Stop the Stigma

Is It Helpful to Talk Around Mental Illness?

Is it helpful to talk around mental illness?

Mental illness can involve feeling really crappy and having a lot of difficulty functioning. That’s not the experience of everyone with mental illness all of the time, but it’s there in the mix somewhere. Yet sometimes it seems like people want to avoid the ugly bits, and talk around mental illness rather than talking about it. So let’s talk about that.

I think that part of the issue is that people might worry that talking about the messy bits is too stigmatizing. But here’s the thing—destigmatizing isn’t about pretending that the messy bits don’t exist. Destigmatizing is about making mental illness be okay. If we’re saying that only the neat and tidy parts are okay, that perpetuates stigma.

The euphemism treadmill

I’ve written before about Steven Pinker’s euphemism treadmill. This is the idea that neutral words become tainted by negative societal attitudes towards whatever they’re attached to, so people come up with new neutral words that essentially mean the same thing, and these are deemed the new “correct” terms. Those “correct” terms then become tainted themselves, and it’s time for new words. As long as you need to keep replacing the words, that’s a sign that the underlying negative attitudes haven’t been deal with.

Not everyone disagrees with a medical model of mental illness, but if we accept that for the sake of argument, mental illness is an accurate, neutral term. Same deal with mental disorder. However, some advocates consider mental illness and mental disorder to be too stigmatizing.

If accurate, apparently neutral terms seem tainted, that suggests to me that the euphemism treadmill is chugging along, and the underlying negative attitudes are still hanging around.

Mental health ≠ mental illness

Sometimes, you’ll see mental health being used as if it’s synonymous with mental illness. This puzzles me, because it makes no sense. People get the difference between physical health and physical illness, so why do the wheels fall off if you substitute the word mental for physical? It shouldn’t be a difficult concept!

Mental health ≠ illness: contrasting mental health and mental illness

Sometimes, this confusion results in people talking about mental health like it’s a bad thing. I came across a group on Twitter quite a while back that was talking about wanting to combat mental health, and I pointed out to them that I don’t think that meant what they thought it did.

It may be the people are simply confused, or this may be a euphemism treadmill issue, especially when organizations saying people shouldn’t use the term mental illness. NAMI, for example, has recommended using the term “mental health” rather than “mental illness” when talking to youth about mental health issues.

The Depression and Bipolar Support Alliance (DBSA) goes even further. They say:

“Use of the term ‘mental illness’ to describe mental health conditions or the words ‘mentally ill’ to describe people living with mental health challenges are loaded with subtext. They imply a perpetual state of misery and abnormality—a perpetual state of illness.”

I don’t know what dictionary they’re using, but that’s an odd interpretation of “mental illness.” The Canadian Mental Health Association (CMHA) is okay with “mental illness,” but they think “mental disorder” is too stigmatizing, even thought the DSM-5 that’s used to diagnose us crazy folk is the Diagnostic and Statistical Manual of Mental Disorders.

If mental illness seems too tainted to some people, mental health may seem neater and prettier. But if mental illness is so bad that you can’t talk about it, talking about mental health doesn’t make that better; it just sweeps the stigma under the rug. That stigma is still there, waiting to jump out from under that rug to bite you in the ass.

Person-first language and creating distance

Person-first language is “Ashley is a person living with depression” or “Ashley is a person who has a mental illness” rather than “Ashley is depressed” or “Ashley is mentally ill.” One of the things that this sort of language is supposed to do is create distance between the person and their mental illness.

Let’s get real, though. There is no distance between me and my mental illness; it’s hanging out right here inside of my head. If anyone else feels the need to try to create distance, that tells me that they have a problem with the fact that the mental illness is hanging out in my head. It’s not all of me, but it’s right fucking here, and I can’t magically make it go away; I haven’t come across that magic wand yet. If anyone’s got a problem with that and thinks distance is necessary, that’s stigma, not an issue of wording. If there is no stigma, there’s no need for distance. We need less distance, not more.

Let’s talk about, not around, mental illness

I want the euphemism treadmill to stop. I want us not to feel the need to come up with new, pretty, clean, untainted words. I want us to talk about the reality of mental illness, not just some sanitized version. For some people, some of the time, it may be fairly neat and tidy, but we can’t make it just about that. The people getting their ass kicked by mental illness are just as deserving of destigmatization as people who have made a lot of progress in their recovery journey. Distancing the well(ish) folks from the unwell folks is not destigmatization; it’s just shifting the stigma around a bit.

Mental illness is a real thing that affects people in many different ways. We need to talk about all of it. Talking around mental illness means pretending to ignore the stigma elephant in the room. It’s there, and pretending doesn’t make it go away.

So let’s stop talking around mental illness, and talk about it in all its complex and sometimes messy reality.

Now available: A Brief History of Stigma

This is part of a series of posts on topics that are addressed in my new book, A Brief History of Stigma.

You can find it on Amazon and Google Play.

61 thoughts on “Is It Helpful to Talk Around Mental Illness?”

  1. I agree. Let’s talk about all of it. For instance. How could someone go from having a seemingly full life to being a semblance of themselves? That happened to me and I know it happened to a lot of your readers. Let’s not pretend that mental illness is easy to recover from.

  2. Well said! I had no idea that some organisations recommend using ‘mental health’, instead of ‘mental illness’, I thought it’s just colloquial.

    ‘Hearing voices is a sign of mental health’. How does that sound?

  3. A very interesting read. I am also confused when people conflate the terms “mental health” and “mental illness”. They are…not the same? That’s the whole point?
    I agree with you that it only perpetuates stigma when we avoid talking about the pain of mental illness by substituting a more comforting word.

  4. Great post! I confess I do prefer people using terms like “person with bipolar illness” to being “bipolar.” But the ultimate issue is when people hear the word “bipolar” no matter how you say they think of someone who is not in control, who may be a danger to self and others and who likely needs some sort of restraint if illness is prevalent or presenting severe symptoms. It’s not so much how you say “bipolar,” it’s that you say bipolar at all. Just kidding around – what about saying you are a person with an “acute brain malfunction?” That takes the stigma off the patient and puts it on the organ which is what we do with all other types of illness? We don’t say Sally is cancer of the brain we say Sally has an acute case of brain cancer.

    1. It’s interesting, while the biological, brain-based illness idea seems like it should decrease stigma, research has shown that it actually increases stigma. There are a lot of things that are biological and out of people’s control, like skin colour, that are used as a basis for prejudice.

  5. On the subject of misinterpreting language, I totally read the title of this post as “Is it helpful to talk about mental illness” and I was all prepared to talk about whether therapy and/or ranty blog posts have been helpful or not. Just goes to show the importance of language and the importance of reading.😉

    Anyway, getting back to what you actually wrote about, I agree with the points you’ve made. I would say that in general (politics, difficult conversations in the workplace / marriage / family members, etc.), it is better to talk about something rather than around it. If you feel the need to talk around it, that is something of a sign that there is a deeper problem present.

  6. So many nuggets in this post!
    “As long as you need to keep replacing the words, that’s a sign that the underlying negative attitudes haven’t been deal with.”
    Word usage becomes trendy, and I agree, it doesn’t address the fear that is masked, and the realities that are avoided, when using politically correct (whatever that is!) language. Excellent writing… thank you!

  7. When I did my dissertation in psychology our college therapist recommended I use mental health difficulties when talking about mental illness. Even today when I spoke with the lady on the desk in the doctor surgery I said I had mental health issues and that’s why I’d been signed off work. I felt embarrassed saying it and you’re right, I shouldn’t be. It’s a sad reality.

  8. When someone has a physical illness, it’s common to name the illness. When was the last time you asked someone why they were gone from work and they said, “my physical illness was acting up.”

    Maybe many People don’t know shit about mental illnesses and don’t want to. Although replace mental illness with “almost anything” that they don’t think affects their lives directly.

    Another empathy gap?

  9. How does “mental health” with “mental illness” equate – that’s just confusing in that it makes no sense – Who dies that? “How is your mental health?” “Not so great today, I’m feeling a bit down but my physical health is just fine – no aches or pains today”

    And yet I’ve come across the term “mental health professional” – what does that mean exactly?

      1. Hmm, somehow I managed to not notice this comment earlier, so a least the type mention brought it to my attention. Maybe reading the dictionary needs to become a thing again, so people can learn what words mean. Okay, maybe reading the dictionary was never really a think, but I remember it was something that my high school English teacher Mr. Bush did. Somehow, I don’t remember what happened yesterday, but I remember Mr. Bush from 25 years ago…

  10. Completely agree and I love how you’ve highlighted the difference between talking about mental illness and mental health. I think there’s so many campaigns out there encouraging us to talk about mental health, and they’ve been great, but I think when it comes down to the nitty gritty and actually talking about mental illness, there’s still a lot of work to be done. x

  11. You bring up a very interesting point. I find myself doing that very thing of dancing around the topic because I don’t want to say “Mental illness” and bring the stigma down upon me like a toxic cloud that everyone flees from. But by doing this, I only contribute to this problem. I’m just not sure how to bridge that gap in everyday life, such as at work. I usually pretend to be ill rather than admit my anxiety is going off the charts.

      1. Well, before I knew my episodes were seizures, I thought they were panic attacks, so I’d lie and say I had a horrible migraine so I could go home 😵😵😵.

        1. This is a really good point. It is nice to say that we should always be doing everything we can to reduce stigma by speaking openly all the time, but the reality is that people have jobs they rely on and not all bosses are so understanding. I don’t think telling a simplified truth when you don’t feel well enough to work is the worst thing ever. I’m also a very private person and I don’t think one should feel obligated to say anything more than “I don’t feel well, I need to leave early”. Sure, in a perfect world, one would always feel comfortable enough to say “I’m having a panic attack, I need to go home” but I also don’t think one’s workplace is necessarily entitled to such details.

          1. I agree, workplaces shouldn’t be entitled to those kinds of details.

            When I was working as a nurse, my union contract required that people who were off sick for an extended period enrol in the employer’s “disability management” program (even if you weren’t getting paid disability benefits), which involved giving access to medical records. At one point I refused, and the employer refused to let me go back to work until I enrolled in their program. I was seriously pissed off.

          2. No, they are certainly not entitled. But there’s this suspicion of people who say they’re sick. You could be the best for twenty years and one day you say you’re not well and immediately everyone assumes you’re lying lol. It’s sad that I felt like panic attacks weren’t “legitimate” enough to excuse me so I needed something with more cred.

  12. It is hard to say I am mentally ill or that I’m depressed, and that makes me feel worse. Even saying it to myself sometimes. ♡ Wrote about it today but think people won’t read or like it because it’s “whining” or feeling sorry for myself. Such a conundrum.

    1. Part of why I’ve embraced using the word “crazy” to describe myself is that I figure it deweaponizes it, and no one can call me anything worse than what I’m already calling myself. Then again, I’ve given up all pretense of any semblance of normalcy because I just can’t pull it off.

      And I say fuck society who judges that people are feeling sorry for themselves. When things are shitty, we have every right to feel sorry for themselves.

  13. I think what you are talking about here actually contributed the shit show that has been my history with different providers. Yes, the general population has issues accepting mental illness as a “normal” thing, but providers do too. I have had providers literally tell me they think they know what I have, but won’t tell me because of what the label implies. (We are going to completely bypass the part where they were horribly wrong). There was a lot of secrecy around “explaining” my (wrong) diagnoses. Eventually you are seen as the label and not you.

    I think in some respects it’s a generational thing too. I was talking (ahem…ranting) to a friend about my misdiagnosis adventures and she said it still surprises her when anyone, including her son, mentions anything about mental illness casually.

    The way I look at it, the broken system has sucked up so much of my life, I can’t not talk about it because for years that was the only thing in my life. If I’m told its not appropriate to use the only words that could possibly describe the hell I went through, I’m being told my experience is not appropriate, or that its only appropriate now because I’m finally correctly diagnosed with a seemingly more “socially acceptable” disorder. Neither of those is OK.

    1. That whole idea of secrecy around diagnosis and not explaining to patients how diagnoses were arrived at is such bullshit. Mental health professionals should be fully willing to explain exactly how they arrived at a diagnosis, especially when there are discrepancies between that diagnosis and what the patient is actually experiencing. When people can only see the label and not the person, that’s a huge problem.

  14. Here in Australia there seems to push towards using mental mental instead of mental illness. At least it feels that way to me. As you said everyone has mental health. Sometimes it’s good health, sometimes it’s not good but it’s still mental health. That’s my perspective.
    The person person first language I get however that can be problematic when for example people become irate about how others refer to themselves. I’ve seen people tell others you can’t call yourself autistic you are a person with autism.
    I wish people could just accept differences and move on.

  15. I just don’t like calling it an illness because to me (and maybe I’m an odd ball here) an illness can be cured. I firmly believe it is a disorder. I just don’t see people with thyroid issues or diabetes having an illness and to me mental disorders are no different then that. I do agree that we all have mental health so it’s too broad and I hadn’t thought of that before so thank you. 😊

  16. When I think back on all the jobs I have had since college, there are three scenarios. 1) I compartmentalized everything and did not share anything with colleagues regarding the bipolar. I went to the psychiatrist on my lunch break and paid extra to do labs on a Saturday. 2) I shared with a mentor or someone close with me who had mentioned that their aunt or their husband or someone close to them had a mental illness or condition. 3) I exposed myself as bipolar when I had a break-through episode on the job something like sending a very random email up the flagpost. I think about stigma under these 3 scenarios. The only time I did not feel judged (either actively or passively) in some way was in the second scenario. I understand we are to talk more openly about mental health or mental illness in order to make the discussion more commonplace and therefore less prone to stigma. Quite frankly, I don’t find that that has worked very well for me. The only thing I have seen work where stigma reduction is concerned is to find an ally in someone who already has a family member or a friend who has experienced mental illness first hand. When I think about changing hearts and minds about stigma, I think about expanding the circles from the inside out where someone is already aware of the challenges, the impacts, the stereotypes. Perhaps with that being said, stigma reduction in the workplace is next to impossible, whereas stigma in the neighborhood can be conquered albeit a little bit at a time. I have found in the last five years at least two neighbors with anxiety disorders. Talking with neighbors about health concerns is a little less pressured that talking about illness on the job. I don’t think the workplace will ever be a place of solace for people with mental illness diagnoses or troubles. Sorry for my pessimism but I have been there done that so many times.

  17. That’s a really interesting point; that true lack of stigma wouldn’t make
    linking a person and their illness a bad thing. I still prefer the distinction, even if it’s for my own attempt to create distance and remember that I’m still a person, but I really value your point.

  18. I get grumpy when mental health is being used as if it’s synonymous with mental illness. That’s why certain offline friends and certain groups in wider society think their sadness is ‘depression’ when it is NOT adjustment disorder with depressed mood, situational depression, or major depressive disorder. But sadness, which isn’t mental illness.

    Of course, sadness sucks and deserve support. Bereavement is an intense and prolonged sadness/grief which can last a lifetime. No one says that’s not bad. But calling mild sadness ‘depression’ and then saying you ‘overcame depression’ by chit chatting to supportive friends for at most a week shames real sufferers. That’s why we get ignorant opinions about “Ordinary human condition like sadness are being pathologised. EVERYTHING is a mental illness for Big Psychiatry and Big Pharma!”

    Your infographic is great, we’re saving it.

    YES, there’s little room to talk about the reality of mental illness, not just the sanitised version of quick and easy recovery. And of course, SO many mental illnesses are much more heavily stigmatised than depression and anxiety. Anything with psychosis features, for example. And “personality disorders”. Like we’re more prone to violence, or are automatically abusive, when we’re more likely to be victimised etc etc. And Hollywood and Netflix = DID is like we all have a sociopathic self hiding inside.

    1. 78.6% in my country don’t serm help. 40% didn’t seek help due to stigma The most frequently endorsed barrier to help-seeking were concerns regarding the cost of treatment.

    2. Hollywood’s notion of DID is so warped.

      That’s such a good point about people thinking that the field of psychiatry pathologizes everything. The DSM is far from perfect, but if people think they can use it to self-diagnose normal human experience as mental illness, that’s the problem, not the DSM itself. People are dumb…

      1. Oh ya, I’m not a fan of a ton of psychiatric history etc but people are ridiculous with uninformed self diagnosing. Informed self diagnosis is fine with me.

Leave a Reply