Stigma and the Problem with Language Policing

Patrick Corrigan has been an academic crush for a number of years now. And what is an academic 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. 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.

Language is a common focal point for anti-stigma campaigning, and it seems intuitively 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.

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.

Corrigan (2019)

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.

The euphemism treadmill

Steven Pinker’s concept of the euphemism treadmill is useful here. It describes how neutral words become tainted by negative attitudes towards the thing they refer to, so new “correct” words are identified that mean essentially the same thing. The treadmill doesn’t stop until the negative attitudes that are driving the treadmill are addressed.

When people start saying that terms like “stigma” and “mental illness” are too stigmatizing, that seems like a pretty good indicator that the euphemism treadmill is alive and well.

The war on adjectives

Mental illness-related adjectives are a common target of language policing. Proponents of person-first language argue that 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-eyed, educated, intelligent, introverted, Canadian, curious, science-minded, left-brain-oriented, introspective, guinea pig-loving, confident, well-travelled, and so 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.

If I say I’m mentally ill, though, 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 from the way they speak about any “normal” characteristic is fundamentally flawed. The point should be that it isn’t different from other characteristics.

Language policing can make things worse

Not only does language policing not get at the root of stigma, it can actually make things worse.

One way it can harm is by making negative ideas more salient. Telling people what not to say can actually make them think more about that very thing. It’s much like if I were to 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.

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.

Corrigan (2019)

If people perceive word policing efforts as a matter of s political correctness, they’re particularly likely to respond with reactance. 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.

Planting ideas that weren’t previously there

If you tell people “don’t say [X] because it means [Y]”, not only have you made them think more about [X}, you’ve made a connection between [X] and [Y] that they might never have thought of otherwise.

A good example of this is the popular word policing target “committed suicide.” Some advocates say that people need to stop saying this because it suggests that suicide is a crime. I’ve not yet come across a person who doesn’t react with some variation of “huh?” when they first hear of that link. 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, what these advocates are doing is 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 it’s likely that none was intended, as if there wasn’t already enough blatant stigma to have to deal with.

Shutting down dialogue

There’s also the risk of alienating people who might otherwise support anti-stigma efforts by shutting down conversation rather than promoting it.

I’m concerned that this is an issue when it comes to 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.

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?

Who’s the target audience?

Our stigma-challenging efforts should be focused on changing the attitudes of people who have the most negative views. However, sometimes zealous anti-stigma campaigners start venturing into the territory of telling other people with mental illness what to say. That’s very much the wrong audience, though. Stigma does not come from us; it’s about what society has chosen to Other. To change public stigma, the public needs to be the target audience.

It’s especially problematic if people are being criticized for using particular language when talking about their own experiences. 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.

If I choose to use the no-no terms “crazy” and “mentally ill” to refer to myself, and other people have a problem with that, should it be my language that’s the problem, or their reaction to it? Maybe what’s most important is that we encourage people living with mental illnesses to share their stories, and to tell those stories in the ways that feel right for them. After all, telling our stories has the power to change attitudes by replacing stereotypes with real human faces.

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’s 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 folks dealing with mental illness to change their curtains in order to fix other people’s foundations simply doesn’t make sense.

Is there a better way than language policing?

When people have positive attitudes about something, the nitty-gritty of word choices really shouldn’t matter.

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 mentally ill folks over the head with their words, it’s time to check your compass, because you’re facing in the wrong direction.

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 language policing isn’t an effective way of reaching the key target audience, 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.

Reference: Corrigan, P. W. (2019). Beware the Word Police. Psychiatric Services, 70(3), 234-236.