# 1 Language

There is an important debate about the use of language around mental health and how this impacts on and reflects our understanding of it. In this section of the course you will begin by examining the use of language in mental health and the assumptions that are associated with it.

You will now undertake an activity which is designed to introduce you to the impact of language use when discussing mental health and mental ill-health. During this activity you will be familiarised for the first time with a conversation between four different mental health professionals, all of whom have worked in, written about and discussed their experiences.

## Activity 1 Words and their meaning

Allow about 30 minutes

To begin, read the discussion in Reading A, written by OU academics. While you are doing so you may wish to take some notes about why the use of language is important in mental health and what its use might suggest to those who have mental ill-health and how it is perceived and treated.

## Reading A The impact of language on mental health perspectives

> One aspect of the debate that surrounds mental health is how to refer to people who experience mental ill health. The use of language is a contested area that generates a lot of discussion and disagreement. Whether most people realise it or not, it is closely related to the perspective that is taken on mental health, what causes mental ill health and what approach should be used to treat them.

> One of the ways that perspectives can influence approaches to mental health is through the language that is used. For example, some people who use mental health services identify themselves as ‘service users’ or ‘patients’, while others argue that they are ‘survivors’ of an oppressive psychiatric system, and there is a range of positions between these two points of view. There is increasing recognition that other people can be a useful resource when an individual is affected by mental ill health; this resource, made up of personal contacts, is sometimes referred to as ‘social capital’ (Webber et al., 2014).

> Similarly, practice can vary between different types of practitioners. Some psychiatrists who have medical training might take more account of social factors than others. Some community psychiatric nurses focus on monitoring medication and others on more psychological approaches such as specific forms of talking or behavioural therapy. However, while some nurses who work in the community may lean towards one approach in their own practice, they are likely to work in a community mental health team made up of workers from different professions and who take different approaches.

> For example, the term ‘patient’ tends to be used by psychiatrists, mental health professionals and members of the public who subscribe to a biomedical view of mental ill health as mental illness. This perspective tends to view mental ill health as having a biological basis. In other words, because ‘faulty brains’ are causing the symptoms, there is a need for medication to provide a remedy. This idea of ‘being treated’ through medical intervention implies a passive role for the ‘patient’ in relation to the professional ‘expert’.

> Such passivity may be rejected by many who emphasise that ‘patients’ can (or should) be seen as both experts in their own right and active participants in their recovery. They also argue that expertise arises out of the experience of living with mental ill health, which in itself provides a deep knowledge of the nature of their own condition. Also, it is argued that people receiving mental health services need not play a passive role but should be active in making choices that determine how their condition will be managed. Indeed, in recent years, the term ‘expert by experience’ has been proposed as a term that captures this different perspective.

> Some have chosen to adopt terms such as ‘service user’ or ‘client’ to describe the way in which managing mental ill health involves a range of different kinds of support (not just the medical care you would associate with the word ‘patient’). A further implication is that service users or clients exercise choice over which services to use – in the same way one might engage a lawyer or an accountant to meet a particular need. Indeed, it is because such terms are in general use that they seem more neutral and carry less social stigma than the idea of illness associated with the term ‘patient’.

> In contrast, the term ‘survivor’ is not neutral at all. It has sometimes been used by people who view themselves as survivors of the mental health system, or alternatively, surviving the experience of having mental ill health (Campbell, 2009). The first of these usages represents a view that the coercive aspects of the system can be quite damaging and are a challenge to ‘survive’.

(A text entry box would appear here, but your browser does not support it.)

### Discussion

In this short discussion are ideas which you will look more closely at in this course. Some of the terms that are used in Reading A reflect the fact that those experiencing mental ill-health have different preferences about how they should be referred to within the world of mental health. These preferences often stem from the desire to express, or have recognised, a more nuanced, more social and less medicalised view of what mental ill-health involves, and how an individual experiences them. They also imply a particular role for the practitioner. Someone who may be medically oriented might use the term ‘patient’, while someone who adopts a more social perspective would be more likely to use the term ‘service user’. Different terms carry with them assumptions about the practitioner – for example, harm is implied by the term ‘survivor’, while professionalism is implied by the term ‘client’. Likewise different countries use language differently. So, even within the United Kingdom, in Wales, the preferred term used in the social care sector is ‘individual’ or ‘citizen’.

## Core teaching point

The language that is used in mental health is important as it underpins the different perspectives on mental health and mental health care.

In the activity you were encouraged to think about the words used to describe and define mental health. There are many different perspectives on what causes mental ill-health, including those with lived experience – sometimes referred to as a ‘service user perspective’ – lay (personal or ‘common sense’ rather than professional), psychiatric (or biomedical), psychological, and social interpretations of mental health. Similarly, the definitions may have already challenged some of the assumptions you previously held and the impact this has on how you think about mental health. Additionally, the language used to talk about mental health changes over time, and terms that were considered appropriate to use previously, may not be considered appropriate now. You may encounter some of these terms as you engage with this course and the history of mental health approaches.

In the next section you will undertake another activity which will give you further opportunity to consider meaning in mental health and to develop your note-taking skills.

OpenLearn - Mental health in society
Except for third party materials and otherwise, this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence, full copyright detail can be found in the acknowledgements section. Please see full copyright statement for details.