“Words Make Worlds”: Language and the Culture of Mental Health in Workplace Wellness

by Donna Hardaker and Sally Spencer-Thomas

Part III: Words about Mental Health

In Part I: “Words Make Worlds”: Language and the Culture of Mental Health in the Workplace”, we explored the rationale for being mindful and intentional about language as we address stigma and social prejudice due to archaic and unconscious speech. In Part II, we addressed specific language about suicide. Here in Part III, we look at specific language about mental health.

“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 as a whole and have a significant contribution in generating social inclusion or exclusion. Workplaces can be powerful change agents when they create caring cultures through mindful attention to how suicide and mental health are discussed.

Photo by Benjamin Child

It is difficult for us to write this article in a simple “Say This” and “Don’t Say This” way. The topic is far more complex than swapping out words. This discussion is inside of a social movement (generally referred to as the recovery movement) that seeks to draw attention to unconscious bias held by the powerful dominant group who own and operate the communication methods that describe people who are not in the dominant group.

Generally, clinicians are the dominant group who name this experience. Clinicians use diagnosis-based thinking. Thoughtful language about mental health and suicide does not rest on diagnostic categories, but rather tries to communicate more clearly, accurately, individually and holistically about the experience. We constantly look to find language that is dignified, empowering, and inclusive as well as being as descriptive as possible.

This is not about political correctness. It is about altering how we all speak, and therefore how we all think, in order to permanently end social injustice in this area. Just as with other social justice movements, polite society no longer accepts these terms: “mental retardation”, “handicapped”, “colored”.

It is not easy to find “the best” language; we are forced to use common terminology developed by the dominant group that does not emanate from the empowered voice of the people being talked about:

1. The terms are often clinically based and clinically biased. Many people in the recovery movement push back against the term “mental illness” because it puts the descriptor of a person in medical language. This forces a medical presence inside the naming of a group who do not always wish to be identified based on a medical perspective. The medical model, when socialized in the media and in boardrooms, 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!” It is important to keep in mind that diagnosis serves the medical practitioner in treatment planning. 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 should not be the focus of how we educate.

Clinical bias mostly does not include a trauma-informed approach. It is very common for people who have received a label regarding mental health or substance use to have a significant history of trauma. 

This correlation is ignored in the language, and often in treatment too. The trauma experience is not addressed, only the set of “symptoms” currently seen.

2. The choice of words is not mindful. In heavy usage is the word “suffering” as in “people who suffer from depression”. This paints a pathetic picture of nothing but suffering inside this experience, which is a fallacy while suggesting a passive state of inaction.

Another common term is “the stigma of mental health”. This word usage infers that there is stigma inherent inside of mental health. Instead, words should more accurately describe that stigma is an attitude of prejudice towards a group of people by a group of people who are dominant. See below for suggested alternatives.

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, the “normal” things.  “Dis” infers “other than” and forces the thought that a person described this way has a value relative to the desirable given, and of course 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 to this dilemma.

4. Better terms require more words. Because we are forced to use terms that represent dominant culture mindsets, we can refer to them as labels, not as 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 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 us 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 themselves using language from the left-hand side of the chart below, we support their 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.)

Moving language away from…	Moving language toward…
Phrases that perpetuate incorrect thinking ·         “stigma of mental health” ·         “mental health stigma” Infers that there is something inherently stigmatizing about mental health.	More appropriately descriptive phrases ·         “stigma, discrimination and social prejudice towards people who are deemed to be in the group labeled as having a mental illness” We recognize that this is too long, but let’s continue in this vein! Especially important is the insertion of “social prejudice” to call out the group who are engaged in the attitudinal damage.
Words that promote only one aspect of the experience ·         “people suffer from a mental health challenge” ·         “people who struggle with a mental health challenge” It is inaccurate to indicate that the entire experience is one of suffering and struggle.	·         “have a mental health challenge” ·         “lives with a mental health condition” ·         “living through suicidal thoughts.” Language here begins to communicate resilience. It could be appropriate to speak about functional impact with use of the word “struggle” ·         “overcomes struggles with concentration” ·         “finds ways to cope with the struggle of fatigue”
Confusing lay usage of clinical terms ·         “he is acting so bipolar” ·         “the weather is schizophrenic”	Test your language by swapping out a term for an experience that is generally accepted, for example, you wouldn’t say “he is acting so diabetic” or “the weather is cancerous”
Hate speech ·         “psycho” ·         “cray-cray” ·         “nutjob” ·         “whacko” ·         “lunatic”	Respectful language that promotes dignity. Ask: would you enjoy the word being used to name someone you care about? ·         ”a person in distress” ·         ”a person in emotional distress” ·         ”a person with a history of psychological distress” ·         ”a person experiencing a mental health challenge” ·         “a person living through overwhelming life challenges”
Language that cuts a broad swath and defines people by their conditions. ·         “the mentally ill” ·         “the homeless” ·         “the disabled”	Wording that recognizes individual experiences and differences. ·         “people who have mental health challenges” ·         “people who live with mental health issues” ·         “people whose experiences are labeled as a mental illness” ·         ”people who experience homelessness”
Language that uses clinical or legal identifiers ·         “a patient” ·         ”a case” ·         ”a client”	·         ”a person who is engaged in treatment” ·         ”a person who is receiving services”
Language that emphasizes a diagnosis, not the person ·         “he is a schizophrenic” ·         “she is bipolar” ·         “he is an addict”	People-first language ·         ”he is a person who has received a diagnosis of schizophrenia/bipolar disorder” ·         ”she is a person who experiences addiction” ·         ”he is a person who identifies as an addict” Shorter, but problematic due to diagnosis as a descriptor: ·         “he has schizophrenia” ·         “she lives with an anxiety disorder” ·         “she is in treatment for depression” ·         “she is coping with the effects of trauma.”

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).

In conclusion, 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.

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ABOUT THE AUTHORS

SALLY SPENCER-THOMAS: As a clinical psychologist, mental health advocate, faculty member, and survivor of her brother's suicide, Dr. Sally Spencer-Thomas sees the issues of suicide prevention from many perspectives. Currently, she is the CEO and Co-Founder of the Carson J Spencer Foundation, a Denver-based organization leading innovation in suicide prevention. One of the main programs of the Carson J Spencer Foundation is “Working Minds: Suicide Prevention in the Workplace” – the nation’s first comprehensive and sustained program designed to help employers with the successful prevention, intervention and crisis management of suicide (www.WorkingMinds.org). Additionally, she is the Co-Lead of the Workplace Task Forces for the National Action Alliance for Suicide Prevention, and the Co-Chair of the Workplace Special Interest Group of the International Association for Suicide Prevention.

DONNA HARDAKER:Donna is an internationally recognized industry expert in the emerging field of workplace mental health. She is an award-winning curriculum developer, advocate, public speaker, writer, and advisor, who has leveraged her personal experience of mental health challenges and their impact on her employment history into a significant body of work. She is the Director of Wellness Works, a workplace mental health training program of Mental Health America of California that has been evaluated as highly effective in stigma reduction with lasting behavior and culture change. She is also a member of the Workplace Task Force for the National Action Alliance for Suicide Prevention. Donna is from Toronto, Canada, but now lives in Sacramento, where she greatly enjoys the California sunshine.

Learn more about the National Action Alliance for Suicide Prevention: http://actionallianceforsuicideprevention.org/