Guest Post from Professor Patricia Casey: Language and Stigma

Posted: November 4, 2013 in guest posts

Today I’m delighted to introduce this article which was very kindly volunteered by Prof Patricia Casey, Professor of Psychiatry at UCD and consultant psychiatrist at the Mater Hospital in Dublin. I love this article – as Professor Casey says, it is not “political correctness gone mad”, but “instilling basic respect for those who have personal difficulties and health related problems”.  The story I alluded to yesterday shows that we haven’t even got that far yet, alas.

I’d like to thank Patricia Casey for her work with this and with no further delay continue with the article. I think it’s a message we can all pay attention to.

Language and Stigma

Words speak volumes, in every sense. Not only do they convey our own personal messages to others but they are also a reflection of the values we hold in our culture on particular topics. Take our attitudes to those with physical disabilities – in the past we referred to them as “spastics” or “cripples”. And those with intellectual disabilities we called “imbeciles”. Originally these words may have had a benign meaning but over time our use of these terms shifted, because the intent behind them changed from being simply an agreed descriptor to one that connoted derision, mockery and dismissal.

These terms were applied to specific groups marked out for this treatment – in other words these individuals were stigmatised/branded because of some aspect of their appearance (physical disability, height), character (learning disability, mental illness) or tribe (age, sex, race). And it was society at large that identified the groups who should be the butt of this disdain, thus enabling the words to reflect the cultural understanding of these domains and reinforcing them also.

Many groups who once were victims of such prejudice no longer are and this in part is because the words are no longer acceptable to society as a whole – so terms like spastics and imbeciles are no longer acceptable when describing people with physical or intellectual disabilities. Just as we no longer refer to “n***ers” or “midgets”.

Yet the one group still singled out for derisory and negative stereotyping are those with mental illness. Research shows that those with mental illness experience more stigma than any other illness group. This has practical implications for how we regard them and behave towards them. It also means that discrimination in employment is an ever present reality.

The public’s attitude to mental illness is complex and ambivalent. On the one hand reams have been written and spoken about ending the stigma and attitudes directed to those with mental illness when, at the same time, society regards many of the treatments for those with mental illness with disdain. This particularly applies to the use of medication. Furthermore, while lip service is paid to respecting those with mental health problems, the language used in public discourse is negative and even derogatory.

The headlines in our newspapers scream words like ”psycho” to depict somebody who is violent, reinforcing the belief that mental illness and violence fit hand-in-glove. Using the term “schizophrenic” to describe somebody who shows two sides to his personality is an inaccurate usage of this diagnosis since those with schizophrenia do not have, what is mistakenly called a “split personality”.

Words in common parlance for those with mental illness include “looney”, “basket case” and “nutter”. One study of young people in Britain found 240 derogatory words used by young people to describe peers who experienced mental health problems. Comedians regularly lampoon the mentally ill with few objections being raised as do children’s cartoons. For example a study of Disney animations found that 85% of them used terms that were reported as denigrating and inaccurate depictions of characters with mental illness.

“Political correctness gone mad” I hear you say. Well – no. Discouraging words that are offensive is not a deliberate attempt to hamper communication because of a political ideology but an attempt to alter the disdain and disrespect that such words embody and the grave offence and hurt that they cause to those so named. It is about instilling basic respect for those who have personal difficulties and health related problems. But its reach is much greater. It is directed to challenging and ultimately altering inaccurate beliefs about some members of society, whose lives are blighted as a result of these perceptions. We should do all we can to alter the casual use of language that offends or brands some group.

Even within the specialty of psychiatry itself, professionals sometimes use terms that do not necessarily give offence but are irritating to those to whom they refer. “Service users” or “clients” were introduced as a supposed non-paternalistic way of describing “patients” while others speak of “survivors” or “users”. Yet there is now an abundant body of research identifying the terms preferred by those with mental health problems.

One recent study published in The Psychiatrist (a journal) used a sample of over 300 people attending psychiatrists. Interestingly their term of choice was “patient” when they are consulting doctors or nurses while “patient” or “client” was equally acceptable when dealing with social workers or occupational therapists. “Service user” was disliked overall while a minority wished to be referred to as “survivors” or “users”. The comments provided by the participants in this study were instructive –“I am NOT a user of any kind”, “I would like [to be] referred to as a patient but I feel I am trying hard to be a survivor”, “I do not like client – it is reminiscent of prostitutes”.

The commission of these verbal lapses is not in the same league as the use of stigmatising or pillorying language but if the profession preaches respect then it should respect the wishes of our patients rather than foisting our beliefs about terminology on them.

Language is ingrained in our culture and it is a powerful tool in conveying and reinforcing our beliefs and attitudes. On present evidence the terms used relating to people with mental illness are discomfiting and unsettling.

  1. Anne Marie Sheridan says:

    A concise and thought provoking piece

  2. I agree – language is indeed a powerful tool in reinforcing our beliefs. It’s time I evaluated my own vocabulary and the words I use every day.

    • Oh yes! I know I use words like “mental” almost as a reclamation, but words have the power to wound. And it’s sometimes the softest ones that are the most lethal. We all have something to learn from this.

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