Lost for words: how the language we use stigmatises and disempowers service users

Psychiatric, elitist discourse dominates mental health services

Psychiatric, elitist discourse dominates mental health services

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Our choice of language expresses something of how we interpret the world. It points to inner thoughts, attitudes and beliefs. Verbalising these further reinforces them. It is important then to attend to language use and its consequences.

Yet how often do we stop to consider the language we use as mental health nurses, its effect on our practice and therapeutic relationships? And who can blame us for not doing so, since the system leaves little room for critical thinking of this kind?

Unique language

Psychiatry is a way of interpreting the human condition. Its unique language of mental illness, disorder and symptomatology lends unfamiliar names to emotional, psychological and life experiences.

The language is categorical. It assists society to demarcate the boundaries of ‘normality’, what is and is not acceptable, and who does and does not require intervention. Its technical terminology convinces us of its own necessity.

Psychiatry appears to have found words for phenomena beyond the grasp of common speech. In providing order, interprofessional shorthand and apparent scientific rigour, psychiatric discourse has come to dominate mental health services and, by extension, mental health nursing. A socially accepted way of viewing reality, it can easily lead us to lose sight of the fact that psychiatry is a way of seeing, not an objective truth.

Nursing is about therapeutic connectedness between human beings. It requires us to work relationally and invite people into dialogue. What does it mean then to speak with or describe people in language that is elitist rather than shared? There are real ethical implications. Power imbalance is created between those who ‘speak psychiatry’ and those who do not.

Losing the nuance of experience

The people to whom what is said matters most, and their language, can become devalued or disregarded, and the nuances and uniqueness of their experiences can be lost. We assert professional insight when, at best, we are offering only another perspective or interpretation that may or may not hold value.

As part of the human community, we all have potential to experience mental health difficulties. However, when one person’s distress is pathologised, it becomes ‘other’. Social distance is created between their suffering and our own, and we no longer relate in the same way. Diagnoses change the words we use to describe similar experiences. People can never simply ‘have a bad day’ when seen through the lens of psychiatry. Notably, many legitimised terms heard in mental health practice are pejorative: ‘manipulative’, ‘entitled’ and ‘inappropriate’. Through choice of language, people are stigmatised by the services mandated to empower them.

Language is not inconsequential. As new generations of mental health nurses emerge, there is opportunity to engage critically in the field’s use of language, to consider mindfully how it shapes practice and imposes dynamics on the relationships we offer. To date, contemporary research in this area is partial and fragmented. More focused research is needed.

Freya Sewell is a community mental health nurse for NHS Shetland

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