Get loud with the Right Language

Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health at the IWK Health Centre and Dalhousie University

In the 1940’s, George Orwell, the English writer is famously known as author of the dystopian novel Animal Farm, penned a less appreciated but equally prescient piece: Politics and the English Language, in which he noted that: “the slovenliness of our language makes it easier for us to have foolish thoughts”.  He may have been predicting the linguistic confusion now playing out in the mental health arena.  Unfortunately, our current mental health linguistic jambalaya may threaten the resilience of young people, expose countless to un-needed and costly therapies and make rapid access to effective care for those with a mental illness who require it increasingly problematic. This Mental Health Awareness Week, let’s stop confusing life’s everyday emotions with mental illness.

In travelling our country, listening to young people in junior high schools, secondary schools and on campuses, chatting with their teachers and professors and reading media reports that seem to constantly link the phrase “mental health” with “crisis” or “epidemic”, I cannot escape the Orwellian reality that language once used to describe pathological states of emotions, cognitions and behaviors is now commonly applied to everyday experiences.  Or in his words: “gives an appearance of solidity to pure wind”.

Here are a few recent examples: “I’m so depressed, I didn’t make the soccer team”; “I have exam anxiety disorder and need to be excused from exams”; “June checks her work before handing it in, she is so OCD [Obsessive Compulsive Disorder]; “She [the teacher] said I didn’t know what the answer was, I’m totally traumatized”.  Such confusion. Sadness is not Depression.  The normal stress of writing an exam is not an Anxiety Disorder. Attention to detail is not OCD. Umbrage is not trauma.  The ability to identify and express the nuances of normal emotional experiences seems to be evaporating.  Listen carefully to the conversations.  Where are the words upset, distressed, disgruntled, dejected, perturbed, concerned, worried and despondent?  These are all useful and necessary parts of our emotional lexicon.  They have been replaced by the cultural application of the language of pathology; depression and anxiety.  And the increasing demand for therapy, pills and all matter of interventions that replace the necessary engagements with uncomfortable life circumstances that are the building blocks for developing resilience, threatens to deskill our youth.  If life circumstances are experienced as illness – learned helplessness may be the result.

It’s interesting to note that the rise of programs for building resilience in young people has developed in parallel with this lexical confusion.  No other historical cohort was thought to be incapable of developing resilience on its own.  The exhausting and as yet unfinished march for human rights, the eradication of poverty and the creation of just societies was embraced by those who had no need of a resilience program.  They saw injustice and took up the challenge. Despair and dread were life exigencies to be overcome, not medical conditions to be treated.

And it is not just young people who are confusing the terminology of illness with nuanced descriptions of normal emotional states.  Not a day goes by that a radio or television commentator does not fling forth the phrase “mental health issue”.   What is a “mental health issue”?  A two year old having a tantrum because they have been denied candy is having a “mental health issue”.  A homeless person in a psychotic state is having a “mental health issue”.  A person with dementia or delirium is having a “mental health issue”.  None of these are the same thing.  Why is the phrase so commonly used?  Is it that we fear naming the illness?  How can we know when and how and with whom to intervene if everything is an issue?  Nobody uses the phrase “breast lump issue”.  Nobody reports that their pancreas is “having an issue”.  So why is the phrase “mental health issue” so frequently used?

Critically examining this may lead us to the uncomfortable conclusion that unwillingness to use the right words is actually another form of stigma.  People that are living with Depression know that it is not the same thing as feeling upset.  People who are working through the challenges of OCD know that it is not the same as checking your homework.  Students with an Anxiety Disorder know that it is not the same thing as the challenge of taking a test.  Using the words of pathology to describe normal emotional states can additionally trivialize the challenges of those who live with mental illness.

And, if everyday life experiences become framed in the language of illness – the response is not to embrace them and develop useful coping strategies, but to seek treatment.  Not only can this lead to an inability to develop skills needed for meeting the challenges and opportunities that life brings, but no treatment is without its cost and potential for adverse effects.  If distress is considered to be disorder, the demand for treatment puts additional strain on a system already underfunded and unable to meet the needs of those who are living with a mental illness.  The entry funnel widens and access becomes more problematic.

There are solutions to this cultural phenomenon.  Addressing this does not mean that the myriad of other challenges in improving rapid access to effective mental health care will be simply solved.  However, as Orwell noted, using clear language is a necessary start.  It is essential to become mental health literate.  It is essential to understand what the words mean and to use them correctly.  It is essential that daily challenges and opportunities be embraced and addressed, not with therapy, pills and interventions, but with courage, support from those who matter most to us and with the desire to learn the competencies that help us cope and adapt to the exigencies of life.  We can do that.  Let’s start by getting the language right.