The language manifesto

Language matters. And wherever I see the catchphrase, I wish I had some hair to pull out. Just about inevitably, whoever says/writes it, they refer to some words which should or should not be used. So, tired of ‘language matters’ as I am, I decided to write a post on what I think the slogan should mean. So, here is my language-matters manifesto!

Over the years, I have sat on or listened to recordings of more psychiatric or psychological interviews than I care to remember. Yes, of course, there were some good ones, but more often than not, I was just flabbergasted by what I heard. I heard both psychiatrists and psychologists simply incapable of asking a patient simply to talk. They just pummelled their patients with leading questions, with assumptions that made my teeth ache, forcing them to say what say what the clinician wanted to hear. I fell out with colleagues/friends who asked me to comment on their interviews, as they told me that I was unreasonable and biased.

I keep wondering whether a friend who showed me a fragment of an interview in which they rammed their assumptions down their patient’s throat really believed the interview was good. It was an interview in which a leading question followed a leading question and the patient finally asked whether she was supposed to repeat what the doctor said. I lost a friend after we talked about the interview. And that still wasn’t the worst interview.

The worst interview I heard was conducted by a British shrink – it was so bad, I cancelled a research project, knowing that disclosing such interviews would undermine the medic completely. The psychiatrist didn’t even ask questions. They were speaking for the patient, expecting the patient to agree. The second project that couldn’t happen was in Poland – the psychologists who were asked to do the interviews were incapable stick to the question schedule, deciding that forcing informants’ answers was the way to go. In both cases, however, all were convinced of their communicative greatness.

Over the years, I got used to women being asked about housework and men about paid employment. I got used to two or three questions at a time making it impossible to understand what the patient’s answer referred to. Intimate questions, questions about remote family, and just inability to use verbs were just so frequent I stopped caring. It seems a shrink or a psychologist are simply incapable of asking how people sleep, they just must ask what sleep is like.

I guess my favourite is when a psychiatrist asked a patient:

Are you more depressive or more manic now?

I want to stress: it’s a real question asked by a real psychiatrist. And I fell off the chair when I heard it. It’s a little gem which in a nutshell shows how wrong you can get it. I was wondering if the patient’s answer would include a useful reminder than the bipolar disorder is coded F31 in the ICD-10.

Closely following are questions such as:

Was there generalised anxiety?

And here is my problem. With this kind of level of communication skills, do you really want to worry about a word or two? I do beg your pardon – about a label or two! I might be unlucky but coming across a clinician who is simply capable of conducting a conversation is like finding a unicorn! So, do forgive me that I find language guides quite problematic. And I really don’t care whether they are media guides or guides for clinicians, you really do have much more pressing issues to worry about.

I’d say that instead of banging on about ‘labels’, you could teach trainee clinicians to ask questions, so you don’t come ask them in the Justyna Ziolkowska described it. I urge the clinicians to read her paper and ponder for a while the fact that psychiatrists seem not to be able to ask questions which simply get patients to talk. And please beware of making an assumption that Polish psychiatrists are different and inferior. They’re not.

Instead of talking about ‘the labels’, you might put some energy into making clinicians aware of language in general, and not only a few words you do or do not like. Please do note that I make this last point about clinicians in general. Why? Well, because I went to the newly established UK’s Association of Clinical Psychologists.

I didn’t spend much time (life is too short and Netflix awaits), but in the minute or two of perusing the website, I came across the statement about how ACP UK works. Here is the first paragraph:

We have an elected leadership team of clinical psychologists with representation from the four nations and experts by experience. We have members who have expertise and experience in specific specialities who provide expert advice and comment in response to consultations, in response to relevant national events and to publicise the profession proactively.

One paragraph and so many problems. Let me point to two of them. First, the pronoun ‘we’, considered by some to be the most manipulative word of them all. There are two uses of the pronoun:

  • We have an elected leadership team of clinical psychologists
  • We have members who have expertise

and I hope you have all noticed that from one sentence to the other, the pronoun changes its identity, as it does not refer to the same group of people. In the first instance, it is likely to refer to members in general, in the other it cannot. Members cannot have members, so, it is more than likely to refer to the ‘leadership team’. I’m always suspicious of such changes and in this case the problem is what follows the above paragraph:

  • We create task and finish groups in response to national issues and proactively as a result of strategic decisions by the leadership team.
  • We provide accessible and timely professional advice to members and a legal advice service for those having difficulties with employers or the HCPC.
  • We will provide professional practice guidelines for clinical psychologists in general and for specific specialities and their services.

and I am lost as to who exactly is ‘we’. Who does all these things, the membership or the leaders? Judging by the last reference, this is the ‘leadership team’ speaking and, interestingly, the general membership is nowhere to be seen. And yet, the statement starts with a reference to the general membership and I wonder why. What do the initial sentence and the identity shift aim to achieve?

Still, I’m not a member, but if I were, I would like to be involved a little bit at least. You know, just a slim sliver of the pie. However, I have no idea what ‘reality’ is like. Maybe the pie is sliced with equity, as I hope. But then perhaps it’s worth looking at what and, crucially, how you write!

Moreover, on reading the paragraph I immediately wondered who elected the leadership team and if it was the general membership, why it is not stated explicitly. I can also see how the membership can have (own?) the team, for the life of me, I cannot see how the leadership team can have (own?) members. It’s an unhealthy relationship, don’t you think?

The second point I would like to make concerns this little snippet:

an elected leadership team of clinical psychologists with representation from the four nations and experts by experience

and that raises the question about the so-called experts by experience (EbEs). So, why is the representation of psychologists made on the basis of their nationality and the EbEs’ not? Do EbEs not have nationality and are miraculously transported outside the concerns of the nation-state? Are Scottish EbEs somehow homogeneous with those from Wales and Northern Ireland?  Whatever is the case, what transpires from this little half-sentence is that psychologists and EbEs are groups of people that are constructed to be unequal. That, perhaps, is inevitable, after all, this is an organisation for psychologists, but do you really want to make a point of this?

I could go on, but I would be getting more and more unkind and I just wanted to point to a problem or two.

And here is the point I want to make. I think before you, as a profession (professions), start telling people how to speak, it might be a good idea to understand and reflect on the language you yourselves use. I think the two clinical professions (there is significant variety, of course), on balance, are so far away from getting to grips with the language they work with that if language matters, they should urgently start looking at their language.

A few years ago, I had a conversation with one of the top Polish psychiatrists. We talked about language and he was telling me how important language in psychiatric practice was. I nodded and asked what he meant. Disappointingly (at the time) he offered me exactly the same spiel as I have heard many times since. If a patient says a particular word, instead of the word the shrink expects, that’s significant. I see, I said, and what about the fact that none of the patients in depression I interviewed ascribed depression directly to them. In other words, none ever said anything akin to:

  • I am depressed.
  • I am ill.

Instead they said:

  • When one is ill…
  • When you are depressed….
  • Depression is….

Given that people in depression are said to almost universally have insight, shouldn’t they have said the former?  He was taken aback. It was so outside anything he even considered considering that he had nothing to say. He mumbled something vaguely patronising. And that’s my experience of language conversations with psychologists and psychiatrists. Words or labels, depending on whether you talk to a regular clinician or a critical one. When you attempt to take the argument further, the eyes glaze over.

So, I suggest a linguistic call to arms. Stop worrying about ‘labels’, stop worrying how people talk. But do start worrying about how you yourselves speak/write, both in clinical and public settings. Stop knowing better what language is and consider that the mantra ‘language matters’ is just about meaningless, unless you start considering language in its full complexity.

 

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