Language is our way to express thoughts and build relationships. It holds memories and creates a sense of community. The words we use influence our attitudes, beliefs, and feelings. It is passed down through generations. Almost like a blueprint for how people go about their daily lives. It shapes the way we see the world, associate with our neighbors, raise a family, treat others; and that’s only to name a small fraction of examples of what is hidden within a language. Therefore, our word choices have a powerful effect on how we view mental health and individuals who live with mental health conditions.
Language and the brain
Psychologist Daniel Kahneman, the founding father of modern behavioral economics, describes in his book “Thinking Fast and Slow” the Machinery of Thought, which divides the brain into two systems:
Given that System 2 tends to be uninvolved unless prompted, System 1 largely guides our thinking process, and this is particularly important when it comes to our language. Evidence shows that System 1 easily takes charge in producing a response to words. This is called “Associative Activation” and it’s a result of seeing or hearing a word. The words that people store in their semantic memory activate the corresponding concepts. This activation then spreads to other surrounding concepts that are associated with them. A word sparks an idea, an idea brings on more ideas and System 1 keeps making connections between all those ideas by resurfacing memories, which in turn recalls emotions that bring on other emotions and so on.
Understanding the important process that words trigger in our brains may help us be more thoughtful in the words we use to describe mental health. Remember that 1 in 6 of us is experiencing high levels of distress or a common mental health problem every week. Therefore, being respectful is critical, it can do wonders for our brain’s associative activation and for the emotions of the people around us.
That is to say, many of us use words without thinking about their implications. How many times have you used words such as Bipolar or cracked a joke about being “OCD” when describing daily events? Being super organized is not the same as living with Obsessive Compulsive Disorder. Similarly, experiencing mood swings is not the same as living with Bipolar Disorder.
Would you want someone to be joking about something you have no control over? Something that seriously affects every aspect of your life?
How we talk about mental health in our immediate environment is critical. Everyone deserves to be treated with respect and that starts with respectful language. Person-first language emphasizes the individual and puts them before their diagnosis, which reinforces that people coping with mental health concerns are human beings and should be treated as people first. However, some individuals see their disability as a fundamental part of their being and prefer identity-first language, such as Autistic person or Disabled woman. This language conveys disability as an important part of a person’s identity and personhood.
In the context of mental illness and wellbeing, negative words can be experienced as condescending, isolating, and stigmatizing, whereas positive words can convey dignity, empathy, and hope. According to NHS Clinical Director, Colleen Vojak’s research, “when used indiscriminately, words can create barriers, misconceptions, stereotypes and labels that are difficult to overcome. Labels can promote separateness and isolation while promoting hierarchical power differentials.”
Establishing a shared currency of values and principles to set the foundation of the language associated with mental health, ensuring consistency and best practice, would enhance the quality of care, and influence a culture and standard of communication which diminishes stigma and promotes language that is appropriate, respectful, and empowering.
Mental health stigma
According to the WHO, Depression is now the leading cause of suffering worldwide. That means that in our own backyard, and in every country, women, men, and children are suffering. And we’re not talking about it nearly enough. Talking about mental health is an important step in tackling it. However, negative words can stop people wanting to talk about it altogether.
Stigma is still a reality for many people with a mental illness. They report that how others judge them is one of their greatest barriers to a complete and satisfying life according to the Canadian Mental Health Association.
Stigma often reflects a lack of understanding or fear and can be a major barrier for people to seek professional support for their mental health. Studies on stigma published by The Lancet shows that many people still have a negative view of those coping with mental illnesses.
The different types of stigma identified by researchers:
Encouraging a dialogue through positive language is one way to fight stigma. When people aren’t sure what terms to use, they feel uncomfortable talking about it and may often avoid talking about it altogether. Silence is the enemy of mental wellbeing, so it’s important to encourage a conversation and it’s just as important to be mindful of the terms we use. When someone is open about their mental health, they can put their colleagues and friends at ease talking about it too. The more open they are, the more likely they have a chance of being supported. If nothing is said, and people suffer in silence, people don’t know that support is needed. Less discussion means a lack of understanding. This worsens the stigma. Lack of understanding causes confusion and fear for both the person experiencing it and their colleagues. When people can identify their own problems, it can help them understand the issues and make them better equipped to seek help early.
The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:
A collective responsibility
Because 1 in 6 of us is experiencing mental distress, the language we use and how we communicate is critical to support good mental wellbeing. The person in distress could be a family member, friend, colleague or even yourself. Changing the narrative from negative to positive means that we no longer see mental illness as a weakness or something of which to be ashamed of. The same way we don’t expect someone with a broken leg to feel ashamed. Having conversations about the challenges and successes of managing our mental health is very important and can be a great inspiration to others. It can also improve everyone’s understanding that those coping with mental health issues still achieve great things, which helps to normalize the issue. And because individuals experiencing psychological distress may struggle to access help from others, the stigma and negative perceptions surrounding mental health may explain why people are reluctant to approach others for help. Improving public awareness of the services and resources that are available, as well as screening for psychological distress in primary care services, may be necessary to improve mental health and wellbeing.
Language is constantly evolving. As times change, word preferences also change. To show respect in conversations with others, be mindful of the impact your word choices have. And when confused just ask. Let’s mindfully join the conversation and do our part to help end the stigma around mental health.