The Impact of Language on People with Lived Experience of Mental Health Issues
Language is the medium with which we communicate. It is the means by which we share our thoughts and opinions. It is the tool we use to negotiate social situations.
The language we use every day plays an important role in defining how we experience reality.
There is perhaps no area of human endeavour for which this holds true as strongly as it does for mental health.
There is immense stigma around mental health. There is no way of getting around this fact (although, or course, campaigns to reduce stigma are welcome). Words like “schizo”, “psycho”, “madman” or “nutjob” have all been used to label people with various diagnoses of mental illness. Each of these examples carries a particular sting; a particular taint. These words imply that a person with a mental illness, with or without diagnosis, can be unstable, violent, irrational and a lesser human being.
Clearly we have to change these words. We must obliterate their use.
But things get a bit more complicated when the words used to describe our mental and emotional states are being used by our doctors and psychiatrists and clinicians.
For example, a person may be diagnosed by a doctor or psychiatrist or clinician with “schizophrenia”. Whilst this diagnosis has a relatively clear meaning in the medical world – implying that the person has been experiencing delusions and/or hallucinations over a period of time – the word has unfortunate connotations. A person with schizophrenia may be “psycho”, disconnected from reality, unreasonable, unpredictable and dangerous.
We need to change the way members of the public respond to words like schizophrenia. This involves helping people understand what a diagnosis of particular mental illness means, and what it does not mean.
We need to go deeper still. We must be careful in saying in saying that a person has or experiences their diagnosis, rather than that they are their diagnosis. So for example, I would prefer it if people say “you have schizophrenia” rather than “you are schizophrenic”. My colleague prefers people to say they are “living with bipolar disorder”, rather than “you are bipolar”. To say that someone is their diagnosis is to limit the potential of who and what they can be, and is contrary to principles of recovery-oriented practice.
We have now come some way in talking about mental illness. But there is further to go.
Many people, with good reason, object to the entire business of labelling human experiences as sick or pathological. Under this argument, to even use phrases like “he/she/they have mental illness” again limits their potential, stigmatises them and is contrary to recovery-oriented practice. It is here that the phrase used often in mental health advocacy comes alive: “lived experience of mental health issues”. This phrase has the utility that it does not “essentialise” what would otherwise be the label of a mental illness. It is relatively neutral.
At this point some may say we have taken things too far – this phrase is too long and indirect and avoids the reality of diagnosis. I cannot comment on this argument. However, it is fairly common practice for people working in mental health to describe the people they work for as “having lived experience”; a useful shorthand.
Finally, we have the word “consumer”. This again is shorthand, referring to “people who consume a mental health service”. Whilst the term consumer is short and clear, it may not capture people who have or have not been diagnosed and have lived experience but do not use a mental health service. The term also defines people by their relationship with mental health services; not encompassing everything they can want and be with recovery-oriented practice. Nevertheless, on a pragmatic level it may be “the best that we’ve got”… until something better comes around.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
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Dr Richard Schweizer