Critical Values Based Practice Network

C-VBP-N

The role of language in mental health

Written by Victoria O'Key on . Posted in Clinical Psychology Bite-Size

The role of language in mental health

Issue 31 – July 2012

Author: Victoria O’Key (c/o jenny.poole@nottshc.nhs.uk)

Key points

  • Language does not simply reflect the way events are, but shapes the way we see and experience them.
  • The language we use serves particular functions (e.g. blaming, justifying).
  • The terminology used to make sense of emotional distress is very powerful, and greatly influences how service users see themselves.
  • Some ways of talking about distress are more stigmatising than others. For instance, labelling someone’s personality as ‘disordered’ is likely to be shaming.

Implications for practice

  • It is important to consider a broad range of ways of talking about emotional difficulties.
  • It is useful to consider how language can impact upon and limit the ways distress is understood.
  • It may therefore be beneficial not to take for granted the language which dominates services, but instead to ask – is this way of talking helpful and who is it helpful for?  
The language used to make sense of emotional distress is extremely important. The terms and labels used to describe distress impact on staff interactions with service users, how service users experience their own distress and even the kinds of treatments and therapies made available. For example, if we talk about emotional distress as a consequence of individual faulty thinking, we may offer the person help to correct their dysfunctional thoughts. Alternatively, the language we use may present distress as related to a challenging or damaging environment. In this case it would not make sense to target the way a person thinks, but instead to focus upon the person’s social and relational circumstances. Certain ways of talking about emotional distress get used more frequently than others. When one version becomes dominant, it can become seen as more ‘real’. If a version is seen to be more real, it can go unquestioned and make it difficult to identify alternatives. It is therefore important to remain aware of the impact of language and to explore its functions; for instance, who loses out and who benefits from a particular way of talking? Focussing on language in this manner can help us think about what assumptions are contained in the way we speak; and assist us to consider whether such language and assumptions are helpful or disempowering? These issues are introduced below in terms of diagnostic labels.

What’s in a name?

To be given a diagnosis is to be offered a particular way of being in the world (e.g. if someone is labelled ‘mentally ill’ they may come to understand themselves as having something medically wrong with their psychological states). This will have implications for the ways people in services experience their difficulties (e.g. as needing to be corrected by expert medical intervention). Language plays a role in producing problems and solutions, rather than simply reflecting the ‘reality’ of these. Some ways of constructing distress are more pervasive than others, and tend to dominate how we understand, think and feel about peoples’ emotional and behavioural difficulties. For instance, the medical model and diagnosis remain pervasive ways of talking about distress. In this sense, the dominance of these models limits how people talk about, and therefore experience, their difficulties. People are therefore not free to choose any way of talking that they wish. Mental health services offer people versions of events through the language they use; for instance, ‘patient’ or ‘service-user’, ‘schizophrenic’ or ‘voice hearer’ all shape how people understand themselves. The following section considers the impact of language with regards the diagnosis of personality disorder.

Constructing the ‘disordered personality’

It is common place and feels natural to talk about our own and others personalities, however the concept of personality did not exist prior to the late 18th/early 19th century 1,2. Since its invention it has become a primary way in which we talk about the self and make sense of one another. There are certain features of the concept of personality which make the personality disorder diagnosis problematic:
  • This diagnosis medicalises personality and the self. In doing so, the label serves to categorise a person’s sense of who they are as needing to be in some way ‘corrected’ through medical intervention.
  • The concept of personality is an individualistic way of talking about distress, placing responsibility for managing difficulties with the individual. It therefore conceals the role of the environment and experience. This is particularly damaging given that the development of characteristics deemed ‘disordered’ are related to high levels of negative childhood experiences (e.g. parental invalidation, sexual abuse, family instability) and socioeconomic deprivation 3,4,5,6.
  • It is common to describe personality in terms of character and ‘character flaws’. Features of someone’s personality are often used in conversation to indicate whether we do or do not like them. Thus the language of ‘characteristics’ is not neutral but typically involves a moral judgement about a person’s likeability 2. In this sense, the personality disorder label attributes ‘abnormality’ to people’s characters and so to have a ‘disordered personality’ is to ‘be the disease’ (rather than ‘have a disease’) (p. 78) 7. This label can therefore be experienced as stigmatising and shaming, and may be used to justify approaches to working which are more punitive 8.
  • The concept of personality assumes that characteristics are, at least in part, biological and relatively stable. Thus the personality disorder label presents difficulties as innate and lifelong, and runs the risk of inferring helplessness and hopelessness for change.

Implications

It can be useful to consider how a particular way of talking can impact upon the way distress is understood; for instance, if difficulties are described as a feature of personality then they become seen as biologically driven, contained within the individual and isolated from the wider context. We therefore need to reflect on and give respect to a broad range of perspectives and ways of talking about distress. It may be beneficial at times to question the language which dominates services. For example, diagnostic language is very powerful. Supervisors may wish to encourage staff to reflect upon and question this way of talking (e.g. by asking, is it helpful and who it is helpful for?). Remaining aware of, and questioning, the language used within services can open up space to consider potentially more helpful alternatives.

REFERENCES

  1. Speed, E. (2011). Discourses of acceptance and resistance: Speaking out about psychiatry. In M., Rapley, J., Moncrieff & J., Dillon (Eds.), De-Medicalizing misery: Psychiatry, psychology and the human condition (pp. 123-140). Hampshire, UK: Palgrave Macmillan.
  2. Stainton-Rogers, R., Stenner, P., Gleeson, K. & Stainton Rogers, W. (1995). Social psychology: A critical agenda. Cambridge: Polity.
  3. Castillo, H. (2003). Personality disorder: Temperament or trauma? An account of an emancipatory research study carried out by service users diagnosed with personality disorder. London: Jessica Kingsley.
  4. Singleton, N., Meltzer, H., Gatward, R., Coid, J. & Deasy, D. (1998). Psychiatric morbidity among prisoners in England and Wales: Summary report. London: Office of National Statistics.
  5. Warner, S. (2000). Understanding child sexual abuse: Making the tactics visible. Gloucester: Handsell.
  6. Warner, S. (2009). Understanding the effects of child sexual abuse:       Feminist revolutions in theory, research and practice. London: Routledge.
  7. Bourne, J. (2011). From bad character to BPD: The medicalization of ‘Personality Disorder’. In M., Rapley, J., Moncrieff & J., Dillon (Eds.), De-Medicalizing misery: Psychiatry, psychology and the human condition (pp. 66-85). Hampshire, UK: Palgrave Macmillan
  8. Sontag, S. (1991) Illness as Metaphor/AIDS and Its Metaphors. Harmondsworth: Penguin.
 

Trackback from your site.

Leave a comment

You must be logged in to post a comment.