The 20th century saw a revolution in how mental health difficulties were perceived and discussed, both by health professionals and by the public. By the beginning of the 21st century, many medical and psychological terms from classification systems like the ICD (International Classification of Diseases), the RDoC (Research Domain Criteria) and the DSM (Diagnostic and Statistical Manual of Mental Disorders) had filtered into the public domain, and are now widely used. It can be difficult at times to know the meaning of these sometimes complex words, and also to know when to use them. What is the difference between a friend who is sad and one who has depression? Most experts now recognise that this is a very difficult distinction to make, and that our understanding of these conditions and their nature lags far behind what our long lists of exact diagnostic terms may seem to suggest. So, how can we learn to talk sensitively about such complicated and still misunderstood issues? Here are some points to keep in mind when talking about mental health difficulties.
1. Just Ask
Discuss the words and labels openly. Be honest, and know that it is okay to say “I’m not really sure what words to use” or ask someone directly what term they prefer to use to describe their mental health difficulties. It is important to listen carefully to the way a person speaks about their own difficulties, and pay attention to the language they use. For example, if someone with a diagnosis of Bipolar Disorder says “when I am having a manic episode” or “when I have mania”, and uses that phrase freely, it may be okay for you to use it too in discussing it with them. However, if they say instead “when I am not myself” or “when I am sick”, you can take your cue from this and say “when you are not yourself” or “when you are sick” as opposed to “when you are having a manic episode”.
2. A Person, Not a Label
For health professionals especially, it is easy to drift into seeing the label rather than the person. Any two people who may share the same diagnosis or label can have vastly differing experiences of it. A simple way we can remind ourselves to pay attention to the person is to use the phrase “a person experiencing X” rather than just a label itself, for example to say “a person experiencing psychosis” rather than “a psychotic”. This can take some getting used to and seem awkward at first, but it is worth the effort as it can influence how we think about that person, and how the person feels about themself.
3. If It Offends, It’s Offensive
Words that are well intended can be perceived as hurtful and many benign phrases have become insulting over time. For example, words like “lunatic” and “hysterical” were once used frequently by legal and medical professionals and even included in textbooks and in laws. These phrases have passed into history for the most part, but more recent terms have also evolved to become insulting. Perhaps one of the saddest examples of this is how the phrase “you need help” has become an insult and a euphemism for mental health difficulties in modern society. Whatever the phrase, if a person with difficulties finds it offensive, then avoid it. One person may welcome their difficulty being called an illness, since this can increase access to health services, reimbursement by insurance companies and things like rights to time off work. However, for others, using terms like illness or sickness may increase perceived stigma and feelings of social isolation. We are all different, and should strive to respect each other’s individual experience and preferences.
4. “Mental Health Difficulties”
Broad terms like mental health difficulties cover a range of experiences without the need to assume an understanding of the underlying nature or causes of the difficulty. There are times and places where more exact labels can be appropriate and useful (for example, in scientific papers), but they can also lull us into believing that we can fully understand someone’s difficulties just by knowing the name currently given to it. There are also times and places where we need not use a particular word, phrase, or label at all, and the right thing to do is just to listen. When the occasion does call for us to use some word or phrase to describe the different problems with mental health that many people face, the general phrase “mental health difficulties” can be helpful.
We can all empathise with having difficulties, whether we have ever been assigned a diagnosis. This helps us to remember that mental health difficulties are something experienced by all of us, in very differing ways and to differing degrees of severity.
If you have personal experience of mental health difficulties and would like to contribute to scientists’ understanding of which words we should use to describe them and how they make people feel you can follow this link to participate in an anonymous, open-ended response questionnaire.
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