Challenging ideas in mental health
Challenging ideas in mental health

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Challenging ideas in mental health

1.2.1 Boundaries and terminology

In another context Shakespeare asked, ‘What's in a name?’, and suggested by way of an answer that a rose may smell as sweet whatever it is called. In the context of social boundaries, however, the language used is actually very important in determining ‘who's in’ and ‘who's out’.

Activity 1: Looking at language

Timing: 1 hour 0 minutes

What is the language of mental distress? Who are the people who experience it?

Make a list of all the words you can think of (in past as well as present usage, and including colloquial and slang words) that describe the condition or experience. Then list the words used to refer to the people who have the condition or experience, again including slang terms.

Then read the articles by Rachel Perkins and Diana Rose (Readings 1 and 2 below) and write a short summary of the authors' views on language and terminology.

Click to view Reading 1 [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

Click to view Reading 2.


Your list probably contained some or all of the following terms: lunacy, mania, madness, insanity, mental ill health, mental illness, mental distress, mental health problems. More specifically, you may have mentioned schizophrenia, depression, anxiety, neurosis, psychopathology and paranoia. One of the course testers suggested possession and witchcraft.

Your list of names for the people concerned probably contained some or all of the following: lunatic, madman/woman, mentally ill person and mental patient, as well as slang terms such as loony, nutter, psycho, schizo and weirdo. Course testers added: mental, maniac, barking, loopy, touched, unhinged and highly strung. In addition, there are the names adopted by people on the receiving end of the terminology and services, such as users, clients and survivors. Some of these terms are combined to become mental health service users/survivors.

The two authors are themselves users of mental health services as well as being involved in mental health research and practice. Perkins dismisses the word ‘distress’ as being too inclusive. Her argument is that everyone experiences distress but not everyone experiences ‘madness’, and to claim they do is to diminish and trivialise the latter experience. She suggests that service users should ‘embrace mad pride’ and celebrate their differences. Rose accepts that some service users regard their experience as an illness that can be treated. She argues, however, in favour of the term ‘mental distress’. At the same time, she suggests that this should be linked with a more positive outlook that includes valuing and learning from that experience, and connecting it with ‘the discourse of rights’.

What are we to make of this? One conclusion to be drawn is that there are no easy answers to the question of what terminology to use, nor any ready-to-use terms that are acceptable to everyone. However, this course aims to draw on these accounts – and the accounts of others – to use language that is acceptable and meaningful. This probably means using ‘mental distress’, but not in a way that demeans or trivialises. Instead, it means taking a positive stand – celebrating difference and diversity, valuing people's experiences of mental distress and supporting their rights, especially their right to be included in the mainstream of society.


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