Back in the 90s, we all learned that the language that we used to refer to people could have a lot of influence. An immense amount of brain power, struggle and argument went into defining the appropriate terminology to refer to people of various ethnicities and minority groups. While I actually think this was a useful and worthwhile exercise, it’s not what I want to discuss here.
Instead, I want to look at the terminology that is used to refer to us mentalists. There is a parallel process underway at the moment in our society to come up with the proper terminology to use when talking about those of us who see psychiatrists regularly. I don’t like the way it’s going.
I refer to myself as mentally ill. I experience my illness as an alien force that spends its time trying to find ways to make my life as hard and miserable as possible. I’d give anything to be rid of it, but I understand that I don’t get that option, I have a lifetime membership of the bipolar club. I get sick, I am a patient in hospital some of the time, I see doctors and nurses, I take medication and get regular therapy. All things that someone with a serious chronic illness can expect to do over their lifetime.
I loathe and detest being referred to as a ‘service user’. I am seeing a bloody doctor after all, not patronising a brothel. Service user is such a painfully right-on euphemism. It reeks of ‘let’s not upset the poor mentalists by implying they are ill’, or that mental illness is so shameful and awful that we have to refer to it in this roundabout way, like whispering if one knows the way to the ladies powder room in a 1930s film. It differentiates between the physically ill, who are still referred to as patients, and the mentally interesting, with their nice little piece of pseudo-euphemistic terminology all to themselves. We’re not sick! We’re just a bunch of mentalist weirdos!
Similarly, it makes me angry that MIND insist on referring to ‘mental distress’ and not ‘mental illness’. This kind of ill-advised condescension feeds the opinion held by many members of the public that mental illness isn’t real. We don’t refer to someone in need of dialysis as undergoing ‘kidney distress’ do we? Mental illness is real, as real as renal failure, and I don’t see why we need a special set of terminology to refer to it. MIND are not getting a penny out of me until they revise this particular policy.
One in Four magazine has followed suit, referring to “mental health difficulty” which is less objectionable but still beats about the bush.
I am quite frankly baffled by this. Why are sufferers of mental illness going to such pains to stigmatize themselves by using insulting and divisive language? What end could this possibly serve? What on earth is going on? Answers on a postcard or in the comments please.
“Why are sufferers of mental illness going to such pains to stigmatize themselves by using insulting and divisive language?”
Innate human stupidity?
If my cat gets served cat food twice a day, does that make her a service user? She’s a demanding one.
DeeDee, I agree with your points about vacuous euphamisms 100%. What sort of language or terminology would you like to see used?
I think “patient” and “mental illness” fit the bill just fine….
The OT department did a poll at work asking what term everyone thought should be used. All the OT people and management said service users, all the nurses and patients said patients. Guess which term we have to use
*****giggles*****
I think it started with the ICD-10 and DSM-IV – once you start to be pigeon-holed it continues until it gets to a point where the powers that be backtrack and it sounds like the British tea-and-biscuit there,there “service-user” approach is the best they can come up with to stop us going postal in case we sue their arses for human rights or something. I mean, I stick shedloads of money into the health system here in Switzerland and am now outraged that I am just a patient and that my “mental distress” (WTF?!) is just Atypical Depression. how disrespectful!!
***Sighs and feels cheated by her medical insurers, psychiatrist, psychologist…….****
In my hospital, the patients are referred to as patients, or occasionally clients or residents (on my ward, which is a relatively long-term ward, people ont he acute ward were always called patients). I don’t personally identify as a patient though unless int he strict context of this hospital (ie. patients vs. staff). The reason is that I conside rmy condition (autism) to be a disability rather than an illness. Because of this, I used to be very uncomfortable with the word “patient” and more so with the word “ill” in reference to me, particularly when the acute crisis that landed me int he hospital, had gone. What remained is not illness, it is disability. But then again, I don’t hate “patient” and “ill” nearly as much as I hate “service user” or “consumer” and “distressed”.
I do draw an important distinction between conditions such as deafness and autism, which are disabilities where I am told the main problem is how society reacts and doesn’t accommodate them, and mental illness which causes pain and distress in and of itself, if you see what I mean… I can see you would object to being called a patient.
I agree with Astrid – but then I’m Autistic too… We don’t fit very well into the Mental Health system – because our Index Offence isn’t Mental Illness.
However, If I was Mentally Ill, which I’m not and I have a nice letter from Dr Julio-Julio to prove it, I’d want to be a Patient and to be treated for Mental Illness.
This issue has been discussed ad infinitum since the nineties at most of the meetings I ever went to, from the Patients’ Council at our local hospital to national conferences for people who had been in mental hospitals, often, it seemed, to avoid more difficult discussions on other more serious matters (the quality, or lack of it, of the refreshments provided at various venues was another favourite subject, IIRC.)
I have heard people who are mentally ill described to others as “having mental health”, without any irony at all, because they use “mental health services”.
I didn’t realise all this was on the agenda again.
I call myself crazy and a patient. When I refer to myself as crazy in front of the professionals I get a lot of flack for it and it pisses me off because I know darn well I have thought this through more than they have and because it is ME. I call myself crazy, or refer to my experiences of mental illness or the mental illness as “my crazy” which isn’t grammatically normal, but adds to the effect I’m after. To me, if I refer to myself as “mentally ill” or if I say, “I have depression” (which I wouldn’t primarily because diagnosis is far too complex a subject and because I think diagnosis in mental illness is seriously flawed), that makes people react to me in a very different way than if I say, “I’m crazy.” For some reason, the professionals seem to fear that I will get stigmatized more if I call myself crazy, but I haven’t found that to be true at all, and I suspect that is common. If I were calling someone else crazy, that might add stigma to them that calling them “mentally ill” might not, but when I call myself crazy, it gets taken more lightheartedly than any other label I could apply to myself (except maybe, “I’m mad as a hatter,” which, now that I think of it, I might take up). If I call myself “mentally ill” or “depressed”, people will pity me whether I intend that or not. People will think I am fragile whether I am or not. They might try to pry into my private life to “help” me. If I say I am crazy or mad as a hatter, they know that I am comfortable with this because I can make a joke out of it. They are less likely to pity me, think me fragile, or offer unwanted “help.”
I object to the terms like “client” and “service user” primarily because they don’t reflect what is going on very accurately. Mental health care is very paternalistic and the professionals hold and wield a lot of power over the patients. “Client” and “service user” indicate that the patient has the power in the situation and gets to call the shots, which has never been true. There is also the fact that I don’t hear people agitating for medical patients to be called “clients” or “service users”, but that would make me want to call mentalists something other than “patients” to distinguish them from medical patients because they are not treated like medical patients no matter what the big wigs say to the contrary.
As for the terms that downplay the seriousness of mental illness to the extent of making actual mental illness seem nonexistent. I don’t have a good way to handle this. I do believe in mental illness. I do not believe that everyone who is so diagnosed actually is mentally ill, and I think this is a big problem. But I think there are people who experience “mental distress” to a lesser extent than actual mental illness, but who also need, want, and deserve help.
I’m not a patient, neither do I have a current diagnosis so I can’t be referred to as mentally ill. I do, however, experience mental distress. I don’t feel that makes my experiences seem any easier or harder to deal with than someone with a care plan, and I don’t feel it’s insulting – to me it’s just a descriptive term for what I go through. When appropriate I can narrow it down further e.g. ‘voice hearer’ but sometimes a catch-all term is needed, and for me mental distress fits OK (this is of course when I need to talk formally, with friends I generally speak about nuttiness and being a loony). What I do find insulting is the idea that distress is somehow lesser than illness, that in order to be taken seriously I need to be in therapy or taking medication, that I need to have an illness or be a patient. For me, the choice to live outside of the mental health system came at great personal cost and the maintenance doesn’t come cheap either. To read that through that decision I am thought to be helping create stigma is really quite upsetting. I agree that the different trends over the years leave a lot to be desired – a personal favourite of mine though not strictly mental health-related was a few years back when the job centre referred to me as a “customer”! – but it’s going to be very hard to find a term which everyone is happy with. I usually live by the rule of accepting everyone’s own definition (if you’re mentally ill that’s fine by me), but you can’t do that when you’re a writing a document that’s going to end up applying to thousands of people. I think the best we can hope for is that the intention behind the language is good, and if someone chooses to refer to themselves as something different then it’s accepted without derision.
The job centre would want to learn about customer service before using the term customer!
I’ve worked with people who’ve described themselves as patients, residents, service users and clients. I’ve also worked with people who’ve not been comfortable with any of those terms and have chosen to use mental distress to describe their experiences. I’ve never questioned any of them, prefering to live by a similar rule to Aliquant and accepting their own definition.
On official documents, we are supposed to use the term “service user” as I believe that’s the term of the moment, but I have seen it change quite frequently over the years.
Personally, I’m not fussed about what people call me on pieces of paper. As long as, when they are treating me/listening to me/supporting me, they refer to me by my name and treat me as an individual (rather than as someone who comes under a big umbrella or fits in a box), then I’m happy.
nice topic dee dee, the different terms are something I struggle with as a nurse, especially joint working with social services who are even more scary at attempting this PC correct (incorrect) labelling, trying not to offend anyone, but by doing so offending everyone sensitive to such labels. It’s the same problem that occurs all the way to the core of the NHS in that decisions are made by people who don’t have a clue and those who have had or currently do have a mental illness are not consulted on how the care should be provided including such terminology. Mental health care in the UK is not ‘person centred’ or ‘client centred’ as my trust bulletins keep harking on about, it is centralised and extended in a non individualistic way, it is up to us nurses to be vigilant and keep our wits about us and communicate with each individual in a manner that they find comfortable and not insulting or patronising.
My least favourite term is client. I feel like that is someone who goes to see a prostitute. Patient would be my preferred term, but if I had to choose between client and service user then I would go for service user. But I don’t actually understand what is wrong with patient. Or mental illness. I like that Jessa calls herself crazy. Professionals don’t like that. They tell you that you’re not crazy.
Quite right DeeDee.
“One in Four magazine has followed suit, referring to “mental health difficulty” which is less objectionable but still beats about the bush.” – Actually I think it’s just as bad. If you get food poisoning you don’t have a gastrointestinal health difficulty.
These attempts to rebrand “mental illness” reflect in a silly way the fact that the mental health community doesn’t agree on what mental illness is or whether it exists. This is broad generalization but – you have two kind of patients, those who think of themselves as ill and those who don’t. The first kind want better medical treatment, the latter don’t want medical treatment at all. A psychiatrist would say the former have insight and the latter don’t. The former want to make mental illness be accepted as “an illness like any other”, the latter think that’s a myth to oppress people. In fact these two kinds of people have almost nothing in common except that society currently labels them all as “mentally ill”, both kinds don’t like this because it associates them with the other kind, hence all the crap about names.
Thanks, that explains things pretty well.
BTW, “If you get food poisoning you don’t have a gastrointestinal health difficulty.” made me laugh out loud
.
One problem with concentrating on Mental Illness rather than Mental Distress is it lets them off the hook, to say ‘not our problem’, as Mental Illness is what they deal with – a couple of days before my suicide attempt I was assessed by a psychiatrist, one who had seen me before as I recall (it was a long time ago), and there was no questioning that I was suicidal, but what mattered to them, and their job, was: “is he ill?” They thought not, so it was goodbye and I’d rather you didn’t. I believe that I was ill, and that they were naively misled by the textbook calm of having made the decisions, but although they always praised my insight I guess they weren’t too impressed with my clinical judgement!
The most ridiculous warped language I’ve ever seen was on a blackboard at a nurses’ college, which suggested the nurses had been learning about ‘S&EMH’ – presumably Severe & Enduring Mental Health!
“He’s severely mentally healthy! Quick, we need to make him depressed before he annoys us to death by walking around like a human Care Bear!”
I spot an Onion article in the making here.
@DDR – I totally agree. ‘Service user’ is a horrible term. It’s cold and implies that the individual is merely using a ‘service’ as opposed to being treated by a caring profession.
‘Patient’ on the other hand, implies a very special type of relationship, namely a relationship where the patient can expect a certain level of care and a certain level of professionalism. Patients are able to avail of the care of health professionals – which means that they also benefit from the rules of conduct that have been developing since Hippocrates.
I think that patients with mental illness already have a very hard time – so lets spare them the patronising labelling as ‘service users’ – let’s recognise that ‘client’ is a term to be used in a business arrangement and lets centre our thinking on a caring relationship with our patients!
I was about to refer to this site here:
http://madpride.org.uk/index.php
as a dead link as I thought it died many years ago. I like their terminology. Nice to see it is still going.
When I call up my electricity provider, I’m a service user. I can choose to go with another provider if I don’t like their service. Can “mental health service users” say the same?
“Patient” has a dignity to it that “client” or “service user” lacks.
And “mental health nursing” has always got on my nerves. We deal with mental illness, let’s at least be honest about that.
I’ve never got why it’s ‘mental health nursing’ but still ‘psychiatrists’ and not ‘mental health doctors’!
‘I’ve never got why it’s ‘mental health nursing’ but still ‘psychiatrists’ and not ‘mental health doctors’
I think it’s the same reason that dentists are called dentists and not ‘teeth doctors’
Brainologist?
lol nc! But the nurses are still called dental nurses, not teeth nurses, at least they match! Why do psychiatrists get to hang onto a dusty old dicky bow of a title when everyone else has moved on?
my brain hurts.
because a lot of them are dusty old dickies? Some of the psychiatrists I know are so defensive of their diagnosis and treatment you’d think they were the ones that needed medicine for their self delusion. At some point in the future people will look at them with ridicule as science progresses and they stay stuck, upholding ideas that were concocted in a bygone era, they are becomming more like the creationists and flat earth believers every day in my eyes. Bring on the Brainologists!
Another post that I totally agree with and it’s something I regularly complain about.
I’ve actually found the BBC to be massive culprits of this.
In the past couple of months there have been a couple of stories referring to people with mental illness and depression, which have used a range of euphemisms.
The story about Marcus Trescothick returning from India due to his recurrent depression and anxiety was described as “stress-related”. Although this may be true, it just seemed like it wasn’t acceptable for it to be depression/axiety even when Trescothick has been open about his illness.
Another example simply described some celebrity to have experienced “distress”. Not even “Mental Distress”, but it mentioned how she had been admitted to The Priory so one would assume it was of the mental variety.
I’ve also found it within services. For Creative Remedies we have a flyer describing what it is about. On the flyer it mentions “Mental Health Difficulties” and even this was deemed as being too frightening for people. They are considering changing it to refer to “mental wellbeing” or some such other fluffy term. I explained my anger at this, especially as it is a service for people with mental illness of all forms, not just those struggling with their “mental wellbeing” but also the seriously ill, and it seemed to be pointing the service in the direction of mild depression and stress. I also pointed out that until we can talk about mental illness in straight honest terms it is going to be impossible to challenge stigma. Something Mind could do with realising.
Rethink have a similar stance against these terms too. The readers panel tore apart the “New Horizons” document for often referring to wellbeing and mental distress instead of illness.
“Similarly, it makes me angry that MIND insist on referring to ‘mental distress’ and not ‘mental illness’”
As I recall, MIND used that term so as to include people who experience problems that the system doesn’t necessarily recognise as “illness”, i.e. isn’t in DSM or ICD.
I can remember when the term “service user” first came in, late 80′s-early 90s. Then it was liberating: the term “patient” had acquired overtones of “passive recipient” which it now seems to have shed.
These changes in terminology are usually introduced with good motives, but eventually the “new” term acquires the negative connotations of the one it was intended to replace. Thus we need to be constantly examining and changing the terminology – words and their meanings are ever mutable.
I personally will stick with being a JAN (Just Another Nutter).
And for the hard-of-thinking, yes JAN is actually tongue-in-cheek and irony-laden.
Haha, I genuinely thought Jan was your name!
And good points well made.
‘Patient’ misses people who aren’t currently accessing formal treatment providers.
In which case they are just people, or ex patients.
‘Patient’ misses people who aren’t currently accessing formal treatment providers.
So does “service user”.
Meant to reply to this earlier – I completely agree. And, when they say “client” or “service user”, I think it’s a capitalism/consumerism thing. (And I agree with the person above who said clients are people who go to see prostitutes.) See also: choice in hospitals, when most people would probably much rather their nearest hospital was clean and competent when they’re having a medical crisis. I hate when people bring the language of consumer choice into healthcare. Oh, right, I don’t have a legal right to a second opinion? I don’t have a legal right to change my psychiatrist? It’s this guy I can’t stand or nothing at all? Stop talking like I picked my optional extra out of the Yellow Pages, then.
And I think there is such a problem with mental illness not being taken seriously, that terms like “difficulty” and “distress” just make worse. I can sort of see the social-model viewpoint, that calling it “distress” emphasises that the mentally-ill person would rather not be dealing with this either, and don’t go making their life even more difficult. But then that’s giving in to the stigma rather than fighting it – oh, mental illness is bad, okay, we won’t say we have mental illness then. Oh no, we’re not like Those People.
How about ‘differently mentally well’? Seriously, apart from being sick-makingly PC and patronising, ‘service user’ as used just now leaves out all the rest of the ‘service users’, i.e. the family & friends. And although I’ve given in and started using it I’ve never liked ‘carer’. While I’m on the subject I’m glad this site is mainly but not entirely free of vile, lazy Sociologese & Psychobabble, ‘issues’ and the like.
Oh, and I was proud of being a psychiatric nurse, who we were told in the 60s were to be properly qualified professionals with a specific role as opposed to ‘mental nurses’, who had been large, cheery lads & lasses who were good at organising and participating in football matches, dances in the main hall and the like.