Language matters: language and mental health recovery |
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| Wednesday, 22 February 2012 |
Health writer Emma Razi explore the role that language plays in mental health recovery. Language is powerful. It can provide hope, empowerment and optimism. It is becoming increasingly well recognised that we can use language as a tool to guide people with mental health problems towards recovery. Louise Fraser reflects her experience: "One psychologist I saw stood out from all the others. It was just like talking to a friend; there was no jargon – he just spoke to me normally. The language he used and the way he spoke made me feel like he really cared and that I wasn’t on my own – this gave me courage to work through my problems."Yet the language used by some mental health professionals may not be conducive to recovery. Bob Bogle states: "Language can have a negative effect on an individual’s recovery. When people say 'I suffer' from my condition, that’s inaccurate; I don’t suffer. I live with my condition and I self-manage it. I don’t want to be defined as a 'sufferer'. I find other terms such as 'mentally ill' stigmatising – I’m not mentally ill. I live with a mental health condition, I have good days and more challenging days – but I’m not ill – this is just who I am." The use of generalising terms such as 'non-compliant' and 'low-functioning' have also been highlighted as words that can hinder recovery. Labelling a person as 'low-functioning' when their problem may focus on their ability to socialise with friends – rather than in all aspects of life – can reduce confidence. In addition, labelling an individual as 'non-compliant' when they may not be taking their medication for good reason can be patronising and demoralising. Kathy Hamilton from the Mental Health Advocacy Project in West Lothian adds: "Instructions such as 'I told you to' or 'I told you not to' are heard in conversation and are not very recovery focussed, they promote a relationship more akin to parent and child with the service user as the passive recipient. In addition the use of sarcasm can be problematic and something we hear from time to time. It causes a lot of confusion for people who experience mental health problems. When a sarcastic comment is made, staff may laugh but the person can struggle to understand what is funny. This can be very disempowering and alienating." In order to support recovery, whatever our roles, I think most would agree that we should use language in a responsible and intentional way. Research suggests that a significant hindrance to recovery can be the risk of becoming stuck with an identity of 'illness'. This happens when people become defined by their diagnosis and experience of illness. For some, breaking out of this identity can be both liberating and transformational. One of the best tools we have to support this process is the careful use of language. Lori Ashcraft and William Anthony, two leading writers on recovery in the United States, have developed a set of alternatives to words and phrases that are commonly used. Ashcraft and Anthony aim to encourage the use of language that "promotes acceptance, respect, and uniqueness." (Ashcraft & Williams, 2006)  Examples of Ashcraft and Anthony’s alternatives include using terms such as 'not open to…' and 'chooses not to…' rather than labelling an individual as 'resistant'. Another is the use of terms such as 'taking personal responsibility' and 'beginning to think for him/herself' rather than defining an individual as 'non-compliant'. People are also often described as 'helpless' and 'hopeless'. Ashcraft and Anthony suggest using terms like 'unaware of capabilities / opportunities' as a more positive alternative. Many people share different views when it comes to using a specific diagnostic label. Louise Fraser believes: "When people describe me as 'bipolar' I get annoyed. I’m lots of things like a manager, a film lover and a good auntie – I don’t want to be labelled as bipolar, it’s not who I am – I just happen to have bipolar symptoms." Kathy Hamilton adds: "Some people don’t have any issues with language such as 'bipolar' and 'schizophrenia' it is very much an individual choice. In terms of recovery, language is perhaps something that requires a completely individual approach. It is perhaps about language being guided by the individual’s choice and not perhaps the services." Having worked in a busy NHS clinic, I can understand the stressful environment of healthcare. When you are working close to pain and suffering, you need some distance. Labelling an individual can help to establish distance and detachment from those using the service. But there are other, kinder ways of achieving detachment; for example professional supervision and support from colleagues.  Dr Jim Crabb, Consultant Psychiatrist at Forth Valley Royal Hospital believes: "There are no hard and fast rules when it comes to using the right language, every person is different. What a person finds acceptable language can depend on many things, for example their past experiences, cultural background, age and level of understanding. I also think it’s important to regularly ask if clarification is needed; as there can be a lot to take in – and I want to make sure I’m being clear and not confusing the person I am talking to. In addition, I think its important for people to feedback to me if they don’t like any words or phrases I use as – as good communication is a two way process." Language reflects and shapes our thinking and our behaviour. The right use of language can show empathy and understanding while promoting hope and empowerment. But using the right language all of the time is not easy – it takes discipline and constant attention. Language is constantly adapting and changing with new words coming to prominence over time. But that doesn’t mean we should think that any changes are 'just a fad' or 'political correctness'. If I worked in an office in the 1970's and complained of being called a 'bird', or any other terms that are derogatory to women, people might have laughed at my attempt to change their language and their views of me as a working woman. We should all be intentional and considered in our use of language and take time to choose our words carefully and think about how our words can impact on an individual’s recovery.  To stop recovery language becoming simply rhetoric – we must also consider the beliefs, values and attitudes we have that govern our use of language in the first place. True compassion will ensure that the right language we use is the first thing that pops into our head and out of our mouth!Please share your views about the use of language and its effect on recovery. Do you have any good or not so good examples? How do you feel about using diagnostic terms to describe people such as 'schizophrenic' and 'bipolar'? References Ashcraft L & Anthony W. (2006) Tools for Transforming Language: The way we describe people affects how we treat them. Available online. Comments (7)
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written by Ivan Carnegie, February 27, 2012
If you want some more examples of stsigmatising words, how about "forensic" (usually used in a derogatory fashion)and "mentally disordered offender" or MDO?
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written by Melody Edwardson, February 23, 2012
Thanks for this interesting article. It is very relevant for me this week as that is what we are talking about in my Masters.
This is a new booklet “Psychobabble: the Little Red Book of Psychiatric jargon”that may be of interest to Scottish People even though there will be many different terms than we use in Australia. the booklet is free to downnload here http://www.ourcommunity.com.au/files/OCP/PsychobabbleFeb2012
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written by Linda Dickson, February 22, 2012
"Labelling an individual can help to establish distance and detachment from those using the service. " I think this says it all in terms of the NHS attitude to patients. Imagine if the NHS actually wanted to understand how the patients were feeling instead of trying to detach themselves for fear of catching the dreaded mental health problem! Non-compliant and resistant are such patronising terms often used by those who have no understanding of what it is like to live with these conditions and to be constantly rediagnosed and prescribed an array of medications none of which seem to make any difference except to the profits of the companies who make them.
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written by john Sawkins, February 22, 2012
I picked up some good advice from Dr Terry Lynch in his book, Selfhood, (specific to improving relationships): cut down on your use of the pronoun "you"; only "I" is part of your world. i.e. you should not (and cannot) expect to be able to control other people's thoughts / feelings / behaviour. Just express what you think and feel, starting with the word, "I".
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written by Tricia Cochrane, February 22, 2012
Language has changed over the years and agree that education is very important. Not a "you cannot say that" attitude but talking about how it makes people feel when they are called or described as something. Stephen Lawrence enquire covered language and behaviour of not only the police to race, and training was to be put in place for all professionals. The police have gone along way but the NHS is still playing catch up but so is society. We must learn from each other and make mistakes along the way but always looking to see if we have offended and apologies if that is the case.
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written by Ruth Brown, February 22, 2012
Thank you for this thought provoking article. It's too easy for some to dismiss carefully chosen words as "political corectness". A good rule of thumb is to try not to describe others in terms I would find unacceptable if applied to myself. If unsure how to describe some-one, I can always ask them what words they would choose.
... written by Wanda McGregor, February 22, 2012
I felt very pleased reading this article and for me, consideration of the language used is of the utmost importance in providing recovery focused care. I make a conscious effort not to label people when I am talking to them and prefer to use the term 'experience' rather than 'illness' or 'condition'. However, having read the article I am guilty of using some of the jargon mentioned in my notes which is language I learned as a student nurse. Perhaps this is something that needs to be addressed at education level?
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