Commentary

by David W. Oaks*

david-w-oaks.jpgHow we can try to be more inclusive with our language in the mental health field? How can we show those who have been marginalized by psychiatric labels that we are listening and welcoming?"

The term "mentally ill" is very much a medical model. If you want to use that term about yourself that is one thing. But when people use the phrase "mentally ill" about others, including me and other psychiatric survivors, the implication is that since an "illness" is the problem then a doctor ought to be part of the solution. "Mental illness" also says since the problem is like a materialistic physical illness, then perhaps the solution ought to be physical too, such as a chemical or drug or electricity.

This is a call to stop the use of the term "mentally ill," and find replacements!

Here are some suggestions:

* Mental health consumer
* Psychiatric survivor
* Person labeled with a psychiatric disability
* Person diagnosed with a psychiatric disorder
* Person with a mental health history
* Person with mental health issues
* Consumer/Survivor/eX-inmate (CSX)
* Person who has experienced the mental health system
* Person experiencing severe and overwhelming mental and emotional problems
(describe, such as "despair")
* Person our society considers to have very different and unusual behavior (describe, such as "not sleeping")

The suggestion for substitution is not about perfection or correction! I love word origins, and the true meaning of the word "perfect" is "finished." Are we ever really finished with a living language? Can we ever perfectly describe reality? No!

This essay is not about being "politically correct." What is "correct" changes with the winds and tides and individual.

Note a subtlety
My call is not about opposing the medical model, or any other particular model. My call is about opposing domination by any model in this complex field. My call is about opposing bullying in mental health care.

So let's also drop the use of other words that tend to confine us in the dominant model. Let's stop legitimating the use of words and phrases like "patient" and "chemical imbalance" and "biologically-based" and "symptom" and "brain disease" and "relapse" and all the rest of the medical terminology when we are speaking about those of us who have been labeled with a psychiatric disability.

Please do not brand us
The emergence of the medical model as psychiatry's dominant ideology has a fascinating history, such as in the 1800's in England when "mad doctor" elites jostled with one another to create the early journals, regulations, associations, licensing, government funding and large institutions. The medical model was simply a tool then to consolidate the power of the dominant psychiatrists, and was not about science. After all, the main "medical model" during the rise of that ideology was phrenology, the study of bumps on the head, which even then was beginning to be discredited. I highly recommend the book Masters of Bedlam to understand how a few hundred elites in England helped construct the medical model domination system we see today.

Ironically, today, psychiatry's own official label bible, the Diagnostic and Statistical Manual (DSM), does not refer to "mental illnesses," but to disorders. Even inside the DSM, which psychiatry generally believes albeit falsely to be scientific, they do not use the phrase "mentally ill" in diagnosing, so it is actually scientifically impossible, by psychiatry's own standards, to be officially "diagnosed mentally ill."

Psychiatric diagnosis has a tremendous amount of undue power. I was diagnosed schizophrenic and bipolar, which are both under the umbrella of psychosis. To admit one has been officially labeled psychotic is perhaps one of the deepest closets to come out of, because the discrimination against those with that label is so immense. I prefer to talk about "discrimination," rather than "stigma," because discrimination is something we can actually challenge and change, such as through legislation. The word stigma, of course, comes from "branded," and implies that my identity as a psychiatricaly labeled person is inherently negative, which is not always the case.

Who is doing the branding?
Certainly, in the long run, taking away the unfair legal power that a few hundred psychiatrists have in literally voting on what courts and legislatures consider "normal" is an important goal. American psychiatrists are currently working behind closed doors on their fifth revision of the DSM which has international implications. Despite our many requests, the organizers of early meetings on these revisions, such as the influential psychiatrist, Dr. Darrell Regier, have refused to open those doors, or to even respond to civil inquiries.

The language we choose to use
This call is about values of inclusion, diversity, respect and empowerment!

I understand that many people do define themselves as "mentally ill," and accept a medical model. That is their choice. However, at this time, the "medical model" is dominant. As some Texans like to describe themselves, the medical model is "large and in charge." The medical model is a bully in the room. Language that somehow encourages that domination isn't helpful to the nonviolent revolution in the mental health system we need, a nonviolent revolution of choice, empowerment, self-determination.

What about the many other people who define their problems from a social, psychological, spiritual or other point of view? And what about those who don't see their differences as problems, just as differences, or even as qualities?

In fact, what about the subject of defamation? According to an attorney we work with, to falsely claim an individual is officially "mentally ill" with intent to harm them has been used in law schools as a classic example of defamation.

We've come up with some of the suggested alternatives listed above using good old-fashioned plain English. Each phrase and word has difficulties of its own. There are many creative ways to address this. Perhaps you have some suggestions yourself, let us know.

I've heard that some feel that using alternatives to medical model language somehow diminishes the seriousness of their personal pain, that, for example, being diagnosed with "clinical depression" underlines the gravitas of their crisis better than, say, "sad." But there are words in the English language more fierce than "sad." How about, for example, "extreme and catastrophic life-threatening anguish"? That phrase has a lot more gravitas than any clinical language I've ever heard! (The origin of the word "clinical" by the way, is simply "bed.")

So speaking of everyday English, what about slang words for us? As with any oppressed minorities, these words can hurt, and sometimes they are meant to hurt.

Some activists at certain times have sought to reclaim the words society has thrown our way. I realize others may not choose to ever use words like "mad" or "lunatic" or "crazy" or "bonkers" to describe themselves. We probably ought not use those colloquial terms in certain contexts, like arguing our rights in front of the United Nations or a court hearing. But now and again, some of us, myself included, like to have some fun and be outrageous, such as at MAD PRIDE events, where it is okay to be creative and reclaim language that has been used against us.

In the right context, I love to recapture some of the words used about us. We do, after all, get a lot of the fun animals such as squirrelly, crazy like a fox, bats in the belfry and loon. When we have a mad potluck, I have been known to bring nuts, bananas and crackers in a cracked pot.

I love it that the word origin of "mad" is essentially change, similar to the two letters "mo" in "motion" or "emotion." You bet some of us want change, and often change is considered "mad." Perhaps you've heard someone whisper about a mutual friend going through emotional turmoil, "She's... changed."

This can lead to fascinating discussions. For instance, the phrase "stark raving mad" is one of the ultimate descriptors for those considered psychotic. Word origins could translate that into "staring in hungry pursuit," in other words, similar to that look a wild animal has in the final seconds before landing on its lunch. It's revealing that society has described that particular "extreme assertiveness," shall we say, as inherently always a sickness.

MindFreedom has a policy of nonviolent action, but nonviolence can certainly include assertiveness. Any discussion of language needs to include a mention of how Martin Luther King, Jr., in over ten of his speeches and essays, said he was proud to be psychologically "maladjusted." King and Gandhi often said that civil disobedience was not a form of passivity, but of soul force or satyagraha.

Words such as "crazy" can actually be positive in certain contexts. Consider, "I'm crazy in love," or Apple's early motto for their computers, "Insanely great." The word origin for crazy is "cracked," and in Japanese art the pottery with a beautiful imperfection has a special Wabi-Sabi value. On the other hand, a newspaper editorial or journalist disparaging certain citizens as "lunatics" ought to be opposed. Complicated, isn't it?

The point is we are not going to be perfect or correct. Our "mad" social change movement has wrestled with language for decades, and there is no consensus.

We can all show we are trying
The immensity of psychiatric industry oppression is so great it can sometimes be overwhelming. But most of us can still control our tongues, our fingers, our language, our writing. An oppressed group often seeks to redefine themselves as a first step toward liberation. Academics, such as Linda Morrison, Ph.D., author of Talking Back to Psychiatry, have even written treatises on the history of our movement's ongoing wrestling match with language.

Through our choice of words we can show we are trying to listen to psychiatric survivors and others who have strong preferences for what we call them.

We can show we are trying to include a wide diversity of perspectives, including those who have often been excluded. This is a reminder that our words and even our whole social reality of normality aren't forced on us God-given by the heavens, but are constructs that we mortals all co-create, in our imperfection, together.

We can show we care, and that we too seek a nonviolent revolution in the mental health system!

So please, let's drop the use of the phrase "mental illness," and search for more inclusive and creative phrases.


*Executive Director, MindFreedom International
This originally appeared in MindFreedom International (29 Dec. 2007) and is reprinted here with permission.

Comments (8)
Jean Arnold:

WAY TO GO, DAVID !

Posted by Jean Arnold | March 4, 2008 10:53 AM
mwb:

Good work David, well done!

Posted by mwb | March 6, 2008 2:27 AM
Rob W:

I don't know, I like the term mentally ill because it reminds me that this is an illness which is treated well with medications. I am well aware that no amount of talk therapy can cure my illness with or without meds. The benefit of talk therapy for me is it gives me a place to vent and get some of the crap out of my head that I can't share with others. However, the 'big problems' that I deal with with my illness (schizoaffective) are dealt with effectively with medications. I don't like psychosis, it almost made me homeless just about 2 months ago today. When I got back on meds, it was like I was quite literally a different person (it took about 7 days on meds for that to happen). The delusional thinking and paranoia left me, and those had been driving me to go and do strange things. Back on meds, I am really a different person.

This is a physical illness, in that the mind is a product of a physical brain.

Posted by Rob W | May 29, 2008 8:30 AM
Michael Carozza:

As a Social Work major, I tend to prefer the term Mental Health consumer. I think that a greater effort must be made to eliminate the stigma of mental illness.Mental Illnesses are disorders of the brain. We as a society, have great sympathy for people who battle Cancer, ALS and other serious, physical disorders . My question is, why can't we extend this understanding to those who struggle to keep their unhealthy thoughts and feelings in check?

Posted by Michael Carozza | May 30, 2008 3:58 PM
Sally Leger-Schneider:

I have never liked the term mental illness or mental health and removed it from the door of the psychiatric unit in my town when I assumed leadership.

I have never cared for the term "consumer" because it sounds like someone who is hungry for a large meal.

It does not signify a cooperative treatment relationship to me.

We use the term behavioral health.

Posted by Sally Leger-Schneider | June 2, 2008 4:07 PM
Diane Riley:

Mr. Oaks' article is well taken. I think that re-languaging needs to start on a national level. One organization that needs to step up to the task is NAMI (National Alliance on Mental Illness).

Their use of "mental illness" as part of their organizational name counters the advocacy activities in local and state arenas that work to change such stigmatizing language.

To be in denial of the abusive use of such terms counters the important strides in the establishment of recovery oriented languaging in our communities.

Posted by Diane Riley | June 4, 2008 9:33 AM
Mrs. Lou Ross-Johns:

This article is very well written, and took a great deal of
thought. I have Dissociative Identity Disorder, have recovered.
It used to be called Multiple Personality Disorder which was
a clearer term really. I have used the term mental illness and
it certainly feels like an illness. I am afraid often doctors
and hospitals let out a selective groan when you come in the
door with your brain bleeding onto the floor (symbolic). You
are viewed as a nuisance sometimes because they receive so
little training in med school about the various mental illness's. Having said that I have received a lot of great help
too. The best help is one which doesn't presume you have a list
of things wrong with you and the doctor will fix it with abc.
Good help seems to be two individuals with equal worth trying
to figure out a journey towards health of the mind.
How about creatively crazy for a label. I wouldn't mind that,
the mind is being creative and all the behaviours have meaning.
Maybe crazy is still negative. Lots to think about. Love Lou

Posted by Mrs. Lou Ross-Johns | March 24, 2009 7:43 PM
Stephanie:

I agree with Rob W. above. For those of us who DO choose to take meds and ARE helped by them and embrace our mental illness as an illness, it's not unreasonable then to call it an illness.

I am neither a consumer (sounds so capitalistic) nor a survivor of psychiatry. Psychiatrists and psychiatry have done nothing malevolent to me personally, but have in fact helped me tremendously to live comfortably, adapt to my symptoms and take good care of myself.

"Person with mental health issues" sounds even worse than a mental illness. Issues?

What really needs to change is attitudes--both of institutionalized medicine (psychiatry AND other specialties) AS WELL AS attitudes of consumers as it were who, if and when they don't like how they are treated, should say and do something about it.

Yes, mental illness is one closet to come out of, but many of us have many closets, mental illness (however you want to label it) is not any harder or worse than any of the other stifling closets we all want/need to come out of --but at our own place and in our own time.

Posted by Stephanie | March 16, 2010 3:15 PM
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