Tag Archives: Donna Hardaker

Language and Mental Health (Part 3)

[The other three parts of this series can be found here and here.]

“Power is the ability to define reality and to have other people respond to your definition as if it were their own.”
– Wade Nobles

“Words are powerful. Old and inaccurate descriptors, and the inappropriate use of these descriptors, perpetuate negative stereotypes and reinforce an incredibly powerful attitudinal barrier.”
– Kathie Snow

Workplaces are microcosms of society and can be powerful change agents when they create caring cultures through attention to how suicide and mental health are discussed.

It is difficult for us to write about language and mental health in a simple “Say this” and “Don’t say this” way, but we must strive to do better. Generally, clinicians dominate the discussion, but thoughtful language about mental health and suicide does not rest on diagnostic categories. Rather, it tries to communicate more clearly, accurately, individually and holistically about the experience. We must constantly look to find language that is dignified, empowering and inclusive as well as being as descriptive as possible.

See also: The Daily Grind Is Good for the Mind  

It is not easy to find “the best” language, but we can do better.

1. The terms that are used are often clinically based and clinically biased. The term “mental illness” puts the descriptor of a person in medical language, even though the person may not always wish to be identified based on a medical perspective. The medical model contributes to rampant oversimplification that looks like this: “All that has to be done is to get these ill people to seek treatment; they take a pill, and they are fixed!” Diagnosis serves the medical practitioner in treatment planning, but it does not provide good information or understanding about the whole person and encourages us to see a person only in terms of a medical condition. And diagnosis is often incorrect, so it should not be the focus of how we educate.

Although it is very common for people who have received a label regarding mental health or substance use to have a significant history of trauma, the correlation is ignored in the language, and often in treatment too. Only the set of “symptoms” currently seen is addressed. The trauma is not.

2. The choice of words is not mindful. The word “suffering” is used often, as in “people who suffer from depression.” This paints a pathetic picture of nothing but suffering, which is a fallacy, while suggesting passive inaction.

Another common term is “the stigma of mental health.” In fact, the stigma is an attitude of prejudice toward a group of people. See below for suggested alternatives to the term.

3. Terms promote “other than” thinking. The words “disorder” and “disability” inform us that those who fall into these categories are other than “ordered” or “able.” “Order” and “able” are the givens, the desirable things. “Dis” implies that a person described this way falls short. Consider this: the term “non-white” is not used to name a person who is other than Caucasian, because it would be deemed to be disrespectful. Unfortunately, we do not have a wording solution for mental health.

4. Better terms require more words. We are forced to use terms that represent dominant culture mindsets, even though they are just labels, not the “truth.” For example, a better way of saying “a person who has a mental illness” could be to say: “a person who has the experience of having been assigned a medical label in the category called ‘mental illness.’“ But this makes writing and speaking very cumbersome.

5. We do not have consensus around best language. Inside what is known as the recovery movement, we do not have consensus on best language, and that is okay. Let’s all keep thinking about this, talking to each other and pushing collectively toward better communication.

The chart below provides some principles of progressive language. The suggestions that appear in the right-hand column are far from perfect, and we hope that they will continue to adapt and improve. To fulfill our desire to support self-determination, please note that if a person with the lived experience of a mental health challenge wishes to identify himself using language from the left-hand side of the chart below, we support that choice.

(This is not an exhaustive list, and for reasons of space does not hold all the terms and usage that we wish would change.)

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Portions of this chart have been adapted with permission from Each Mind Matters, California’s Mental Health Movement, funded by counties through the Mental Health Services Act (Prop 63).

See also: Why Mental Health Matters in Work Comp

Words matter, especially where there is such a long history of marginalization, misinformation and mystery around daunting topics. When it comes to language related to mental health, we may not have all the right answers, but many of us are in the struggle to do better.

Language and Mental Health (Part 2)

[Part 1 of this series focused on why language matters in mental health advocacy and on suicide prevention in the workplace. This article explores wording related to suicide that we want to see change. Part 3 will look at wording related to mental health.]

We are often asked: What is the best way to talk about suicide?

“Died by suicide”

Much of the language related to suicide death comes from a stigmatizing history. The term “committed suicide” originated when suicide was thought of as a sin or a crime, instead of as a fatal outcome of a set of thoughts, often a result of a mental health condition. The phrase is still the most common way for people to describe a death by suicide in the general public, the media and even in the mental health sector. We can ask ourselves: Does someone die by committing a car accident? By committing cancer?

Certain terms are commonly used to describe whether a person has died or not: People talk of a “successful” suicide or an “unsuccessful” attempt. The use of the word “successful” is highly insensitive to the tragedy of a death by suicide. Similarly, we hear the term “completed suicide” to refer to a death by suicide. In North American culture, we place a positive value on success and on completion, so we suggest a certain amount of good when we refer to a suicide as successful or complete.

When talking about suicide in general, test language by substituting the word “cancer” for the word “suicide.” If the result sounds odd, chances are the phrase has come from a stigmatizing origin. For example, we wouldn’t say “the cancer was successful”; we would say “a person died from cancer.” Thus, “died by suicide” is the best option we have to describe suicide death.

See Also: The Daily Grind is Good for the Mind

We should talk about suicide by viewing it through the same lens we use to look at cancer, car accidents and other causes of death. We can seek to apply a public health advocacy approach, rather than a blame-the-victim approach, which is a result of the use of archaic language.

“A person who is thinking of dying by suicide”

When we label people, and group them according to an identifier, we are seeking to simplify who they are. It is a short-cut language strategy that also short-cuts understanding and connection. In suicide, there is often a label: “a suicidal person”; “he is suicidal.” Using our rule about swapping “suicide” for “cancer”: Are you cancerous, or are you a person who has cancer? We prefer:a person who experiences suicidal thoughts,” “a person who is thinking of dying by suicide.”

For most who die by suicide, we believe their choice would have been to live if they could have found a way out of the mindset of dying. Unbearable psychological pain may be accompanied by very strong internal commands to die. This experience is not the usual type of rational choice in the way we commonly think about choice. People often say “a person chose to die by suicide.” Inside this thinking, there is a sense of absolving of responsibility anyone other than the person who died, which we understand. It is very difficult to grasp that a person has died by suicide, and we often seek solace in language that implies that the person acted completely freely. We wish to undo this type of phrasing that implies that true “choice” is part of the picture. We prefer that people do not use the word “choice” when talking about a death by suicide.

Also in the language of suicide, we find phrases that imply that a person who has made a suicide attempt is manipulative and is just “seeking attention.” The phrase “suicide gesture” has an implication that intent is not genuine. We prefer: “an action with suicide intent.”

“Precipitating events”

When a person dies by suicide, and we wish to talk about what led up to their death, we often talk about “triggering events.” The word “trigger” is problematic because of its strong connection to firearm use. Also, by calling something a triggering event, the phrase denies an opportunity for people to have mastery over the impact of the event. It is preferable to use a more objective term to describe prior events and challenges. We prefer: “precipitating events.”

Clarity around “survivor”

The term “suicide survivor” is confusing. Depending on how it is used, this phrase may mean a loved one left behind when a person dies by suicide. At other times, the term means someone who has survived a suicide attempt. Thus, the preferred terminology for people who are left behind is: “a person who is bereaved by suicide,” or “a person who is surviving a suicide loss.” People who attempt suicide but do not die can be referred to as: “a person who attempted suicide and survived.”

In addition, the field of suicide prevention also seeks the expertise of people who have lived through a suicide crisis and did not have an attempt. Sometimes these folks are included under the umbrella of “people with lived experience of suicide.”

In conclusion, “messaging matters” in suicide prevention and suicide grief support. For more best practices, review “The Framework for Successful Messaging by the National Action Alliance for Suicide Prevention”: http://suicidepreventionmessaging.actionallianceforsuicideprevention.org/.

Language and Mental Health

“Commit suicide,” “successful suicide,” “the mentally ill,” “suffering from a mental illness” —These phrases rattle off the tongue, yet we, as social justice advocates, find they rattle our souls as people continue to use them in well-meaning workplace education programs and community discussions. Let us explain…

In 1984, George Orwell said, “If thought corrupts language, language can also corrupt thought.” The above phrases are commonly used inside and outside the mental health sector and, because of this common usage, they are accepted. We suggest that they corrupt the thinking of those who speak them and those who hear them. We would like to change this.

What if being more mindful of our language could release new ways of thinking that eventually open up new opportunities for creative ideas, thoughtful approaches and ultimately true social inclusion? What if we make a conscious effort to find words that more accurately reflect the experience of mental health conditions and suicide — would we be better able to have empathy, support and inclusion in our workplaces and communities through the use of more skillful language? We argue: Yes.

Neurolinguistics tells us the words we use as we speak inform the way our brains store and process information about whatever it is we are talking about. Words carry current meanings and history of meaning. Many words are associated with inaccurate and unfair messages that serve to perpetuate misunderstanding and prejudice. The labels applied by clinicians to people who have mental health challenges create assumptions, expectations and interpretations that can set misperceived limits on how much growth and performance is possible, while also creating the means for social exclusion. We believe this process is often unconscious and has an insidious effect on our collective thoughts and feelings, especially regarding marginalized groups, such as people who live with suicidal experiences and mental health conditions.

See Also: Breaking the Silence on Mental Health

We are hard-wired to remember problems, especially when we perceive these problems to be dangerous. So, using language that is negative, connotes difference and insinuates a threat tends to be very “sticky.” To undo this, we need to spend extra effort to build a vocabulary that is life-affirming, dignified and inclusive. Paying attention to our language as we talk about mental health and suicide, while constantly working toward improving our language, will help create a workplace culture of compassion, vitality and engagement.

Stigma reduction campaigns and workplace mental health trainings that do not pay careful attention to language are limiting their impact and may be the reason why, even after many years, we are not much further ahead in terms of reducing stigma in the workplace.

Language is the most powerful tool in understanding each other. In any social movement, language must be addressed. How we speak about people informs us about them, so when we speak unconsciously, without attention to bias and misperception, we are perpetuating social prejudice and damage. By changing our language, we alter our perceptions and attitudes; this is social justice.

In a sequel to this blogpost, we will explore the history, impact and alternatives of specific words that are often used when talking about suicide and mental health.

The Daily Grind Is Good for the Mind

The human brain thrives on what work gives us: activity, routine, social contact and identity.

The act of working gives employees far more than just the benefit of earned income. The World Health Organization names it as a health factor that, when present, contributes to health and, when absent, can increase the chances of ill health. This is particularly relevant in the discussion about mental health. What is it about work that contributes to mental health, and why should employers and insurers consider the health benefits of work?

Activity

When human beings are engaged in doing things, areas of the brain related to attentiveness are stimulated. When someone is off work, it is harder to find regular daily activity—it is not as easy to find the many everyday behaviors we do when we are working. Work provides a structure that tells us what to do. We then engage in hundreds of behaviors every day. Being in the act of doing these behaviors keeps us healthy. When we are not working, it can be hard to answer the question: “So what did you do today?” This absence of activity can have a profound impact on a person’s sense of accomplishment and purpose, which has an impact on mental health.

Routine

Work forces us into a rhythm and regular behavioral patterns that are actually good for us, even if sometimes we may resent the structure. Our bodies and brains enjoy the routine and benefit from the repeated predictable patterns of behavior. If we don’t have something to get out of bed for, it can be difficult to get out of bed. When someone is off work for any reason, the lack of daily direction can have a significant impact on well-being.

Social contact

We spend more waking hours with the people we work with (when we are working full-time hours) than with the people we love and live with. Human beings as mammals are social creatures and seek and thrive on social contact. Neural activity related to social contact is crucial to mental health, and social isolation is a risk factor for mental illness. We are connected to our co-workers because we are social beings who are genetically programmed to monitor and build social connections. We rely on the hundreds of exchanges inside the social context at work to meet our needs for belonging and connection. When people are off work, they lose this continuing social contact, and the isolation has a significant impact on well-being.

Identity

Work gives us identity. When we work we have a title, a position, a clearly defined set of tasks and a label that provides information to the world about who we are, this informs us about who we are in relation to others, and in how we view ourselves. Loss of this identifier has a significant negative impact on self-esteem and self-worth, with a predictable risk to mental health. When employees are off work, it is hard for them to answer the common question: “So, what do you do?”

Any person facing unemployment experiences changes in all of these factors and is at risk for developing mental health issues. A person who already is experiencing mental health challenges, and then goes off work, may find it difficult to build steady recovery, because the essential health need of work is not present.

Many disability plans have an all-or-nothing approach to an employee’s ability to work. If employees are off work, they are deemed not able to work. If employees wish to find regular daily activity to help build their recovery, they may put their claim at risk. This approach to disability management may actually be making employees stay off work longer. The longer an employee is off work, the harder it is to return to work. Systems that do not allow employees who are on a disability claim to work, even to perform volunteer work, are preventing employees from tapping into the health benefits of working and may be contributing to needless work disability.

Employers may also have the mindset that an employee who is sick should be off work. When it comes to mental health issues, it is not best practice to use this all-or-nothing approach. The key here is for employers to have the capacity to address individual employee needs as they return to work or, better yet, have flexible processes and structures that allow employees to stay at work. Staying at work during early days of recovery could be part-time, with the disability benefit covering the balance of an employee’s income from salary.

Continuing activity, routine, social contact and identity build employee recovery and can reduce the cost of the disability claim. There is less work disruption, and continuity can be maintained for the employee and the family, the work team and the organization. This contributes to increased employee health. And healthy employees are productive and engaged employees.