Is It Helpful to Talk Around Mental Illness Rather than About It?

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.