but we should talk about stigmatized characteristics in a different way to make them less stigmatized? Does anyone else see the holes in that?
The English language-mangling really gets going when people compare identity-first language to something “I am cancer,” which is a bit like trying to substitute “I am Canada” for “I am Canadian,” or “I am English speaker” for “I am English-speaking.” In the English language, nouns and adjectives don’t work the same way in a sentence. Even more absurd is when people offer “I am cancerous” as a what-not-to-say. You can’t just change the meaning of words to make them say what you want them to say.
Let’s talk disability
Some people take this kind of thing more seriously than others do, and I decided to write this post after I came across the Language Guidelines for the Psychiatric Rehabilitation Association. They seem to take person-first language, and themselves, extremely seriously.
If one must talk about the type of condition that people have, they prefer the term “psychiatric disability” rather than “mental illness” because “terms focusing on ‘illness,’ ‘disorder,’ and ‘diagnosis’ reflect a medical model rather than a psychosocial rehabilitation perspective.” I find this a bit odd, because I bet if you did a poll, those of us actually living with whatever you want to call it would be choosing mental illness rather than psychiatric disability as our preferred terminology.
The folks at the Psychiatric Rehabilitation Association believe that terms like “the mentally ill” and “chronic” are “dehumanizing or pejorative,” and they consider them to be unacceptable. Really? They add that “serious,” “severe,” or “persistent” are preferable to “chronic,” which apparently implies “hopelessness.” I’ve gotta say, I’m just not seeing it.
On the other side of the coin is the haphazard use of illness adjectives or the co-opting of mental illness terms that really don’t mean what people think they mean, but I think that’s a distinct issue from fussing over what to call someone who actually does have a condition.
Stigma is too stigmatized
Stigma is bad; discrimination, prejudice, bias, or negative stereotype are okay. Really? At least most mental health organization aren’t jumping on this particular word policing caboose.
“Stigma refers to a mark or token of infamy, disgrace, or reproach. There is nothing inherent in people who have psychiatric disabilities or mental illnesses that deserves to be remotely associated with infamy, disgrace, or reproach; nor is ‘stigma’ inherent in people with diverse sexual orientations, gender identities, ethnicities, cultures, colors, or sizes. Therefore, the word ‘stigma”’ is considered unacceptable, and is not used.”
The concept of stigma in the context of mental illness was first described by sociologist Erving Goffman in the late 1950s, and his work was the foundation of much of the stigma research that’s been done since. The fundamental idea of stigma is that it’s not inherent in whatever characteristic is stigmatized; it’s about who society decides to view as more or less human. It encompasses stereotypes and the prejudiced attitudes and discriminatory actions that result from them. It’s an entirely social phenomenon that represents societal norms rather than being a reflection of the stigmatized characteristic. What these people are arguing against misses the boat entirely on what stigma actually means.
And really, when you’ve got a Manhattan Institute fellow writing In Defense of Stigma, you’ve got to know that telling him he should change “stigma” to “discrimination” completely misses the boat.
Is any of this helpful?
This ended up being less focused on person-first language than I originally thought it would be, but it all falls under the umbrella of talking around things rather than talking directly about them.
It reminds me of Steven Pinker’s euphemism treadmill, where words to describe something essentially mean the same thing, but some are considered new and clean, while others are considered old and tarnished because they’ve picked up the societal prejudice.
If someone thinks that being mentally ill makes me a violent “psycho,” the issue really shouldn’t be that I need to stop talking about having a mental illness or being mentally ill rather than being a person with a mental illness. Using similar words that mean the same thing seems totally unlikely to change any underlying attitudes, and in the end, it’s those attitudes that create problems for those of us living with mental illness.
And finally, if we’re telling people with illnesses/disabilities that they’re supposed to talk about themselves or their experiences, that’s very much targeting the wrong audience when it comes to stigma.
What are your thoughts on person-first language or the idea of stigma being too stigmatizing?
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.