This post is about ‘neutral language’. It’s about why it makes no sense to use such a phrase and make arguments based on it.

I’m writing this post still recovering from the discussions on my last post, on language-use guidelines. I heard so many times that I don’t understand something that I was considering counting them. It seems I also undermined half psychology (only the good half, of course) and went to the dark side of the force. Needless to say, I wrote my post because of my various vested interests. Oh well, this post is likely to land me in hot water again.

One of the arguments used in the discussion was about ‘neutral language’. It seems I didn’t understand that I was against rules imposing the use of ‘neutral language’. I think this issue is worth responding to at some length.

First, let me say that that it is never clear what people mean when they use the expression ‘neutral language’.  I actually think that the expression is just a label (it is ironic, to be honest) which is attached to words (I am yet to hear of neutral grammar) the user of the expression likes. The way I understand it (and what I think might be understood by it) is that ‘neutral language’ refers to such words which do not (explicitly or implicitly) take a particular (ideological) stance or a point of view.

The problem is that there is no such language. Every language use, I mean, every language use, carries with it a host of assumptions for example about the world, the interaction, the person you communicate with or indeed yourself. Basically, it encodes a worldview of which we might, but also might not be aware of.  For example, the sentence “The sun is rising.’ carries a number of assumptions about what moves and what is stationary in the sky, even if you don’t give it another thought.

Similarly, when you say  a simple ‘Hello, Darek’ to me, you in fact make assumptions about our interaction and relationship. In other words, you take a stance as to where you want to position yourself with regard to me and vice versa. Is it neutral? Hardly. In the same way, when asked whether I am in my office, if you want to respond seriously, you are more likely to say: “Yes, I’ve seen him.”, rather than “Yes, I feel his presence”. This is because you take a stance, for example, as to what evidence is. Neutral? Hardly.

Yes, you might now argue that “Yes, I’ve seen him.” is more ‘neutral’ because it’s more common. That, however, would make ‘commit suicide’ very neutral (is neutrality a scale?), as it is, judging by experience, considerably more frequent than ‘die by suicide’. And yet quite a few suicidologists want to get rid of the former expression. For what it’s worth – on balance, I think they’re wrong.

And then, I challenge anyone to tell me what is the ‘neutral’ way to talk about sex. Would it not be a context-dependent spectrum starting with silence and ending with talk which would make me blush? It simply depends. And while, knowing my grandmother, she might never have used  (the Polish equivalent of) the word ‘blowjob’, in contrast, I have just used it publicly. Which is more neutral? Silence or a blog?

But all these examples do not get us closer to the issue I am ‘really’ writing about – medical language. The problem is that things, again, are complicated and if ever I have to, for example, talk about sex to my doctor, I will never ever use ‘blowjob’ in front of him or her, I would speak of ‘oral sex’. Again, I challenge anyone to say that medical language is not ‘neutral’ in such a context. Moreover, some time ago, I wrote about my insisting that an optometrist use the word ‘strabismus’ and not ‘squint’. I have no idea whether either was neutral, but I wanted the former. In any case, I was making assumptions by the dozen saying it. Neutral? There is no neutral language and there cannot be.

I hope by now it is also completely clear that any idea that an academic/clinical discipline can have a neutral language is just nonsense. Every term has a whole history of use, research, assumptions, measures…To say about all this is ‘neutral’, makes no sense at all.  Now, I accept entirely that you might want to replace a word or a set of words with another one. In fact, psychopathology has a whole history of word changes. But to say that when you replace, for example, ‘patient’ with ‘service user’ somehow the latter is neutral is, again, nonsense.

The same applies to the example that I was faced with. Apparently, ‘hearing voices’ is ‘more neutral’ than ‘schizophrenia’. I think, again, it is completely implausible to make such a claim. ‘Hearing voices’ is by now a term which is explicitly used as resisting the noun ‘schizophrenia’ and as such it just cannot be ‘neutral’. It is as political as any other psychopathological term. Now, I want to stress that I completely accept that there are people for whom such a change is useful and helpful, I actually sympathise with them.

They should also use ‘service user’ all they want; some might use ‘psychiatric survivor’ (is that more neutral than ‘patient’?). But for pity’s sake, don’t speak for me and don’t make me use it. I actually prefer to be a patient with all its connotations, which I actually understand quite well. In fact, I choose to use the word, because of those connotations. And I completely reject the notion that somehow if I say ‘patient’, that’s less ‘neutral’ than if I say ‘service user’. Once again, such an argument is complete nonsense.

Now, I want to end with a couple more issues. First, who gets to decide what words are neutral and which are not? It’s important because this is about the power over how I can speak. If I ever wanted to publish in anything associated with British clinical psychologists, I need to speak the way they prescribed. I cannot, for example, use the word ‘patient’, even though I firmly want to. And yet, a group of people decided that I cannot. Do I believe that I am silenced with good intentions? Well, with some persuading I could be. But let’s at least make it quite a clear. Silencing is always an extremely powerful act. Not many people can speak so powerfully. It seems clinical psychologists can, it seems.

Second, I want to re-state what I said before. Time and again, I see mental health care (whether psychological or psychiatric) reduced to ‘language’ (which, really, means a few of ‘those’ words) and in particular having or not having ‘the label’. Yes, labels are important – as my point about ‘strabismus’ suggests, psychiatric labels are likely to be even more important. Yet, over the years, I have listened to all too many clinical interviews (by both psychiatric and psychological). In my view, it is considerably more important to make clinicians sensitive to a host of speaking practices. You know, a psychologist can call me all they want, but if they don’t listen to me, what good does it make? And I am yet to hear a psychologist (or a psychiatrist) admit that they messed up their interview, let alone apologise for it to their patient. And so, I keep challenging this implicit assumption that all that matters in psychological (or psychiatric) language is about changing a few words, and it’s always like running into a wall. You can argue about diagnosis and formulation till you are all blue in the face, it really makes no difference if you can’t ask a simple question. And believe me, a lot of you can’t.

Finally, Polish clinical psychology has for years been based on what British psychologists call formulation. Polish psychologists do not do any nosological diagnosis, in fact, they are very strongly discouraged from even engaging with it. And I have bad news. It really has not transformed psychology or patient experience. Because the problems are located elsewhere. I wish their British colleagues started reflecting on them, stopping prescribing what can and cannot be said.