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 dealt 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 people using “mental health” as 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!
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.
Is “mental illness” seen as too tainted?
It may be the people are simply confused, or this may be a euphemism treadmill issue, especially when organizations are 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 though 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.
There’s more on language use related to mental illness in the post The Problem with Language Policing.
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
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.
I find it really weird when people are telling other people what to call themselves. Let people talk about themselves however they want!
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. 😊
The term “chronic illness” is fairly common, but I’m guessing you don’t use that?
I guess I never thought of that or it in that way… hmmm
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.
Yeah, the potential consequences of openness in the workplace are significant.
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.
I agree that a person is not their illness. I just think that viewing a person as nothing but their illness is a result of stigma, not a failure at linguistic gymnastics.
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.
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.
Even in Canada, with our public health care system, psychological treatments aren’t considered medically necessary, so cost is a huge barrier for that.
Dang. Ugh!
Yup.
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…
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.
Informed being the key word.
Yes 💜💜💜💜💜💜