Mental Health Narratives: The Language Shift We Need
- Abhisweta Bhattacharjee
- Jul 4, 2023
- 7 min read
Perhaps it is not surprising that the area of mental health has been so systematically stigmatised for so many decades that it has settled for a discriminatory lexicon. Stigma and discrimination are the two biggest barriers to having open discussions about mental health, and the problem largely seems to stem from the language we use.
But first, why does it matter?
Our brains are react to words emotionally. Certain words, such as "abnormal," "psychotic," or "mental patient," can subconsciously trigger negative biases, shame, and hinder individuals from seeking necessary care.
Extensive research on associative thinking in the brain reveals the presence of two systems: the "Feely Brain" and the "Thinky Brain".
While the Thinky Brain tends to be inactive unless prompted, the Feely Brain predominantly guides our thinking process. This is particularly important when it comes to our language. Evidence shows that this rapid-thinking Feely Brain readily responds to words through associative activation, whereby a word evokes ideas that connect with memories and emotions, leading to subsequent cognitive, emotional, and physical responses.
It is a cascade of activity in our brain that happens quickly, with no virtual conscious control. Consequently, our reactions to words occur swiftly and unconsciously, and we respond to words without even realising it.
For example, a 2018 article suggested that doctors should employ alternative language when discussing well-known conditions to aid in the recovery process – like using terms like "normal age changes" instead of "chronic degenerative changes" and "needs more strength and control" instead of "instability."
Language is dynamic, and certain words have evolved over time, acquiring emotional charge and becoming stigmatizing in our modern context. Just as we would have struggled to comprehend terms like "Inbox," "Unfollow," and "Selfie" a decade ago, the use of words like "psychotic" and "neurotic" today is considered outdated and carries stigmatizing connotations.
Communication is key
Journalist Andrew Solomon highlights that many individuals still perceive mental conditions as something shameful, indicating personal weakness or failure, “If it’s their children who have mental illness, they think it reflects their failure as parents.” This self-inflicted stigma often prevents people from openly discussing their own mental health issues.
Neuroscientist Sarah Caddick, explains that unlike pointing to a broken wrist, which is easily understood as a physical problem, discussing the complexities of the three-pound mass inside someone's skull, the mind, evokes anxiety. “The minute you start talking about your mind, people get very anxious, because we associate that with being who we are, fundamentally with ‘us’.” Consequently, conversations about mental health can trigger deep-seated anxieties due to the association with our core selves. [Related: Maybe ‘self’ does not even exist].
Mainstream media and its biases
Do these headlines look familiar? The influence of mainstream news and media on our perception of mental health is significant. Headlines and narratives, as mentioned earlier, can perpetuate harmful stereotypes and misconceptions. For example, associating bipolar disorder with violent acts or portraying individuals with schizophrenia as a danger to society. Solomon agrees that these misleading correlations hinder productive conversations about mental health. It is crucial to dispel the notion that all individuals with mental conditions are prone to criminal behavior or that they directly lead to acts of violence.
According to the National Institute for Mental Health (NIMH), 90 percent of people who die by suicide have depression or other mental disorders, or substance-abuse disorders in conjunction with other mental disorders. Yet the media often overlooks the strong link between mental conditions and suicide, instead focusing on external triggering circumstances. Says Solomon, “Just as the association between mental illness and crime is too strong, the connection between mental illness and suicide is too weak.” No one ever killed themselves because of bankruptcy or because their spouse left them. What drove them was the fact that they were terribly depressed.
Additionally, media, retailers, and social media platforms have contributed to the persistence of stigmatizing, stereotyping, and offensive language. Examples include referring to Brexit as a "collective mental breakdown," selling "mental patient" Halloween costumes, producing documentaries that overly emphasize the role of mental health diagnoses in homicidal behaviors, or even trivializing mental health issues through phrases like "Obsessive Christmas Disorder" on Christmas cards. Exposure to such unhealthy imagery and expressions perpetuates stigma and hampers progress in addressing mental health.
Our everyday dialogue
Our everyday dialogue plays a significant role in shaping perceptions of mental health. It is important to address and challenge stigmatizing language that has become deeply ingrained in our vernacular. Terms like "mentally disturbed," "crazy," "schizo," "loonie," or "nutter" perpetuate stereotypes and should be deemed unacceptable, particularly as they are often learned from a young age.
However, the problem extends beyond explicit derogatory terms. Subtle word choices can also contribute to the perpetuation of stigma. NIMH Director Thomas Insel doesn’t like the category of “mental health problems” in general. He says, “Should we call cancer a ‘cell cycle problem’? Calling serious mental illness a ‘behavioral health problem’ is like calling cancer a ‘pain problem.’” In the book 'Mary Barnes - Two Accounts of a Journey Through Madness' published in 1971, Psychotherapist Joseph Berke wrote, "I needed to refine my understanding of the complex changes in consciousness and behaviour so blithely glossed over by the medical profession as 'illness' and to explore new ways of dealing with people who enter into such states."
Another issue lies in how we define individuals based on their mental conditions. Phrases like "I am depressed," "He is schizophrenic," or "She is bipolar" define a person solely by their mental conditions. Comparatively, we do not use such defining language for physical conditions. Just as a tumor does not define a person, the same should apply to mental conditions. While the line between mental health and a person's overall identity can be blurry, it is crucial to make a distinction. People often exercise caution when revealing a mental condition due to the perception of incompetence or dangerousness. Caddick says: “There’s a lot of things that go on in the brain, and just because one thing goes wrong doesn’t mean that everything’s going wrong.”
Separating the person from the problem is essential. Referring to "someone with schizophrenia" rather than "the schizophrenic" honors and respects the individual, acknowledging that the condition is something they are living with, not something that defines them. Identifying someone as simply a “patient”, “service user”, or a “schizophrenic” implies that this is all the person is - that this diagnosis defines them. It is important to use language that allows for the existence of other aspects of a person's identity alongside their mental conditions.
Furthermore, we should be mindful of using the word "suffer" in relation to mental ill-health. While it is crucial to acknowledge the impact and suffering that individuals may experience, we should avoid implying that a diagnosis equates to a lifelong sentence of suffering. By doing so, we create space for hope, recovery, and the recognition that a person's life encompasses more than their mental health condition.
Social media – the double-edged sword:
Social media has emerged as a powerful tool for raising awareness – shattering the stigma around mental health at lightning speed. We are watching celebrities and friends talk openly about anxiety and depression. We’re downloading meditation apps like Headspace and Calm from the advertisements we see. Finding solace in the shared experiences of others on social media also fosters a profound sense of community and reassurance. However, the abundance of material online is somehow not equating to greater public understanding of mental health.
Insensitive memes and posts that aim to generate laughter often shock and offend others. A meme on how all women are ‘bi’ (sexual or polar) went so viral that there are now tee-shirts being sold off of it. In the holocaust of capitalism, anything that gains attention will be commodified and sold, without any deeper consideration of its value. While humor can help address stigma, trivializing or reducing diagnostic terms to adjectives should be radically avoided.
Moreover, the dramatic use of clinical terms on social media has seeped into our everyday language. Ordinary feelings of sadness or disappointment are now equated with depression, natural mood swings with bipolar disorders, tidiness with OCD, and nervousness with anxiety/panic attacks. To add to the complexity, it has become "cool" to have a mental disorder due to the increased attention mental health has received. Social media's focus on what is trending has led to the exploitation of mental health conditions for likes and engagement, creating a jarring experience for many users.
Dan Reidenberg, the executive director of the suicide awareness organization SAVE says that the demeaning aspect of this trend cannot be overlooked. By trivializing true conditions or reducing them to someone's identity, we do a disservice to everyone involved. As Katy Waldman wrote in the New Yorker article 'The Rise of Therapy-Speak', “We ‘just want to name’ a dynamic. We joke about our coping mechanisms, codependent relationships, and avoidant attachment styles…We diagnose and receive diagnoses: O.C.D., A.D.H.D., generalized anxiety disorder, depression. We’re enmeshed, fragile.”
Unfortunately, social media can also perpetuate misinformation and misinterpretation of mental health issues. One instance involved a TikTok video claiming that excessive childhood reading was a sign of "dissociation" and childhood trauma. Eleanor Cummins wrote in the Atlantic, “trauma has come to signify a range of injuries so broad that the term verges on meaninglessness.”
What can I do?
“Being thoughtful with the language we use validates people’s experiences and helps us better relate to one another,” says clinical psychologist Lynn Jonen, Ph.D, Clinical Director for Sierra Tuscon. “I view life as a continuum of different experiences that don’t necessarily have to be permanent,” says Jonen. “Ultimately, the goal is to help people feel safe and lose any shame about what they’re experiencing so that they’re empowered to make the changes that they want to make.”
Furthermore, self-advocacy plays a significant role in reaching out to others who may be going through similar experiences, as well as educating the general public. Sharing personal experiences can have a powerful trickle-down effect, promoting empathy, understanding, and destigmatization. It is equally important to exercise caution and sensitivity when using vocabulary from serious literature or mental health discussions, as these terms can make their way into everyday language and impact people's perceptions and attitudes.
A great relevant resource we found online was Stand-up-to-Stigma.pdf (maynoothuniversity.ie).
The power of language is immense, and it requires a collective effort to ensure its responsible use. We are excited to announce our upcoming project to develop a comprehensive glossary of terms that are not suitable for discussing mental health, accompanied by suitable replacements. This seemingly small task is, in reality, a significant endeavor, and we would greatly appreciate your help.
We invite you to join us in this important initiative. If you're interested in getting involved, please don't hesitate to reach out to us by sending an email to mibraincontact@gmail.com. Let's work together to create a more compassionate and respectful language around mental health.
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