A loyal reader of Five of Friday recently wrote to me with some feedback. She kindly started with a compliment and then expressed her concern for how I spoke about suicide in my TEDx Talk, which she happened upon online.
She is right. That talk is from 12 years ago, and If I were preparing it today, I would choose different words. Hearing from her reminded me that language matters. That how we talk about mental health and mental illness evolves. And that talking about how we talk about mental health is essential. Here are five points to keep in mind that will help promote constructive conversations around mental health.
1. Volition and Assigning Blame. What troubled my reader was that in my 2011 TEDx talk, I spoke about people “committing suicide.” Today, there is a strong movement to say instead “died by suicide.” Some might dismiss such efforts as excessive language policing, but the two expressions convey very different underlying assumptions that have real implications. We don’t say someone committed diabetes or heart disease even though these conditions have significant behavioral components. People commit crimes. Suicide is not a crime. By talking about “dying by suicide,” we remove the assumptions of volition and blame and make room for a better understanding of how mental disorders significantly increase the risk of people dying this way.
2. Person-first Language. I remember it as if it were yesterday. I was a psychology intern on an inpatient psychiatric floor in a large teaching hospital, and our attending physician was walking us trainees from patient room to patient room describing the clinical presentation of various mental illnesses. He stopped outside each door to give us a brief overview. It made me uncomfortable then. It makes me cringe now. With the sincere intention of teaching us, he spoke about “the schizophrenic” in one room, “the addict” who was also “an alcoholic” in another, and “the anorexic” down the hall. The disorders were completely disembodied, and people and personhood were erased. In sharp contrast, person-first language recognizes that people are much more than their mental health condition. Person-first language means saying “a person with schizophrenia” instead of “schizophrenic” or “a person with anorexia nervosa” instead of “anorexic.” Person-first language takes more time. It is also respectful, destigmatizing, and more accurate.
3. The Problem with Crazy. Historically, it was commonplace and socially acceptable to call people with mental illness “crazy,” “psycho,” “loony,” etc. Stigmatizing and discriminatory terms such as these have the pernicious effect of diminishing self-respect and increasing the self-stigma experienced by people with mental health conditions. People with mental illness are at risk of self-stigma that occurs as a result of widespread prejudice and discrimination, and the effect has a significant negative impact on the course of illness and quality of life overall. A 2022 study quantifying trends in the language used on Twitter when talking about mental health offers some encouraging news. Over the past ten years on Twitter, stigmatizing language around mental health has decreased and the phrase “mental health” increased by a factor of two between 2012-2018, suggesting increased openness and open-mindedness about mental health.
4. Mental Illness vs. Physical Illness. This is a bit of a rant of mine. It is very common for people – clinicians, researchers, and the general public alike – to juxtapose mental illness and physical illness as if they are opposites – like black and white or hot and cold. This bifurcation of mental illness and physical illness is patently false. Where would mental health happen if not in our physical being? When we talk about mental health as if it is not physical health, we perpetuate the myth that somehow it is not real, but in fact, mental disorders are often detected and diagnosed based, in part, on physical signs and symptoms. In the case of depression, for example, physical symptoms include fatigue and exhaustion, changes in weight and diet, chest pain, aching joints and muscles, headaches, digestive problems, and more. Further, mental health and other health conditions are intimately linked. Consider, for example, that people who have anxiety and depression following an acute cardiac event are at increased risk of a subsequent event and premature death. It behooves us to recognize that mental health is physical, and is an integral part of our overall health.
5. Don’t Know What to Say. Many individuals ask me about how to talk with someone who has a mental health condition. Should they say something if they are concerned about someone? How can they express their concern without making matters worse? Three general principles guide my thinking on this. First, be specific about what you see and why you are concerned about the person. For example, instead of saying, ‘You seem down’ it is more useful to say, ‘I have noticed that you have been spending more time alone and in your room. I wanted to check in with you to see if there is anything troubling you that you want to discuss.’ Second, you can express your caring with support and encouragement without intruding or fixing, by stating, ‘I am here for you,’ ‘You are not alone,’ ‘There are treatments available,’ and ‘I believe in you.” Third, refrain from trying to make people feel better by inadvertently minimizing the situation. It is not helpful to make comments like, ‘Things could be worse,’ ‘You have a great life,’ ‘Everyone feels down sometimes,’ or ‘It’s normal.’ It is more useful to say, ‘This is a difficult time’ or ‘I hear how much pain you are in.’ And sometimes just sitting next to someone, putting an arm around them, and being present in the moment with them in silence, goes further than words.
As our understanding of mental illness evolves, how we talk about it will evolve as well. The good news is that we are talking about mental health and mental illness more openly these days. With more candid discourse, we also have the opportunity to talk about the language that is and isn’t helpful. Many thanks to the reader who prompted this post. Leaning into such conversations helps us all grow.