1 Language

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’.