On January 3, on CommonHealth I saw the following headline: A Phrase To Renounce For 2014: ‘The Mentally Ill’, written by Carey Goldberg.
My first impression was that the author was debunking the concept of mental illness, but I was sadly mistaken. The theme of the article was the so-called person-first terminology that has been promoted by various bodies and agencies since about the mid-eighties.
The idea is that one shouldn’t say “a developmentally disabled child.” Instead, one should say “a child with a developmental disability.” Similarly, a person should not be referred to as an “alcoholic,” but rather as a “person with alcoholism.” And so on. The idea is to avoid giving the impression that the individual is to be defined by the presence of a disabling condition. The individual is first and foremost a person, and the problem or disability is semantically tacked on to indicate that it is a quality of the person rather than the defining feature.
Personally, I don’t have strong views on the matter. I’ve worked quite a bit in the DD field, where the person-first terminology had its roots, and in my experience, stigmatizing attitudes towards clients did not seem to be particularly correlated with the use of the older terminology. I’ve seen staff members who had all their p’s and q’s correct as far as terminology was concerned, but whose interactions with clients were extraordinarily stigmatizing and condescending, and conversely, I’ve encountered staff who used the older terminology, but whose interactions with clients were at all times non-stigmatizing, age-appropriate, and encouraging.
But – having said all that – I certainly have no objection to person-centered language. It does not harm, might do some good, and I generally use it myself.
Back to CommonHealth’s article. CommonHealth is a blog operated by WBUR – Boston’s NPR station. Carey Goldberg is one of the blogs’ co-hosts. She’s an experienced reporter. She has been with the New York Times (Boston bureau chief), Los Angeles Times (Moscow correspondent), and the Boston Globe (health/science reporter). She has studied at Yale, Harvard, and MIT.
So, as I said earlier, the theme of the article is not the debunking of the concept of mental illness, but rather the promotion of person-first terminology in the mental health field.
The author interviewed three psychiatrists: Paul Summergrad, MD (APA President-elect); Eugene V. Beresin, MD, (Professor of Psychiatry at Harvard), and Steven C. Schlozmanm, MD, (Psychiatrist at Massachusetts General), and the article is essentially a write-up of the interview, with some commentary from Ms. Goldberg herself. Here are some quotes, interspersed with my comments/observations.
“So the term ‘the mentally ill’ creates not just a notion of separateness and otherness, Dr. Summergrad said, but also ‘a notion that it’s a uni-modal type of thing. And I think we need a more inclusive and more granular language.'”
Dr. Summergrad is President-elect of the APA, and will be taking the baton from our esteemed and beloved Dr. Lieberman in May of this year. Already he’s preparing himself for the role. He wants to see “more inclusive” language – in other words, he wants to continue the APA’s relentless expansion of its “diagnostic” net and eliminate any phrases or semantic practices that might run counter to that agenda.
“The trouble, Dr. Beresin adds, is that ‘mental illness’ tends to be stigmatized in a way that ‘medical illness’ usually is not. He points out that medical illnesses generally have psychological and environmental components. ‘For example, high blood pressure is a combination of genetics (biology), stress, obesity, cigarette smoking and numerous other factors. So why don’t we get upset when we hear ‘he has hypertension?’ The same argument should be made for so-called ‘mental illnesses.’ Post-traumatic stress disorder, for example, may be a result of a genetic vulnerability to anxiety, being trapped in a war zone, or being a survivor of a hurricane.’
‘Virtually all illnesses have biological, environmental and psychological components. We could say the same for migraines, ulcers, asthma or diabetes. But it does not make one feel uneasy if we say, ‘He has asthma.’ On the other hand, ‘He has depression or obsessive-compulsive disorder feels so very different. Is that because it is labeled ‘mental?’ Certainly. ‘Mental’ is an arbitrary negative label that segregates something psychic, personal or ‘in the head’ from the body and the environment. It also is very scary.'”
What Dr. Beresin is saying in the material quoted above is that mental illnesses are essentially on a par with medical illnesses, and that the promotion of this concept will destigmatize the former.
This notion – that “mental illnesses” are real illnesses, is being promoted widely by psychiatry in the aftermath of the disastrous DSM-5 launch. One of the most fundamental principles in psychiatry is that it if you repeat a falsehood often enough, it will become true.
“My beef with the term ‘mental health’ in particular is that it is not well defined. Is it a euphemism for ‘psychiatric?’ If so, why do we need a euphemism? What’s wrong with saying ‘psychiatric’? There’s nothing wrong with saying ‘cardiac’…Once the term has its own status as something different, we decide, without quite acknowledging it, that ‘mental health’ is a euphemism for psychiatric health, and then psychiatric health necessarily becomes something culturally and even ontologically different.”
Again the theme: psychiatric illnesses are as real as the illnesses that other doctors treat.
At the present time, psychiatry is under intense scrutiny, and is being critiqued on a wide range of fronts – from a wide spectrum of sources. Its fundamental concepts are being denounced as spurious. Its medicines are being exposed as dangerous drugs that produce abnormal states rather than alleviate or remediate any identifiable pathology, and their successive and much-touted pathological theories have been convincingly debunked.
They have done enormous damage to clients, both in the form of drug damage, and through the disempowerment inherent in their discredited notions of incurable brain diseases which they have promoted zealously.
But – with the exception of a very small number of individual psychiatrists – they have consistently ignored these criticisms, apparently confident in the belief that if they can ride out the storm, all these problems will just go away. Organized psychiatry has become more adept at distractive spin than politicians – and that’s a high standard.
And this latest spin – promoting person-centered terminology – strikes me as a bit like throwing a cup of water on a burning building.
And remember, Dr. Summergrad is no ordinary psychiatrist. He’s the President-elect of the APA, destined, in five short months, to fill the shoes of the eminent Dr. Lieberman, and to shepherd the APA through the difficult times that lie ahead.
But he does not appear to appreciate, any more than does Dr. Lieberman, that psychiatry’s woes are of its own making, and have reached catastrophic proportions.