Language is awesome. It helps us share ideas and challenge those that are rubbish. But we know that meanings change over time. Fizzle used to mean to fart quietly, buxom meant compliant, and boner meant an embarrassing big mistake. So, it’s understandable that our mental health language and its meanings may have shifted over time.
Sick of it
Mental health conversations are peppered with language of ‘illness’ and ‘having anxiety’ or ‘suffering from depression’. People say things like ‘their brain is wired that way’. When we think about things like depression, we often group words, such as “mental illness”, “doctor” and “medication”. This “linguistic framing” shapes how we understand topics by highlighting some things and hiding others.
Our mental health language is based on the medical language we use to describe physical sickness – illness, having cancer, suffering from appendicitis. It frames the mental as medical, the psychological as biological. Confident that medical treatments work for broken bones and kidney disease, this language sets us up to expect medical labels and treatments for our psychological difficulties.
“Mental illness” used to be reserved for people in major psychological or emotional distress. Now, it is used to describe many normal responses to life’s ups and downs. As a result, the few of us who may have genuine need are difficult to tell from the many of us who may not.
This makes my head hurt
In the mid 1800s, even though there were ‘insane asylums’ and ‘loony bins’, medical professionals thought severe mental distress generally came from our social experiences. Things like “remorse after seduction” and “religious excitement” were listed as reasons for admission to British hospitals.
But times changed. Health policies and processes were nationalised, and these admission forms were changed from text box to check list. Admission reasons were standardised, and the more biological causes took preference. The language of mental health changed from social to medical.
After this, came the medication revolution of the 1950s, followed in the ‘60s by theories about being chemically imbalanced. Then in the early ‘80s, the four most powerful institutions of the mental health world got together. The pharmaceutical companies, the American Psychiatric Association (APA), the National Institute of Mental Health (NIMH) representing the American government, and National Alliance of Mental Illness (NAMI), America’s biggest mental health advocacy group, agreed to actively promote that major psychological and emotional distress are signs of brain disease. This embedded into our language that such experiences have biological causes.
One reason for this message was that people experiencing this distress were being stigmatised in society. Since we don’t blame someone for being physically sick, it was thought that presenting psychological distress as a physical disease would minimise people being outcast and stigmatised. This approach reduced some blame, but other aspects of stigma increased. People were more afraid of dangerous and debilitated mental patients; and everyone, including the patients, became more pessimistic about their futures.
Spit it out
The marketing campaign that started in the ‘80s and hasn’t stopped yet, changed the language we heard from "major tranquilizers" to "antipsychotics" and from "minor tranquilizers" to "antianxiety" agents. This was in large part due to the influence of the drug companies on the APA. Drug companies began to sponsor conferences, and invest in medical education and political lobbying. Since then, the drug companies have funded research to show their drugs work. They have often failed to disclose when their drugs don’t work, and have pressured universities to avoid non-drug research and treatments.
This financial relationship and research guided the diagnostic tools used by doctors to identify and label people’s emotional experiences as medical. Academic and Health journalist, Dr Ray Moynihan suggests that each new edition of the guide suffers from “diagnostic creep” – where criteria expands to include more of the population as needing medication.
Meanwhile, drug companies spend their multi-billion-dollar marketing budgets on schmoozing doctors and convincing us that we are broken and only their drugs will fix us. Plus, they teach us how to discuss our problems using their language – language of illness, having anxiety and suffering from depression.
All of these factors have worked together to produce more people identifying or being identified as ‘depressed’. Statistically, the mental health burden is getting more intense and more long-term, particularly in kids.
Thanks for your patients
Mental health is complex. Now that it has been dragged out of the shadows, we need to start talking about the real experiences of this long-term emotional or psychological distress – what science and people genuinely unwell tell us.
Sure, this language needs catchy phrases, but we can’t simplify people’s experiences to marketing slogans. We can’t limit research to Randomised Control Trials, nor treatments to those putting money in the pockets of drug companies. We surely can’t allow those companies to keep expanding what qualifies as mental illness so more of us live our lives medicated.
The powerful coalition guiding the language of mental health feels unbeatable. But things are changing. The NIMH has distanced itself from the traditional diagnostic tools and language, and developed an alternative research framework that looks at more of a person than just their biology.
Psychiatrist George Engel was among the first to propose an alternative approach to healthcare in 1977 that recognizes how our bodies, our brains, and our relationships all affect each other. More recently, there has been interest in “social prescribing”, where GPs and patients identify social activities that will address physical and psychological health needs. These ideas have been known by Australian and other indigenous cultures for millennia; but now we have the scientific evidence to back it up.
Now is the time to shift our language and our understanding of mental health; to reduce it to those of us in serious distress and expand it to include evidence-based treatments beyond medications and a few therapies.
Using language that more accurately reflects peoples' experiences can free us from being medicalized and medicated, and we can finally get past this current boner.
Dave Anthony is a Registered Music Therapist with almost 20 years of professional experience. He spent 12 years working in intergenerational trauma and currently works in an acute adolescent mental health unit, and for recreativ mind:health.