I tend to protest against simple all-or-nothing guidelines of language use for healthcare professionals. Apart some particular contexts, such instructions tend to be counteruseful and, in my view, should not be proposed. This post is about one such set of guidelines.
Before I start, let me repeat, with some exasperation, that this post is, again, about the context. What works for one person, might but, importantly, might not work for another. And so, apart from guidelines of offensive language (and I do understand that various people might understand it differently, but there you are), any rules of language use in clinical (and not only) context are more than likely to fail. In fact, I would suggest that there are, perhaps, two reasonable guidelines. One is: don’t make any guidelines, the other is, if you must have a guideline, follow the person you speak to.
And here we come to the example I want to give. The document was quoted in a Twitter exchange under my tweet that, as a patient, I can speak about my illness in any way I please. Such statements tend to be greeted with understanding, especially, by psychologists, but then @RoseAnnieFlo quoted the Guidelines on Language in Relation to Functional Psychiatric Diagnosis.
Let me be blunt. This document is as far away as possible from any negotiation, acknowledgment, let alone acceptance of my language and, in the process, the way I, a patient, construct my experience. I am very disappointed with it and, I suppose, this post is partly an expression of this disappointment.
The document introduces three principles, which, the authors say:
are intended to suggest a range of possible alternative descriptions, and it is left to authors to decide which might be most appropriate in a given context.
I hope you are all in awe of the ‘tolerance rhetoric’. Alas, it disappears very quickly. The first two principles are introduced by these two sentences:
- Where possible, avoid the use of diagnostic language in relation to the functional psychiatric presentations.
- Replace terms that assume a diagnostic or narrow biomedical perspective with psychological or ordinary language equivalents.
Bloody hell, that’s a bit forceful, isn’t it? Do I, as a psychologist, get to choose? Note that while principle 1 is introduced with the hedge (roughly, an expression modifying the range of the sentence) ‘where possible’, principle 2 is just an order! Where is the choice, for pity’s sake, the alternatives I was promised in the introduction? Could I at least be allowed to consider replacing? Or do I just get on replacing or else?
To be honest, I would suggest replacing ‘principle’ with ‘commandment’ and have it engraved on a stone tablet!
But let’s consider principle 3. This is the situation when the psychologist cannot not use ‘the narrow biomedical’ as opposed to the non-adjectivised psychological wonder-language. There is recipe for this as well. Apart from “indicating awareness of its problematic and contested nature” (obviously psychological language is natural, uncontested and comes from God or evolution, depending on your worldview), you could also use:
quote marks round the diagnostic term, and explaining the reasons for this either in the text or in a footnote.
In case you wonder, yes, this applies also to service user accounts. Well, let’s face it, social stigma just isn’t enough, so psychology can always pile on and make sure that patients are made to look stupid for using the, you know, problematic, contested, narrow(-minded) biomedical and what have you. You can always count on psychology and its quote marks.
Of course, there is more. I have already suggested the subtle normalisation of psychological terminology contrasting it with the ever negatively valued psychiatric one. The bad language is just replaced with the ‘neutral one’. Could I just ask whether the authors of the guidelines actually believe that? Can you really stomach this lovely juxtaposition of “psychological or ordinary language”, which introduces just a smidgeon of ambiguity as to the meaning of ‘or’ and perhaps a hint of a suggestion that ‘ordinary’ can be used as a replacement for ‘psychological’? Really?!
Now, I understand that replacements for the words you don’t like come straight from the ideological assumptions you make. In general, I am actually sympathetic – I do like your stressing of social contexts. But where my sympathy ends, is where you simply impose things on me just because you can. You see, personally, I really do prefer being a patient, mental illness, for me, is not ‘emotional distress’ and I really prefer to be treated rather than ‘supported’. ‘Supported’, I really can’t help it, is just patronising for me and it helps you underscore your superiority and my weakness. But I am happy to accept that it’s just me. Do I count, though?
Yes, I hate being asked about my symptoms, but this is because most doctors and psychologists don’t actually understand what a symptom is. Incidentally, whenever I explain, they seem puzzled, which is consistently a source of merriment.
Now, I fully understand why clinical psychologists want to attract attention to the language which is used in clinical settings. I think it is very important how clinicians talk to their patients (look at Rose McCabe’s research). Yet, to be honest, I am much more interested in clinicians being able to ask me a sensible question, listen to my answers and not ignore them. It is waaaay more important than whether they call me a patient or a service user, or whether they use the word ‘anti-psychotic’ and not ‘neuroleptic’ or the other way round (yes, I read Moncrieff’s wonderful account of the name change). While I accept that there might be patients who care a lot about this, myself, I don’t and you can call me Little Bloody Red Riding Hood for all I care, if you actually can help me suffer less. And I write this in my apparently eminently ignorable ‘insignificant pain’ while you are having another battle of language about which I really don’t care. Really, words cannot express how much I don’t care.
And this is where we come to the non-linguistic point of this blog. When I read the introduction to the document, I was struck by its rationale. I hoped at least for some Dariusz-centred rhetoric. But no, it’s not about me and my suffering at all. In fact, this document is about this:
In this rapidly-changing context, new guidelines for language use in DCP professional documents and publications are needed to ensure consistency with the emerging evidence, with a psychological perspective, and with our publically-stated position.
You actually don’t give two hoots about me, the document is to make sure that your publically-stated position is enforced. And if you, my readers, wondered, what is the source of the strong, unrelenting language, here you have your answer. No, it’s not about ‘helping people’ or giving them choice or all this rhetorical crap (I do beg your pardon). No, it’s about making sure that everybody toes the line.
At the end of the document you ask for feedback. Here is mine: Shred it!