Is it about language?

This post is a response to  “Mind your language”, ‘a guide to language about mental health and psychological wellbeing in the media and creative arts’, written by Peter Kinderman and Anne Cooke. Apart from a comment on the document, I also want to suggest that quite a number debates and documents which are presented as being about language, in fact are not.

Indeed, I think that the document Kinderman and Cooke wrote is not about language at all. Rather, it is a statement about values (ideologies, if you prefer). Yes, of course, those values are carried by language used, this doesn’t mean, however, that the issues written about in the guide are actually linguistic.

Have a look at the first instance. The two psychologists object to the following sentence:

Adjust your medication.

I cannot see any problem with the sentence at all. None of the three words carries any value, it’s not offensive in any way. In fact, I have been told many times that my medication needs to be adjusted. Basically, Kinderman and Cooke encourage people to be sensitive when communicating about mental distress. Needless, to say, it’s difficult to disagree with such a piece of advice. Is it about language? It can be, if words commonly perceived as offensive are used, but there is nothing wrong with the language of ‘Adjust your medication’.

Incidentally, references to medication are used not only when addressing people with ill mental health. Also here, however, the issue is not language, but contextual use of the stigma attached to mental illness through which references to medication are interpreted. In fact, most benign of words can be used in this kind of way. For example, sentences such as:

  • It’s OK to talk.
  • You need help.

given the context, can actually be used in a stigmatising way. Why? Because it’s not about language!

The second issue the two psychologists point to is the problem of medical language. I have written before about difficulties of identifying, for example, ‘vocabulary of disease’. Indeed, the picture of DSM-5 in the guide suggests that somehow using language from that book means using ‘medical language’, which I think is untrue and, again, the boundary between ordinary language and medical language is far from clear.

Now, I quite dislike the leap between ‘medical language’ and diagnosis which is made by the two authors. Medical language doesn’t need to be associated with diagnosis. Words such as ‘mood’, ‘confidence’, or ‘thoughts’ and ‘voices’ are all medical (they are used in diagnostic manuals, at least), yet they are hardly diagnoses. The reverse is true as well – diagnoses do not have to be made in ‘medical language’. For example, clinicians do talk about diagnosis of depression, even though ‘depression’ is not a medical term. It is commonly used to refer to the depressive episode. Somewhat surprisingly, the authors actually do use the word ‘mood’, which is used in the diagnostic criteria of the depressive episode. It means it’s a medical word, isn’t it?

And so, the authors who are opposed to psychiatric diagnosis, suggest that references to diagnoses be avoided. Is it about language? Of course not, it is, rather, about a particular point of view and I wish the authors had been open about it.

The authors then talk about offensive language, such as ‘psycho killer’ and that’s one of only two aspects of the document which is vaguely about language itself. Yet, the reference to such expressions is followed by an explanation that people with a history of mental illness discuss false associations of mental illness with crime. Again, the authors make language use irrelevant.

Now, Kinderman and Cooke suggest that words such as ‘schizophrenic’ should not be used (that’s the other moment when the authors are vaguely concerned with linguistic expressions). Yet, the argument that ‘labels are for things not for people’ is disingenuous. You will find a Twitter hashtag #autisticsinacademia, which uses the label ‘autistics’, much like the label ‘schizophrenic’.  The label is used by people for a variety of reasons and it’s hardly appropriate to tell them to stop. Indeed, the use of ‘autistics’ is another example of subverting potentially stigmatising language for in-group identification, a phenomenon which we, linguists, have known about at least since the work of William Labov. Also, the Polish psychiatrist Antoni Kępiński wrote very poignantly about the use the label, suggesting that it acknowledges the sometimes overwhelming experience of schizophrenia. Whether he’s right or not, doesn’t really matter. I just wish the authors acknowledged how complicated the issue is. But at least, this issue is about language use.

And here we come to the section which I find particularly problematic. The two psychologists dislike words such as:

Ill, diseased, disordered and dysfunctional

What’s wrong with the adjective ‘ill’? In which dictionary is the word problematic, offensive, bad? Ill, as the Internet tells me, means ‘suffering from an illness or disease or feeling unwell’, and if the guide is about language, I would like to know what exactly is wrong with the word! Once again, the guide into language is really a guide into the perspective on mental health proposed by the two psychologists. They simply don’t particularly like talking about mental illness. I just wish they didn’t construct it as problem of what language to use. Their advice is not about language at all.

It’s also ironic that the authors happily use the phrase ‘mental health’ which seems to medicalise mental distress. You can hardly argue for not using expressions such as ‘mental illness’, if you at the same time talk about mental health. Similarly, the authors happily use the word ‘psychosis’ which is hardly ordinary. I’d even suggest that it’s primary use is medical.

Now, I must admit that I also share concerns voiced in a Twitter discussion that the text trivialises suffering. Here is a fragment:

For example many people assume that “clinical depression” is fundamentally different to the low mood that many of us experience from time to time. However in practice the term usually indicates not a different type of depression, but rather that he person’s mood has been so low that they have sought professional help.

I understand that the authors want to suggest that there is a spectrum of low mood and clinical depression is on this spectrum. I think, however, this fragment is quite unhelpful. As it happens, I spoke to many men in ‘clinical depression’. I think describing their experience as simply something for which ‘the sought professional help’ doesn’t even begin to describe the suffering they experienced, including attempts to take their life. Moreover, constructing suffering in terms of getting professional help not only blanks suffering, but also institutionalises it, which, again, seems quite ironic. People suffer, people suffer unbearably, regardless of whether they do or do not seek professional help. Professional help neither authorises, nor legitimises suffering. And I would hope that clinical psychology, which explicitly aims to work with people’s experiences, would acknowledge it. Finally, suggesting that depression is simply about low mood is not only unhelpful, but also untrue.

In conclusion, the authors again talk about ‘ordinary language’, which, as I said a number of times, is a straw man argument. I find nothing ‘ordinary’ in phrases such as

  • difficulties in intimate relationship
  • mood swings
  • has been given a diagnosis of…

I also think that references to mood swings can be extremely stigmatising (and gendered!).

And finally, the most disappointing bit of the document is this sentence:

But avoiding the traps outlined here will avoid unwittingly misleading people and make for better, more accurate, more elegant, journalism.

Really?! People who disagree with your document will be misleading? And if they agree with it will be more elegant? I think it’s very disappointing to read this.

Let me finish with a couple of comments. First, Peter Kinderman and Anne Cooke’s guide to language is not about language. It is, as I said, a statement of values, an ideological perspective (with parts of which I have much sympathy, with others I don’t). But what I particularly don’t like is constructing it as about language. Alas, I think that this more common than it should be. Quite a lot of ideological debates about mental health are constructed as about language. I think in such a way the debate is rendered as about more ‘objective’ things, which, in addition, are easily fixable.  Such discussions suggest that the main issue in mental health is language. But while language matters (yawn), but there is much more to health and illness than language used to describe them. Again and again, the way we speak has multiple sources.  We didn’t start using certain words because we just fancied them and now, we shall simply decide to change them. Just because we abolish the word ‘schizophrenia’ doesn’t mean that people will stop stigmatising certain experiences. They will not.

A couple of posts ago I wrote that I wished clinicians stopped talking about language and started talking about how to help me. I urge Peter Kinderman and Anne Cooke to write about how to help people, not how to speak about them. I know that writing about ‘language’ is considerably easier, though.

Second, ad nauseam, any guide to language must necessarily be acontextual. And that’s why I keep objecting to guides. Moreover, what always strikes me is that it is particularly psychologists who are bent on imposing a way of speaking on people. And I still think of psychology as a professional practice which should follow me. And I wish psychology would not presume what is useful for me. And while I do accept the good intentions behind language guides, they are your guides and not mine. And I wish you also acknowledged such guides as your perspective. An option and nothing more. It worries me that the guide in question is constructed as the right way and any deviation from it boils down to misleading. This is not only untrue, it is also counter useful in the extreme. As you profess to want to help individuals, how about offering them the freedom and right to construct their experience in a way which is useful for them?

 

1 Comment
  1. As a counsellor it isn’t my job to help my clients. If I wanted to help people I’d have found a career in customer service. Nothing in either my education or training has taught me how to help people. I’ve been working in community for a decade & I’ve not ”helped” one person.

    What I have done is worked alongside someone as they’ve created change. Be that change in their clinical symptoms (the things that the DSM deals with) or the other areas of everyday that MI affects – relationships, employment, parenting, confidence, domestic space, subjective well being etc.

    You’re right in saying that this is all about values. It’s about a systemic shift in cultural values. You’ve not once adjusted your medication, what you’ve done is work (within a structured & hierarchical power dynamic) with your Dr to make decisions about the type of drug and/or dosage of drug. It wasn’t something you & you alone do/did. And so ”adjusting your dosage” is the wrong statement. Working with prescribing doctor to make decisions regarding your prescriptions is more accurate. And it also recognises the collaboration that is required to be in care. We are not passive receivers of healthcare. We work with our providers, I work with my clients, in order to make the best decision, with them, as possible.

    I’m Australian, our whole mental health framework is this. We have a wonderful organisation called Blueknot; which is a pioneer in this cultural shift. The NSW mental health commission has great recourses on recovery orientated & trauma informed language. Homelessness services are also working within this language too. Also check out some of the First Nations & refugee service providers; again situated in the values/language paradigm shift.

    While clinical psychology may be, finally, catching up, I can promise you that those of us working within community have been doing this for years.

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