Stigma is created and perpetuated partially through everyday language. Learn about steps to help you be aware of the terms you use around mental health.
Hi. This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel.
Earlier this week I was in NYC and when I was there I was talking to a business leader who was very serious about employers’ responsibility to support mental health as part of workplace wellness. I told her I agreed with her and was especially interested in the terminology used around mental health. How it shows up in policies, and also how we talk about it.
This reminded me of a tweet I’d seen months ago from Canada’s Dr. Javeed Sukhera about terminology and mental health. He wrote:
Next time someone says “mental health” what if we took out “mental” and just said “health?” #mentalhealthishealth
As a literacy and language person, I’m a fan of this way of thinking about the language we use.
This episode is about some steps you can take today, to help you be aware of the terminology you use around mental health.
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When I’m teaching a course or giving a workshop, I’m a big fan of removing obstacles. This can take different forms. For instance, say your goal is for your organization to have better representation from different groups at its regular meetings. I’ve written before about how changing the time or location of these meetings can remove an obstacle to participation.
In the case of mental health, if the goal is shifting the tide on the stigma around mental illness, it seems one obstacle in the way could be the words we use. If you’re a provider, you may be using words unintentionally that suggest or reinforce negative attitudes and assumptions toward patients, clients, or families; toward treatment; or toward the nature of mental health.
And you may be doing this without knowing it.
Time for some examples from research. Stigma may be at their most harmful when they exist within patients, toward themselves. As I see it, disrupting the process of anyone internalizing stereotypes is one of the implied purposes behind any research on stigma in mental health. of course I have links to all of these studies in the show transcripts.
Several recent studies analyze specific language use in relation to mental health stigma. I’ll use these studies as illustrations of different ways it’s possible to step back and analyze language-in-use in everyday contexts: specifically in video games and print media. And then I’ll relate it to how providers can take a look at their own words and phrases, around mental health.
This first study is called Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games. The authors study video game playing “as a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors.”
The researchers intentionally based their keyword search on what we might consider stereotypical terms for mental illness, using words such as “asylum,” “insane,” “crazy,” “mad,” “madness,” “mental,” “psycho,” “psychotic,” “psychosis,” and “schizophrenia”’
The researchers found that “The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc).” Overall, many game elements “perpetuated well-known stereotypes and prejudices.”
Now I’m not suggesting anyone here is using terms in their practice like these researchers used in their study. Language is not always so blatant as the keywords from the video game research. Another recent study—this time, in UK media–provides a helpful example.
In this study, which was a linguistic analysis, the researchers “explored the language used in popular national newspapers when writing about schizophrenia and considered how this may have contributed to the processes of stigmatisation towards people with this diagnosis.”
Whereas the video game study focused on overtly negative language and its ability to contribute to stigma, this study found that “while the press has largely avoided the use of words that press guidance has steered them away from (e.g. ‘schizo’ and ‘psycho’), they still use a range of graphic language to present people with a diagnosis of schizophrenia as frighteningly ‘other’ and as prone to violence.”
This range of graphic language nonetheless may contribute to stigma, as the researchers conclude.
There are even subtler ways that language can signal negative attitudes.I’ve written and podcasted before about the subtle harms done by microaggressions. An important takeaway from this body of research is that microaggressions can be uttered by any of us, aimed at those we love. The same may be said in the case of mental health stigma. I have citations to a study that shows stigma are reproduced and maintained even between romantic partners. That is to say, you don’t have to hold negative views of mental illness, or of people with mental illness, to be using terminology with negative associations.
What might this have to do with providers? It’s possible that part of the challenge lies in how hard it is to notice the words and phrases we’re actually using, versus what we think we’re saying.
This is partly because of the ways we use words and phrases in real life, whether in a personal or professional context. More often than you might think, we tend to be on an autopilot of sorts when it comes to our talk.
We use the words and phrases we’re used to using, and those used by the people around us. Specific bits of language—words and phrases–work their ways into and through our various professional and personal contexts. And then, they come out of our mouths. They land in our policies.
Beneath the surface of our words are particular configurations of values, ideals, beliefs, and priorities. And even as well-intentioned people, we might be saying things we’d consciously disavow. This has been my professional and personal experience for more than 20 years now, and it’s the journey of a lifetime. So I’m inviting you to look beneath the surface.
Being aware of, catching, and then replacing language can help your words flow from your values. As I’ve said before, since language is powerful enough to contribute to health disparities, I suggest it is powerful enough to reduce them.
I’ll also assert that no one, including me, can ‘empower’ you to respond appropriately to the myriad differences among attitudes toward health—mental and otherwise—that you will encounter across your whole professional career.
What makes more sense is for you to bring to your practice an awareness of different possible responses or approaches to mental health that might relate to your patients, your students, your research, and your organizational commitments.
This awareness can start by allowing yourself to pay attention to your language. I agree with the authors of another study that found “framing can serve as a tool in creating anti-stigma messages.” Let’s contribute to shifting the tide on the stigma around mental illness.
Here’s what you can do today
- Catch yourself in the act—or recruit a friend’s help. Pick one small piece of language to pay attention to: Maybe the way you open a conversation, or the metaphors you frequently use. Or if you’re in a policy way, take a look at the specific phrasing in some of your workplace policies.
- Consider the values implied in your words, examples, and explanations. And be ready to make some changes. And tell your colleagues you’re doing this.
- Study the positive in your practice. What have you said that helped? Remember, what you don’t say, as well as the response of listening, count, too. Share with your colleagues.
You can interrogate your terms and phrases—as well as the assumptions beneath them. Then, it’s down to you, to choose the appropriate words and actions for your specific context.
Would you like some help in this process? Contact me at healthcommunicationpartners.com. Find me on twitter @amliebel and on linked in.