On language arguments

Some time ago, Peter Kinderman and Anne Cooke proposed a guide to “language about mental health”. I commented on it at the time and while I don’t think my comments should be seen as imperatives, I am disappointed that the two psychologists simply ignored the arguments. The latest version of their guide still has little to do with language. Running quickly through some of the problems, I would like to take up the issue of language arguments in mental healthcare.

So, the document still doesn’t address that a sentence like “Adjust your medication” is not offensive at all, that diagnostic labels are frequently used by people who ‘wear’ them; I still would like to know what is wrong with the word ‘ill’. I also don’t understand why the authors use the phrase ‘mental health’, as, inevitably, it implies that there must be mental illness.

What’s the reason for writing:

“Whilst some people find the term ‘OCD’ useful, it’s often better just to say what the person does or is anxious about.”?

Why is it better, apart from the two authors’, I assume, strong conviction? Is there research that most people with the diagnosis of OCD don’t accept it? And even if they didn’t, is it enough of a reason?  I must admit that if I were a person who finds the term ‘OCD’ useful, I would feel strongly patronised and gaslighted!

To make matters worse, the above piece of advice seems quite contradictory with this:

When writing about these issues, the best option is usually to use the words that the person him or herself uses.

Do make up your mind! Do you think the term ‘OCD’ shouldn’t be used or should journalists use the words used by the person themselves?  And so, are you really implying that the terms ‘OCD’ is not used by patients?

Finally, I am so tired with countering the arguments about medicalising language, let alone the phrase ‘language of disorder’, which was used in a tweet. As I wrote a number times (for example here), the boundary between ‘ordinary’ and ‘medical’ language is far from clear. As for ‘language of disorder’, I don’t really know what it is. I doubt very much there is anything that could be sensibly described as ‘language of disorder’, much like there is no such thing as ‘vocabulary of disease’. In my view the only function of such phrases is to persuade (I really don’t want to use the word ‘manipulate’) people and not to describe reality. And I do wish psychologists stopped using them. They hardly contribute to any sensible debate.

The Kinderman-Cooke guide is not about language. It is a statement of belief and value by the two psychologists and I wish they were upfront about it. I fully accept their right to make it, I do believe that it is honest and it is meant to be helpful.  But it is not about language, and not by a mile. And this is the moment this post starts in earnest. I want to make a couple of points about ‘language arguments’.

My main grief with language arguments is that they oversimplify things. If the problem were with language, you could simply change it and things would be great. Yet, they’re not. Even if the Kinderman-Cooke guide were to be implemented tomorrow, the stigma attached to mental illness would not start disappearing. Indeed, I keep saying that the history of psychiatry is also a history of label changing. Has it resulted in reducing stigma? No. And I do wish all ‘language guides’ acknowledged this.

Now, I also think that constructing the problem in terms of language to a considerable extent gets you off the hook. You no longer need to worry about stigma in all its variety.  Here is Graham Scambler’s account of ‘weaponising stigma’, which is a good indication of how complex things are. But it’s much easier to talk about ‘language’, it’s a shortcut.

The oversimplification offered by language arguments has another aspect. It suggests that, somehow, ‘everybody’ would benefit from the change in language. Not only is it untrue (and, to be honest, the two psychologists do acknowledge it, albeit implicitly), but such an argument blanks complex consequences of proposed language changes. What happens to me, if you take away my ‘labels’? I do wish people advocating for language change acknowledged this. Yes, probably, some people will be better off, but some will be worse off. I am yet to see anyone who tackles the issue with any seriousness.

Time and again, I see arguments about language ‘locking people into a label’.  And I keep wanting to ask: Does it?! Really? Is it really the ‘label’? Is it really language? Or is it perhaps the diagnostic perspective which reduces people’s experience into an easy and clear category (regardless of how you see nosological diagnosis)? But what language arguments offer is an easy and clear scapegoat. Except that this time, still in line with what Rene Girard teaches us, those to blame are people who use ‘the language’.

The language argument offers an easy enemy. It focuses the mind on language and the complexity of the reality of mental health/illness is reduced to a word or two. Instead of focusing on this complexity, instead of explaining it, the language argument does away with them. No longer do you have to wonder about models, diagnoses, let alone social contexts. You just need to change the words. But the pernicious part of the argument is that you cannot win. People will continue to use the ‘language of disorder’, so the fight never ends. And so, if all fails, we’ll always have language to complain about. As ‘we’ persuaded people that ‘language matters’, we also offered them something to be bitter about. Yes, language matters, of course, it does, but do let’s stop telling people that changing one word for another will transform their lives. It will not. They will still have to see a shrink they hate, a psychologist that will patronise them. They will still be unheard, unlistened to, mistreated, and will not get support they need. But, hey, who cares, right? At least it will all happen without that ‘label’! Yaaay!

For good measure, I want to add my usual rant. In addition to what I said above, the language argument inevitably focuses only on lexical material. Do you use this verb or that noun? It’s as if language consisted only of the dictionary. And I keep repeating it – if you think language consists only of words, take a Polish dictionary and try communicating in Polish. Good luck!

So, let me end with a question. Should journalists pay heed to the language guide offered by Peter Kinderman and Anne Cooke? To be honest, I don’t care. I think it is as unlikely to do any good, as it is unlikely to do any harm. The difference will be that, if they notice at all, some people may become a bit happier and some may become unhappier. The balance will be roughly the same, except it will be different people. Me? I would prefer all this energy that goes into language arguments should go to improving mental healthcare. And when you think that there is nothing else to do, you can than play with words.


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