Beyond ‘words matter’: The language of mental health

Illustration of a person holding pills
Hannah Cooper/File

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I don’t remember when I first learned about mental health. Most mornings as a kid, my dad and I brushed our teeth together in the bathroom. And most mornings, I watched my dad take two pills from a bottle kept up high, tilt them into his mouth and lean over the sink to wash them down with a gulp of tap water.

My crazy pills, he called them, with an irony I didn’t quite understand.

My parents were forthcoming, though, and from a young age, I knew that my dad took antidepressants because he had anxiety and depression. His mundane morning routine kept the chemicals in his brain balanced. He once explained to me, “This medication lets me feel like a normal person.”

His was a down-to-earth, if cynical, attitude toward mental health and one I was fortunate to grow up with. For many, mental health is too taboo a topic to speak openly about. But any reference to mental health we hear as kids, particularly any pejorative one, is formative. As with most abstract concepts, the language we use to approximate mental health shapes our attitudes toward it. In the case of mental health, this often results in growing up with stigma.

Stigma is a three-fold phenomenon: we feel it internally, the public perpetuates it and our institutions codify it. The shame we may feel when experiencing poor mental health is an example of self-stigma. When we see mental health cast in harmful stereotypes, this is public stigma. And when mental health limits our opportunities, institutionalized stigma is at play.

Stigmas surrounding mental health reflect that most cultures don’t normalize proactive mental healthcare, and the stigma refers to the shame and discrimination associated with experiencing mental illness. These stigmas are connected — it’s possible that some of the mental health stigmas even come from a false equivalency between mental health and illness — but they are not the same.

While the topic of mental health includes mental illness, it also includes a much broader range of experiences that may not require medical treatment. Everyone has mental health, but not everyone has mental illness. No amount of self-care can cure a mental illness when it requires a doctor’s attention.

Recently, there has been a push to end the mental health stigma by changing the language we use to describe mental health. Organizations such as the National Alliance on Mental Illness advocate that “words matter,” that we can change the mental health stigma by speaking about it conscientiously.

In the 1970s, the theory of person-centered language emerged, and today many newspapers require it as part of their style guides. With person-centered language, a “depressed person” becomes a “person with depression,” implying that a person’s mental health or illness is just one part of their life and not their entire identity. By consciously using the word “person,” person-first language humanizes its subjects, combatting the otherization that occurs when someone’s mental health becomes the way they are defined.

Person-centered language only goes so far. A criticism of the practice is that it still represents mental health and illness as necessarily negative. After all, using terms such as  “struggle with” or “suffer from” when talking about mental health and mental illness is person-centered, but it still perpetuates a bleak attitude toward both.

Identity-first language is another technique intended to reduce stigma, although it’s more common to use it when talking about disabilities. Identity-first language suggests that one’s disability is not a bad thing; it’s just a fact of life. Identity-first language acknowledges that for some, their condition is an important part of their identity, since it’s a source of community.

Beginning in the late 1990s, there was a push among the English-speaking media to portray mental illness in scientific, medicalized terms to convey to the public that these conditions were as ‘real’ as physical illness. By educating the public about both, the hope was to eradicate misinformation and reduce stigma.

But a 2012 study published by the Acta Psychiatrica Scandinavica journal showed that, although the public became more educated about mental illness, the pejorative attitudes toward it didn’t change. Of course, these efforts weren’t entirely in vain; the study noted that during this time people began to see mental illness as a condition that medical treatment could improve, validating the experience of seeking help. Yet there was no improvement in the social acceptance of people who experience mental illness.

These language-centered campaigns have had tangible impacts. But sometimes they seem like too simple a solution for profound stigma. People who experience mental illness or poor mental health have often said its difficulty occurs on two levels: the experience itself and the shame they and their loved ones feel about it. As such, syntactical changes may only go so far as our ideas and attitudes. Using person-centered language, for instance, doesn’t really help when you’re stereotyping someone or describing your antidepressants as crazy pills.

A focus on changes to language also raises the question of whether having poor descriptors for mental health was ever really the source of the problem. More respectful and sensitive words for mental health and illness are clearly an improvement from the past, but sometimes words are just used for the sake of being polite; the pejorative attitude remains, if unexpressed. If we change our words for mental health, can we entirely change our attitudes about it? Or is language more of an indicator of how society feels about mental health?

Centering language as the solution to anti-stigma campaigns can also create the impression that once language changes are made, stigma is gone. But of course, this is not the case.

Most likely, language changes need to be accompanied by a change in attitude to impact stigma. A 2015 study published by the Psychiatry Research journal investigated whether participating in a program where participants were encouraged and taught how to productively accept and disclose their mental illness to others would reduce self-stigma in participants with mental illness. Compared to the control group, the results showed that the program did help: Participants were less likely to apply negative stereotypes to themselves and self-stigma generally diminished among participants. Intentionally examining our beliefs, then, and training ourselves to change them is also important in the conversation on reducing stigma.

This is not to rule out the possibility that our words do matter. But it’s clear our actions matter too, both in how we treat others and how we confront institutionalized stigma.

Crazy pills, though maybe a silly expression for a family to use, is not an accurate or productive reference to mental health and illness. Still, I already knew that by the time I’d heard it spoken. I knew by the unashamed actions I saw my family members take to tend to their mental health. Visits to psychiatrists, counseling, exercise, taking care of loved ones in crisis and open conversation: In my family, actions and attitudes have spoken louder than words.

Contact Violet Taylor at [email protected].