Mental illness, psychiatric disorder or psychological problem. What should we call mental distress?
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We talk about mental health more than ever, but the language we should use remains a vexed issue.
Should we call people who seek help patients, clients or consumers? Should we use “person-first” expressions such as person with autism or “identity-first” expressions like autistic person? Should we apply or avoid diagnostic labels?
These questions often stir up strong feelings. Some people feel that patient implies being passive and subordinate. Others think consumer is too transactional, as if seeking help is like buying a new refrigerator.
Advocates of person-first language argue people shouldn’t be defined by their conditions. Proponents of identity-first language counter that these conditions can be sources of meaning and belonging.
Avid users of diagnostic terms see them as useful descriptors. Critics worry that diagnostic labels can box people in and misrepresent their problems as pathologies.
Underlying many of these disagreements are concerns about stigma and the medicalisation of suffering. Ideally the language we use should not cast people who experience distress as defective or shameful, or frame everyday problems of living in psychiatric terms.
Our new research, published in the journal PLOS Mental Health, examines how the language of distress has evolved over nearly 80 years. Here’s what we found.
Generic terms for the class of conditions
Generic terms – such as mental illness, psychiatric disorder or psychological problem – have largely escaped attention in debates about the language of mental ill health. These terms refer to mental health conditions as a class.
Many terms are currently in circulation, each an adjective followed by a noun. Popular adjectives include mental, mental health, psychiatric and psychological, and common nouns include condition, disease, disorder, disturbance, illness, and problem. Readers can encounter every combination.
These terms and their components differ in their connotations. Disease and illness sound the most medical, whereas condition, disturbance and problem need not relate to health. Mental implies a direct contrast with physical, whereas psychiatric implicates a medical specialty.
Mental health problem, a recently emerging term, is arguably the least pathologising. It implies that something is to be solved rather than treated, makes no direct reference to medicine, and carries the positive connotations of health rather than the negative connotation of illness or disease.
Arguably, this development points to what cognitive scientist Steven Pinker calls the “euphemism treadmill”, the tendency for language to evolve new terms to escape (at least temporarily) the offensive connotations of those they replace.
English linguist Hazel Price argues that mental health has increasingly come to replace mental illness to avoid the stigma associated with that term.
How has usage changed over time?
In the PLOS Mental Health paper, we examine historical changes in the popularity of 24 generic terms: every combination of the nouns and adjectives listed above.
We explore the frequency with which each term appears from 1940 to 2019 in two massive text data sets representing books in English and diverse American English sources, respectively. The findings are very similar in both data sets.
The figure presents the relative popularity of the top ten terms in the larger data set (Google Books). The 14 least popular terms are combined into the remainder.
Several trends appear. Mental has consistently been the most popular adjective component of the generic terms. Mental health has become more popular in recent years but is still rarely used.
Among nouns, disease has become less widely used while illness has become dominant. Although disorder is the official term in psychiatric classifications, it has not been broadly adopted in public discourse.
Since 1940, mental illness has clearly become the preferred generic term. Although an assortment of alternatives have emerged, it has steadily risen in popularity.
Does it matter?
Our study documents striking shifts in the popularity of generic terms, but do these changes matter? The answer may be: not much.
One study found people think mental disorder, mental illness and mental health problem refer to essentially identical phenomena.
Other studies indicate that labelling a person as having a mental disease, mental disorder, mental health problem, mental illness or psychological disorder makes no difference to people’s attitudes toward them.
We don’t yet know if there are other implications of using different generic terms, but the evidence to date suggests they are minimal.
Is ‘distress’ any better?
Recently, some writers have promoted distress as an alternative to traditional generic terms. It lacks medical connotations and emphasises the person’s subjective experience rather than whether they fit an official diagnosis.
Distress appears 65 times in the 2022 Victorian Mental Health and Wellbeing Act, usually in the expression “mental illness or psychological distress”. By implication, distress is a broad concept akin to but not synonymous with mental ill health.
But is distress destigmatising, as it was intended to be? Apparently not. According to one study, it was more stigmatising than its alternatives. The term may turn us away from other people’s suffering by amplifying it.
So what should we call it?
Mental illness is easily the most popular generic term and its popularity has been rising. Research indicates different terms have little or no effect on stigma and some terms intended to destigmatise may backfire.
We suggest that mental illness should be embraced and the proliferation of alternative terms such as mental health problem, which breed confusion, should end.
Critics might argue mental illness imposes a medical frame. Philosopher Zsuzsanna Chappell disagrees. Illness, she argues, refers to subjective first-person experience, not to an objective, third-person pathology, like disease.
Properly understood, the concept of illness centres the individual and their connections. “When I identify my suffering as illness-like,” Chappell writes, “I wish to lay claim to a caring interpersonal relationship.”
As generic terms go, mental illness is a healthy option.
Nick Haslam, Professor of Psychology, The University of Melbourne and Naomi Baes, Researcher – Social Psychology/ Natural Language Processing, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?
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Throughout her childhood, Julia Lo Cascio dreamed of becoming a pediatrician. So, when applying to medical school, she was thrilled to discover a new, small school founded specifically to train primary care doctors: NYU Grossman Long Island School of Medicine.
Now in her final year at the Mineola, New York, school, Lo Cascio remains committed to primary care pediatrics. But many young doctors choose otherwise as they leave medical school for their residencies. In 2024, 252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.
Lo Cascio, 24, said her three-year accelerated program nurtured her goal of becoming a pediatrician. Could other medical schools do more to promote primary care? The question could not be more urgent. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness.
Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.
The driving force is often money, said Andrew Bazemore, a physician and a senior vice president at the American Board of Family Medicine. “Subspecialties tend to generate a lot of wealth, not only for the individual specialists, but for the whole system in the hospital,” he said.
A department’s cache of federal and pharmaceutical-company grants often determines its size and prestige, he said. And at least 12 medical schools, including Harvard, Yale, and Johns Hopkins, don’t even have full-fledged family medicine departments. Students at these schools can study internal medicine, but many of those graduates end up choosing subspecialties like gastroenterology or cardiology.
One potential solution: eliminate tuition, in the hope that debt-free students will base their career choice on passion rather than paycheck. In 2024, two elite medical schools — the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine — announced that charitable donations are enabling them to waive tuition, joining a handful of other tuition-free schools.
But the contrast between the school Lo Cascio attends and the institution that founded it starkly illustrates the limitations of this approach. Neither charges tuition.
In 2024, two-thirds of students graduating from her Long Island school chose residencies in primary care. Lo Cascio said the tuition waiver wasn’t a deciding factor in choosing pediatrics, among the lowest-paid specialties, with an average annual income of $260,000, according to Medscape.
At the sister school, the Manhattan-based NYU Grossman School of Medicine, the majority of its 2024 graduates chose specialties like orthopedics (averaging $558,000 a year) or dermatology ($479,000).
Primary care typically gets little respect. Professors and peers alike admonish students: If you’re so smart, why would you choose primary care? Anand Chukka, 27, said he has heard that refrain regularly throughout his years as a student at Harvard Medical School. Even his parents, both PhD scientists, wondered if he was wasting his education by pursuing primary care.
Seemingly minor issues can influence students’ decisions, Chukka said. He recalls envying the students on hospital rotations who routinely were served lunch, while those in primary care settings had to fetch their own.
Despite such headwinds, Chukka, now in his final year, remains enthusiastic about primary care. He has long wanted to care for poor and other underserved people, and a one-year clerkship at a community practice serving low-income patients reinforced that plan.
When students look to the future, especially if they haven’t had such exposure, primary care can seem grim, burdened with time-consuming administrative tasks, such as seeking prior authorizations from insurers and grappling with electronic medical records.
While specialists may also face bureaucracy, primary care practices have it much worse: They have more patients and less money to hire help amid burgeoning paperwork requirements, said Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School.
“It’s not the medical schools that are the problem; it’s the job,” Richardson said. “The job is too toxic.”
Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco, spent decades trying to boost the share of students choosing primary care, only to conclude: “There’s really very little that we can do in medical school to change people’s career trajectories.”
Instead, he said, the U.S. health care system must address the low pay and lack of support.
And yet, some schools find a way to produce significant proportions of primary care doctors — through recruitment and programs that provide positive experiences and mentors.
U.S. News & World Report recently ranked 168 medical schools by the percentage of graduates who were practicing primary care six to eight years after graduation.
The top 10 schools are all osteopathic medical schools, with 41% to 47% of their students still practicing primary care. Unlike allopathic medical schools, which award MD degrees, osteopathic schools, which award DO degrees, have a history of focusing on primary care and are graduating a growing share of the nation’s primary care physicians.
At the bottom of the U.S. News list is Yale, with 10.7% of its graduates finding lasting careers in primary care. Other elite schools have similar rates: Johns Hopkins, 13.1%; Harvard, 13.7%.
In contrast, public universities that have made it a mission to promote primary care have much higher numbers.
The University of Washington — No. 18 in the ranking, with 36.9% of graduates working in primary care — has a decades-old program placing students in remote parts of Washington, Wyoming, Alaska, Montana, and Idaho. UW recruits students from those areas, and many go back to practice there, with more than 20% of graduates settling in rural communities, according to Joshua Jauregui, assistant dean for clinical curriculum.
Likewise, the University of California-Davis (No. 22, with 36.3% of graduates in primary care) increased the percentage of students choosing family medicine from 12% in 2009 to 18% in 2023, even as it ranks high in specialty training. Programs such as an accelerated three-year primary care “pathway,” which enrolls primarily first-generation college students, help sustain interest in non-specialty medical fields.
The effort starts with recruitment, looking beyond test scores to the life experiences that forge the compassionate, humanistic doctors most needed in primary care, said Mark Henderson, associate dean for admissions and outreach. Most of the students have families who struggle to get primary care, he said. “So they care a lot about it, and it’s not just an intellectual, abstract sense.”
Establishing schools dedicated to primary care, like the one on Long Island, is not a solution in the eyes of some advocates, who consider primary care the backbone of medicine and not a separate discipline. Toyese Oyeyemi Jr., executive director of the Social Mission Alliance at the Fitzhugh Mullan Institute of Health Workforce Equity, worries that establishing such schools might let others “off the hook.”
Still, attending a medical school created to produce primary care doctors worked out well for Lo Cascio. Although she underwent the usual specialty rotations, her passion for pediatrics never flagged — owing to her 23 classmates, two mentors, and her first-year clerkship shadowing a community pediatrician. Now, she’s applying for pediatric residencies.
Lo Cascio also has deep personal reasons: Throughout her experience with a congenital heart condition, her pediatrician was a “guiding light.”
“No matter what else has happened in school, in life, in the world, and medically, your pediatrician is the person that you can come back to,” she said. “What a beautiful opportunity it would be to be that for someone else.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Almonds vs Walnuts – Which is Healthier?
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Our Verdict
When comparing almonds to walnuts, we picked the almonds.
Why?
It wasn’t just our almond bias, but it was close!
In terms of macros, the main important differences are:
- Almonds are higher in protein
- Walnuts are higher in fats (they are healthy fats)
So far, so even.
In terms of vitamins, both are rich in many vitamins; mostly the same ones. However, walnuts have more of most of the B vitamins (except for B2 and B3, where almonds win easily), and almonds have more vitamin E by several orders of magnitude.
So far, so balanced.
Almonds have slightly more choline.
Almonds have a better mineral profile, with more of most minerals that they both contain, and especially, a lot more calcium.
Both nuts have [sometimes slightly different, but] comparable benefits against diabetes, cancer, neurodegeneration, and other diseases.
In summary
This one’s close. After balancing out the various “almonds have this but walnuts have that” equal-but-different benefits, we’re going to say almonds take first place by virtue of the better mineral profile, and more choline.
But: enjoy both!
Learn more
You might like this previous article of ours:
Why You Should Diversify Your Nuts
Take care!
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The Inflamed Mind – by Dr. Edward Bullmore
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Firstly, let’s note that this book was published in 2018, so the “radical new” approach is more like “tried and tested and validated” now.
Of course, inflammation in the brain is also linked to Alzheimer’s, Parkinson’s, and other neurodegenerative disorders, but that’s not the main topic here.
Dr. Bullmore, a medical doctor, psychiatrist, and neuroscientist with half the alphabet after his name, knows his stuff. We don’t usually include author bio information here, but it’s also relevant that he has published more than 500 scientific papers and is one of the most highly cited scientists worldwide in neuroscience and psychiatry.
What he explores in this book, with a lot of hard science made clear for the lay reader, is the mechanisms of action of depression treatments that aren’t just SSRIs, and why anti-inflammatory approaches can work for people with “treatment-resistant depression”.
The book was also quite prescient in its various declarations of things he expects to happen in the field in the next five years, because they’ve happened now, five years later.
Bottom line: if you’d like to understand how the mind and body affect each other in the cases of inflammation and depression, with a view to lessening either or both of those things, this is a book for you.
Click here to check out The Inflamed Mind, and take good care of yours!
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To-Do List Formula – by Damon Zahariades
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The first part of this book is given to reviewing popular to-do list methods that are already widely “out there”. This treatment is practical and exploratory, looking at the pros and cons of each.
The second part of the book is more Zahariades’ own method, taking what he sees as the best of each, plus some tricks and practices of his own. With these, he builds (and shares!) his optimized system.
You may be wondering what you, dear reader, can expect to get out of this book. Well, that depends on where you’re coming from:
Are you new to approaching your general to-dos with a system more organized than post-it notes on your fridge? If so, this will be a great initial introduction to many systems.
Or are you, perhaps, a veteran of GTD, ToDoist, assorted Pomodoro-based systems, and more? Do you do/delegate/defer/ditch tasks more deftly and dextrously than Serena Williams despatches tennis balls?
If so, what you’re more likely to gain here is a fresh perspective on old ideas, and maybe a trick or two you didn’t know before. At the very least, a boost to your motivation, getting you fired up for doing what you know best again.
All in all, a very respectable book for anyone’s to-read list!
Pick Up Your Copy of Zahariades’ To-Do List Formula on Amazon Today!
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WHO Overturns Dogma on Airborne Disease Spread. The CDC Might Not Act on It.
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The World Health Organization has issued a report that transforms how the world understands respiratory infections like covid-19, influenza, and measles.
Motivated by grave missteps in the pandemic, the WHO convened about 50 experts in virology, epidemiology, aerosol science, and bioengineering, among other specialties, who spent two years poring through the evidence on how airborne viruses and bacteria spread.
However, the WHO report stops short of prescribing actions that governments, hospitals, and the public should take in response. It remains to be seen how the Centers for Disease Control and Prevention will act on this information in its own guidance for infection control in health care settings.
The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others.
While it may seem obvious, and some researchers have pushed for this acknowledgment for more than a decade, an alternative dogma persisted — which kept health authorities from saying that covid was airborne for many months into the pandemic.
Specifically, they relied on a traditional notion that respiratory viruses spread mainly through droplets spewed out of an infected person’s nose or mouth. These droplets infect others by landing directly in their mouth, nose, or eyes — or they get carried into these orifices on droplet-contaminated fingers. Although these routes of transmission still happen, particularly among young children, experts have concluded that many respiratory infections spread as people simply breathe in virus-laden air.
“This is a complete U-turn,” said Julian Tang, a clinical virologist at the University of Leicester in the United Kingdom, who advised the WHO on the report. He also helped the agency create an online tool to assess the risk of airborne transmission indoors.
Peg Seminario, an occupational health and safety specialist in Bethesda, Maryland, welcomed the shift after years of resistance from health authorities. “The dogma that droplets are a major mode of transmission is the ‘flat Earth’ position now,” she said. “Hurray! We are finally recognizing that the world is round.”
The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals, it could evolve to more easily infect people and spread among them through the air.
Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. Such advice overwhelmed recommendations for N95 masks that filter out most virus-laden particles suspended in the air. Employers denied many health care workers access to N95s, insisting that only those routinely working within feet of covid patients needed them. More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.
However, a committee advising the CDC appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities.
Lisa Brosseau, an aerosol expert and a consultant at the Center for Infectious Disease Research and Policy in Minnesota, warns of a repeat of 2020 if that happens.
“The rubber hits the road when you make decisions on how to protect people,” Brosseau said. “Aerosol scientists may see this report as a big win because they think everything will now follow from the science. But that’s not how this works and there are still major barriers.”
Money is one. If a respiratory disease spreads through inhalation, it means that people can lower their risk of infection indoors through sometimes costly methods to clean the air, such as mechanical ventilation and using air purifiers, and wearing an N95 mask. The CDC has so far been reluctant to press for such measures, as it updates foundational guidelines on curbing airborne infections in hospitals, nursing homes, prisons, and other facilities that provide health care. This year, a committee advising the CDC released a draft guidance that differs significantly from the WHO report.
Whereas the WHO report doesn’t characterize airborne viruses and bacteria as traveling short distances or long, the CDC draft maintains those traditional categories. It prescribes looser-fitting surgical masks rather than N95s for pathogens that “spread predominantly over short distances.” Surgical masks block far fewer airborne virus particles than N95s, which cost roughly 10 times as much.
Researchers and health care workers have been outraged about the committee’s draft, filing letters and petitions to the CDC. They say it gets the science wrong and endangers health. “A separation between short- and long-range distance is totally artificial,” Tang said.
Airborne viruses travel much like cigarette smoke, he explained. The scent will be strongest beside a smoker, but those farther away will inhale more and more smoke if they remain in the room, especially when there’s no ventilation.
Likewise, people open windows when they burn toast so that smoke dissipates before filling the kitchen and setting off an alarm. “You think viruses stop after 3 feet and drop to the ground?” Tang said of the classical notion of distance. “That is absurd.”
The CDC’s advisory committee is comprised primarily of infection control researchers at large hospital systems, while the WHO consulted a diverse group of scientists looking at many different types of studies. For example, one analysis examined the puff clouds expelled by singers, and musicians playing clarinets, French horns, saxophones, and trumpets. Another reviewed 16 investigations into covid outbreaks at restaurants, a gym, a food processing factory, and other venues, finding that insufficient ventilation probably made them worse than they would otherwise be.
In response to the outcry, the CDC returned the draft to its committee for review, asking it to reconsider its advice. Meetings from an expanded working group have since been held privately. But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion. Another warned that “supply and compliance would be difficult.”
The nurses’ union, far from echoing such concerns, wrote on its website, “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.” Jane Thomason, the union’s lead industrial hygienist, said the meeting records suggest the CDC group is working backward, molding its definitions of airborne transmission to fit the outcome it prefers.
Tang expects resistance to the WHO report. “Infection control people who have built their careers on this will object,” he said. “It takes a long time to change people’s way of thinking.”
The CDC declined to comment on how the WHO’s shift might influence its final policies on infection control in health facilities, which might not be completed this year. Creating policies to protect people from inhaling airborne viruses is complicated by the number of factors that influence how they spread indoors, such as ventilation, temperature, and the size of the space.
Adding to the complexity, policymakers must weigh the toll of various ailments, ranging from covid to colds to tuberculosis, against the burden of protection. And tolls often depend on context, such as whether an outbreak happens in a school or a cancer ward.
“What is the level of mortality that people will accept without precautions?” Tang said. “That’s another question.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Easing Election Stress & Anxiety
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At the time of writing, the US is about to have a presidential election. Most of our readers are Americans, and in any case, what the US does tends to affect most of the world, so certainly many readers in other countries will be experiencing stress and anxiety about it too.
We’re a health science publication, not a political outlet, so we’ll refrain from commenting on any candidates or campaign policies, and we’d also like to be clear we are not urging you to any particular action politically—our focus today is simply about mental health.
First, CBT what can be CBT’d
Cognitive Behavioral Therapy (CBT) is far from a panacea, but it’s often a very good starting point. And when it seems the stakes are high, it’s easy to fall into such cognitive distortions as “crystal ball” and “catastrophization”, that is to say, predicting the future and feeling the impact of that (probably undesired version of the) future, and also feeling like it will be the end of the world.
Recognizing these processes and how they work, is the first step to managing our feelings about them.
Learn more: The Art of Being Unflappable (Tricks For Daily Life)
Next, DBT what can be DBT’d
A lot of CBT hinges on the assumption that our assumptions are incorrect. For example, that our friend does not secretly despise us, that our spouse is not about to leave us, that the symptoms we are experiencing are not cancer, and in this case, that the election outcome will not go badly, and if it does, the consequences will be less severe than imagined.
But… What if our concerns are, in fact, fully justified? Here’s where Dialectic Behavior Therapy (DBT) comes in, and with it, what therapists call “radical acceptance”.
In other words, we accept up front the idea that maybe it’s going to be terrible and that will truly suck, and then either:
- there’s nothing we can reasonably do about it now (so worrying just means you’ll suffer twice), or
- there is something we can reasonably do about it now (so we can go do that thing)
After doing the thing (if appropriate), defer processing the outcome of the election until after the election. There is no point in wasting energy to worry before then. In a broadly two-party system where things are usually close between those two largest parties, there’s something close to a 50% chance of an outcome that’s, at least, not the worst you feared.
Learn more: CBT, DBT, & Radical Acceptance
Lastly, empower yourself with Behavioral Activation (BA)
Whatever the outcome of any given election, the world will keep turning, and the individual battles about any given law or policy or such will continue to go on. That’s not to say an election won’t change things—it will—but there will always still be stuff to do on a grassroots level to make the world a better place, no matter what politician has been elected.
Being involved in doing things on a community level will not only help banish any feelings of despair (and if you got the election outcome you wanted, it’ll help you feel involved), but also, it can give you a sense of control, and can even form a part of the “ikigai” that is often talked about as one of the pillars of healthy longevity.
Learn more: What’s Your Ikigai?
And if you like videos, then enjoy this one (narrated by the ever soothing-voiced Alain de Botton):
Watch now: How To Escape From A Despairing Mood (4:46) ← it also has a text version if you prefer that
Take care!
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