Stigma is a social phenomenon that encompasses stereotypes, prejudiced attitudes based on those stereotypes, and discriminatory behaviours. There are a lot of anti-stigma advocates, both organizations and individuals, focusing on word usage and what to say or not say about mental illness. This is sometimes referred to as word policing or language policing. Sometimes, those advocacy efforts target mentally ill people and how we talk about ourselves. Except that’s very much the wrong audience.
Stigma does not come from us, nor does it come from how we present ourselves. It’s about what society has chosen to Other. To change public stigma, the public needs to be the target, not us crazy folk.
In the first two paragraphs, I’ve already used two items off the word-policing no-no list: “mentally ill” and “crazy.”
Word policing’s war on adjectives
Person-first language says you can’t describe someone using an illness adjective, because in doing so, you’re reducing them to that, and only that. So if I say I’m “mentally ill” rather than a “person with a mental illness,” I’m supposedly feeding into stigma.
We use adjectives all the time. That’s how English works. I’m tall, brown-haired, blue-eyes, educated, intelligent, introverted, Canadian, curious, science-minded, left-brain-oriented, introspective, guinea pig loving, confident, well-travelled, and on, and on, and on. No one is likely to assume that if I say any of those things, I’m reducing myself to nothing but that, with no possibility of anything else, ever.
But if I say I’m mentally ill, stop the presses. All of a sudden, the English language stops working normally, and mentally ill is all anyone can see.
The grammar is exactly the same. What’s different is stigma; the nature of stigma is that the stigmatized characteristic is seen as subsuming all other identities. One is seen as that thing, and only that thing, until the end of time.
The idea that we should be telling people they have to speak differently about mental illness, or any other stigmatized characteristic, than they do about any “normal” characteristic is fundamentally flawed. Yet to choose a non-person-first approach may be condemned as feeding into stigma.
You can’t talk about suicide
If you consider all the contradictory rules from various different advocates and advocacy organizations (and there’s a lot of contradiction), you might wonder if it’s possible to talk about the topic of suicide without saying something that offends someone. Yet it’s so important that we do talk about it, both for those of us with personal experience and to get the conversation going more generally.
Among the terms that I’ve seen labelled as stigmatizing are committed suicide, completed suicide, suicided, suicidal, incomplete suicide, high-risk, at-risk, and vulnerable. It’s wrong to say someone is a victim of suicide, but at the same time, we’re not supposed to think there was any element of choice, and the person’s mental illness killed them in the same way COVID kills people. With so few ways of talking about suicide that everyone is okay with, how does that encourage anyone to talk?
There are a lot of people/organizations going around saying no one should say committed suicide, because that suggests that suicide is criminal. I have not yet come across a person who doesn’t react with some variation of “huh?” when the committed=crime link is pointed out to them. If it’s never crossed the minds of the people who do use it, and the most common stigmatized suicide stereotypes (like selfishness, harming others) have nothing to do with criminality, all of these advocates talking about criminality are forging and reinforcing that link in people’s minds.
Even more concerning is that this also creates and reinforces that link for mentally ill people. It tells them that whenever they see that language, it should be interpreted as a reference to criminality. It tells people to identify stigma where, chances are, none was intended, as if there wasn’t already enough blatant stigma to have to deal with.
It’s especially problematic if people are being criticized for using particular language when talking about their own experience. Their message matters more than the innuendo that some people want to attach to their words. The fact that so many within the mental health community use words that someone, somewhere considers problematic is a pretty good sign that we need more talking and less word policing. We need to initiate more open conversations about suicide, not give people a laundry list of reasons to keep their mouth shut.
Changing the curtains doesn’t fix the foundation
Stigma comes from deeply ingrained social learning. It’s foundation-level, not surface-level.
Phrasing that’s accurate (like mentally ill) or conventional (like committed suicide) can be a problem if you choose to make it a problem. That’s the curtains of the house that built on people’s foundational attitudes.
Word policing is kind of like telling people to change their curtains but doing nothing about the rotten foundations. Telling crazy folk to change their curtains in order to fix other people’s foundations simply doesn’t make sense.
When people have positive attitudes about something, the nitty gritty of word choices really doesn’t matter. If people with mental illness choose certain words to talk about mental illness, that’s not where stigma comes from.
When people have negative attitudes and you whack them over the head with their words, at worst, they’ll tell you to get lost, or at best, they might try to use your words in public to avoid being bitched at about their curtains, but not much else has changed. Or they might try to just avoid the subject matter altogether.
When people have positive attitudes and you whack them over the head with their words that were intended to be neutral, you may just be shooting yourself in the foot. When you whack crazy folk over the head with their words, it’s time to check your compass, because you’re facing in the wrong direction.
I’ve been reading a lot about this as I work on the chapter on language for my upcoming book. It’s a bit disturbing how many common advocacy approaches, including word policing, can actually make public attitudes worse. Maybe we need to worry less about the words mentally ill folk are using, and focus on generating conversations. And maybe we need to focus more on supporting each other and less on telling people in our own tribe how to talk.
You can find more on mental illness stigma on the Stop the Stigma page.