No excuse for bad language

In a recent article in this paper, writer Madeleine Howell reported the results of a mental health survey in which researchers asked 2,004 adults about their use of a number of mental health diagnoses, such as “autistic”, “psychotic”, “bipolar” and “schizophrenic”. They found that 49 per cent of those surveyed had misused these words, primarily to describe themselves or others in a derogatory manner.

These terms are professional tools. They provide a shorthand for those who work with individuals suffering from mental health problems. A diagnosis confers a wealth of information: most likely symptoms, prognosis, recommended treatments and comorbidity – other conditions likely to occur that may also need attention.

If the results of the survey reflect accurately the way we regard these terms, it’s a concern. Widespread misuse of mental health terminology – particularly when intended to insult or denigrate – may deter sufferers from admitting they have problems and from seeking the help they need.

Although there’s no excuse for using these terms derogatorily, failure to understand exactly what they mean is more understandable. Even professionals sometimes find it difficult to feel certain they’ve arrived at an accurate diagnosis. This often relies on choosing the best fit for a list of symptoms. Any given symptom may appear in the diagnostic criteria of several conditions. For example, insomnia is listed under major depressive disorder, generalised anxiety, bipolar and posttraumatic stress disorders.

A symptom may be nebulously defined. For example, one symptom for major depressive disorder is a diminished ability to think or concentrate. How diminished? From what baseline starting point?

Diagnostic criteria may rely on cultural norms, as in this one for general personality disorder: “An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.” This makes it difficult to compare individuals in different cultures. Another problem is that diagnosis relies partly on observable facts, studying case records and listening to what others have observed.

However, the most important source of information is what the individual in question tells the interviewer about their thoughts and feelings. Unfortunately, this may not represent the individual accurately. They may be frightened or ashamed to admit the full extent of their beliefs or feelings; they may not know accurate words to describe them; they may be influenced by the wording of the questions put to them.

So it’s unsurprising that relatives of a person being diagnosed may ask for a second opinion. Given the current state of our understanding of mental illness, that’s all a psychiatric diagnosis is at present – an opinion. It’s vital, therefore, we don’t add to the confusion by using these terms flippantly.