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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Mosquitoes can spread the flesh-eating Buruli ulcer. Here’s how you can protect yourself
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Each year, more and more Victorians become sick with a flesh-eating bacteria known as Buruli ulcer. Last year, 363 people presented with the infection, the highest number since 2004.
But it has been unclear exactly how it spreads, until now. New research shows mosquitoes are infected from biting possums that carry the bacteria. Mozzies spread it to humans through their bite.
What is Buruli ulcer?
Buruli ulcer, also known as Bairnsdale ulcer, is a skin infection caused by the bacterium Mycobacterium ulcerans.
It starts off like a small mosquito bite and over many months, slowly develops into an ulcer, with extensive destruction of the underlying tissue.
While often painless initially, the infection can become very serious. If left untreated, the ulcer can continue to enlarge. This is where it gets its “flesh-eating” name.
Thankfully, it’s treatable. A six to eight week course of specific antibiotics is an effective treatment, sometimes supported with surgery to remove the infected tissue.
Where can you catch it?
The World Health Organization considers Buruli ulcer a neglected tropical skin disease. Cases have been reported across 33 countries, primarily in west and central Africa.
However, since the early 2000s, Buruli ulcer has also been increasingly recorded in coastal Victoria, including suburbs around Melbourne and Geelong.
Scientists have long known Australian native possums were partly responsible for its spread, and suspected mosquitoes also played a role in the increase in cases. New research confirms this.
Our efforts to ‘beat Buruli’
Confirming the role of insects in outbreaks of an infectious disease is achieved by building up corroborating, independent evidence.
In this new research, published in Nature Microbiology, the team (including co-authors Tim Stinear, Stacey Lynch and Peter Mee) conducted extensive surveys across a 350 km² area of Victoria.
We collected mosquitoes and analysed the specimens to determine whether they were carrying the pathogen, and links to infected possums and people. It was like contact tracing for mosquitoes.
Aedes notoscriptus was the mosquito identified as carrying the bacteria that caused Buruli ulcer.
Cameron Webb (NSW Health Pathology)Molecular testing of the mosquito specimens showed that of the two most abundant mosquito species, only Aedes notoscriptus (a widespread species commonly known as the Australian backyard mosquito) was positive for Mycobacterium ulcerans.
We then used genomic tests to show the bacteria found on these mosquitoes matched the bacteria in possum poo and humans with Buruli ulcer.
We further analysed mosquito specimens that contained blood to show Aedes notoscriptus was feeding on both possums and humans.
To then link everything together, geospatial analysis revealed the areas where human Buruli ulcer cases occur overlap with areas where both mosquitoes and possums that harbour Mycobacterium ulcerans are active.
Stop its spread by stopping mozzies breeding
The mosquito in this study primarily responsible for the bacteria’s spread is Aedes notoscriptus, a mosquito that lays its eggs around water in containers in backyard habitats.
Controlling “backyard” mosquitoes is a critical part of reducing the risk of many global mosquito-borne disease, especially dengue and now Buruli ulcer.
You can reduce places where water collects after rainfall, such as potted plant saucers, blocked gutters and drains, unscreened rainwater tanks, and a wide range of plastic buckets and other containers. These should all be either emptied at least weekly or, better yet, thrown away or placed under cover.
Mosquitoes can lay eggs in a wide range of water-filled items in the backyard.
Cameron Webb (NSW Health Pathology)There is a role for insecticides too. While residual insecticides applied to surfaces around the house and garden will reduce mosquito populations, they can also impact other, beneficial, insects. Judicious use of such sprays is recommended. But there are ecological safe insecticides that can be applied to water-filled containers (such as ornamental ponds, fountains, stormwater pits and so on).
Recent research also indicates new mosquito-control approaches that use mosquitoes themselves to spread insecticides may soon be available.
How to protect yourself from bites
The first line of defence will remain personal protection measures against mosquito bites.
Covering up with loose fitted long sleeved shirts, long pants, and covered shoes will provide physical protection from mosquitoes.
Applying topical insect repellent to all exposed areas of skin has been proven to provide safe and effective protection from mosquito bites. Repellents should include diethytolumide (DEET), picaridin or oil of lemon eucalyptus.
While the rise in Buruli ulcer is a significant health concern, so too are many other mosquito-borne diseases. The steps to avoid mosquito bites and exposure to Mycobacteriam ulcerans will also protect against viruses such as Ross River, Barmah Forest, Japanese encephalitis, and Murray Valley encephalitis.
Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; Peter Mee, Adjunct Associate Lecturer, School of Applied Systems Biology, La Trobe University; Stacey Lynch, Team Leader- Mammalian infection disease research, CSIRO, and Tim Stinear, Professor of Microbiology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Is Marine Collagen Worth Taking?
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I wanted to ask if you think marine collagen is decent to take. I’ve heard a lot of bad press about it
We don’t know what you’ve heard, but generally speaking it’s been found to be very beneficial to bones, joints, and skin! We wrote about it quite recently on a “Research Review Monday”:
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Taurine’s Benefits For Heart Health And More
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Taurine: Research Review
First, what is taurine, beyond being an ingredient in many energy drinks?
It’s an amino acid that many animals, including humans, can synthesize in our bodies. Some other animals—including obligate carnivores such as cats (but not dogs, who are omnivorous by nature) cannot synthesize taurine and must get it from food.
So, as humans are very versatile omnivorous frugivores by nature, we have choices:
- Synthesize it—no need for any conscious action; it’ll just happen
- Eat it—by eating meat, which contains taurine
- Supplement it—by taking supplements, including energy drinks, which generally (but not always) use a bioidentical lab-made taurine. Basically, lab-made taurine is chemically identical to the kind found in meat, it’s just cheaper and doesn’t involve animals as a middleman.
What does it do?
Taurine does a bunch of essential things, including:
- Maintaining hydration/electrolyte balance in cells
- Regulating calcium/magnesium balance in cells
- Forming bile salts, which are needed for digestion
- Supporting the integrity of the central nervous system
- Regulating the immune system and antioxidative processes
Thus, a shortage of taurine can lead to such issues as kidney problems, eye tissue damage (since the eyes are a particularly delicate part of the CNS), and cardiomyopathy.
If you want to read more, here’s an academic literature review:
Taurine: A “very essential” amino acid
On the topic of eye health, a 2014 study found that taurine is the most plentiful amino acid in the eye, and helps protect against retinal degeneration, in which they say:
❝We here review the evidence for a role of taurine in retinal ganglion cell survival and studies suggesting that this compound may be involved in the pathophysiology of glaucoma or diabetic retinopathy. Along with other antioxidant molecules, taurine should therefore be seriously reconsidered as a potential treatment for such retinal diseases❞
Read more: Taurine: the comeback of a neutraceutical in the prevention of retinal degenerations
Taurine for muscles… In more than sports!
We’d be remiss not to mention that taurine is enjoyed by athletes to enhance athletic performance; indeed, it’s one of its main selling-points:
See: Taurine in sports and exercise
But! It’s also useful for simply maintaining skeleto-muscular health in general, and especially in the context of age-related decline and chronic disease:
Taurine: the appeal of a safe amino acid for skeletal muscle disorders
On the topic of safety… How safe is it?
There’s an interesting answer to that question. Within safe dose ranges (we’ll get to that), taurine is not only relatively safe, but also, studies that looked to explore its risks found new benefits in the process. Specifically of interest to us were that it appears to promote better long-term memory, especially as we get older (as taurine levels in the brain decline with age):
Taurine, Caffeine, and Energy Drinks: Reviewing the Risks to the Adolescent Brain
^Notwithstanding the title, we assure you, the research got there; they said:
❝Interestingly, the levels of taurine in the brain decreased significantly with age, which led to numerous studies investigating the potential neuroprotective effects of supplemental taurine in several different experimental models❞
What experimental models were those? These ones:
- Taurine protects cerebellar neurons of the external granular layer
- Effects of taurine on alterations of neurobehavior and neurodevelopment key proteins expression
- Neuroprotective role of taurine in developing offspring affected by maternal alcohol consumption
…which were all animal studies, however.
The same systematic review also noted that not only was more research needed on humans, but also, existing studies have had a strong bias to male physiology (in both human and assorted other animal studies), so more diverse study is needed too.
What are the safe dose ranges?
Before we get to toxicity, let’s look at some therapeutic doses. In particular, some studies that found that 500mg 3x daily, i.e. 1.5g total daily, had benefits for heart health:
- Taurine and atherosclerosis
- The Anti-Inflammatory Effect of Taurine on Cardiovascular Disease
- Taurine supplementation has anti-atherogenic and anti-inflammatory effects before and after incremental exercise in heart failure
- Taurine Supplementation Lowers Blood Pressure and Improves Vascular Function in Prehypertension
- Taurine improves the vascular tone through the inhibition of TRPC3 function in the vasculature
Bottom line on safety: 3g/day has been found to be safe:
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What immunocompromised people want you to know
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While many people in the U.S. have abandoned COVID-19 mitigations like vaccines and masking, the virus remains dangerous for everyone, and some groups face higher risks than others. Immunocompromised people—whose immune systems don’t work as well as they should due to health conditions or medications—are more vulnerable to infection and severe symptoms from the virus.
Public Good News spoke with three immunocompromised people about the steps they take to protect themselves and what they want others to know about caring for each other.
[Editor’s note: The contents of these interviews have been condensed for length.]
PGN: What measures have you been taking to protect yourself since the COVID-19 pandemic began?
Tatum Spears, Virginia
From less than a year old, I had serious, chronic infections and have missed huge chunks of my life. In 2020, I quit my public job, and I have not worked publicly since.
I have a degree in vocal performance and have been singing my whole life, but I haven’t performed publicly since 2019. I feel like a bird without wings. I had to stop traveling. Since no one wears a mask anymore, I can’t go to the movies or social outings or any party.
All my friends live in my phone now. It’s a community of people—a lot of them are immunocompromised or disabled in some way.
There are a good portion of them who just take COVID-19 seriously and want to protect their health, who feel the existential abandonment and the burden of all of this. It’s really isolating having to step back from any sort of social life. I have to assess my risk every single time I leave the house.
Gwendolyn Alyse Bishop, Washington
I was hit by a car when I was very young. I woke up from surgery, and doctors told me I had lost almost all of my spleen. So, I was always the sickest kid in my school.
When COVID-19 hit, I started working from home. At first, I wore cloth masks. I didn’t really learn about KN95 masks until right around the time that COVID-19 disabled me. [Editor’s note: N95 and KN95 masks have been shown to be significantly more effective at preventing the transmission of viral particles than cloth masks.]
I actually don’t get out much anymore because I am disabled by long COVID now, but when I do leave, I wear a respirator in all shared air spaces. My roommate and I have HEPA filters going in every room.And then we test. I have a Pluslife testing dock, and so we keep a weekly testing schedule with that and then test if there are any symptoms. I got reinfected [with COVID-19] last winter, and a Pluslife test helped me catch it early and get Paxlovid. [Editor’s note: Pluslife is a brand of an at-home COVID-19 nucleic acid amplification test, which has been shown to be significantly more effective at detecting COVID-19 than at-home antigen rapid tests.]
Abby Mahler, California
I have lupus, and in 2016, I started taking the drug hydroxychloroquine, which is an immunomodulator. I’m not as immunocompromised as some people, but I certainly don’t have a normal immune system, which has resulted in long-term infections like C. diff.I started masking early. My roommates and I prioritize going outside. We don’t remove our masks inside in public places.
We are in a pod with one other household, and the pod has agreements on the way that we interact with public space. So, we will only unmask with people who have tested ahead of time. We use Metrix, an at-home nucleic acid amplification test.
While it’s not easy and it’s not the life that we had prior to COVID-19’s existence, it is a life that has provided us quite a lot of freedom, in the sense that we are not sick all the time. We are conscientiously making decisions that allow us to have a nice time without a monkey on our backs, which is freeing.
PGN: What do you want people who are not immunocompromised to know?
T.S.: Don’t be afraid to be the only person in a room wearing a mask. Your own health is worth it. And you have to realize how callous [people who don’t wear a mask are] by existing in spaces and breathing [their] air [on immunocompromised people].
People think that vaccines are magic, but vaccines alone are not enough. I would encourage people to look at the Swiss cheese model of risk assessment.
Each slice of Swiss cheese has holes in it in different places, and each layer represents a layer of virus mitigation. One layer is vaccines. Another layer is masks. Then there’s staying home when you’re sick and testing.
G.A.B.: I wish people were masking. I wish people understood how likely it is that they are also now immunocompromised and vulnerable because of the widespread immune dysregulation that COVID-19 is causing. [Editor’s note: Research shows that COVID-19 infections may cause long-term harm to the immune system in some people.]
I want people to be invested in being good community members, and part of that is understanding that COVID-19 hits the poorest the hardest—gig workers, underpaid employees, frontline service workers, people who were already disabled or immunocompromised.
If people want to be good community members, they not only need to protect immunocompromised and disabled people by wearing a mask when they leave their homes, but they also need to actually start taking care of their community members and participating in mutual aid. [Editor’s note: Mutual aid is the exchange of resources and services within a community, such as people sharing extra N95 masks.]
I spend pretty much all of my time working on LongCOVIDAidBot, which promotes mutual aid for people who have been harmed by COVID-19.
A.M.: An important thing to think about when you’re not disabled is that it becomes a state of being for all people, if they’re lucky. You will become disabled, or you will die.
It is a privilege, in my opinion, to become disabled because I can learn different ways of living my life. And being able to see yourself as a body that changes over time, I hope, opens up a way of looking at your body as the porous reality that it is.
Some people think of themselves as being willing to make concessions or change their behavior when immunocompromised people are around, but you don’t always know when someone is immunocompromised.
So, if you’re not willing to change the way that you think about yourself as a person who is susceptible [to illness], then you should change the way that you consider other people around you. Wearing a mask—at the very least in public indoor spaces—means considering the unknown realities of all the people who are interacting with that space.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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4 Critical Things Female Runners Should Know
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When it comes to keeping up performance in the face of menopause, Shona Hendricks has advice:
Don’t let menopause run you down
- Prioritize recovery! Overtraining without adequate recovery just leads to decreased performance in the long term, and remember, you may not recover as quickly as you used to. If you’re still achey from your previous run, give it another day, or at least make it a lighter run.
- Slow down in easy and long runs! This isn’t “taking the easy way out”; it will improve your overall performance, reducing muscle damage, allowing for quicker recovery and ultimately better fitness gains.
- Focus on nutrition! And that means carbs too. A lot of people fighting menopausal weight gain reduce their intake of food, but without sufficient energy availability, you will not be able to run well. In particular, carbohydrates are vital for energy. Consume them sensibly and with fiber and proteins and fats rather than alone, but do consume them.
- Incorporate strength training! Your run is not “leg day” by itself. Furthermore, do whole-body strength training, to prevent injuries and improve overall performance. A strong core is particularly important.
For more on each of these (and some bonus comments about mobility training for runners), enjoy:
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Small Changes For A Healthier Life
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I am interested in what I can substitute for ham in bean soup?
Well, that depends on what the ham was like! You can certainly buy ready-made vegan lardons (i.e. small bacon/ham bits, often in tiny cubes or similar) in any reasonably-sized supermarket. Being processed, they’re not amazing for the health, but are still an improvement on pork.
Alternatively, you can make your own seitan! Again, seitan is really not a health food, but again, it’s still relatively less bad than pork (unless you are allergic to gluten, in which case, definitely skip this one).
Alternatively alternatively, in a soup that already contains beans (so the protein element is already covered), you could just skip the ham as an added ingredient, and instead bring the extra flavor by means of a little salt, a little yeast extract (if you don’t like yeast extract, don’t worry, it won’t taste like it if you just use a teaspoon in a big pot, or half a teaspoon in a smaller pot), and a little smoked paprika. If you want to go healthier, you can swap out the salt for MSG, which enhances flavor in a similar fashion while containing less sodium.
Wondering about the health aspects of MSG? Check out our main feature on this, from last month:
I thoroughly enjoy your daily delivery. I’d love to see one for teens too!
That’s great to hear! The average age of our subscribers is generally rather older, but it’s good to know there’s an interest in topics for younger people. We’ll bear that in mind, and see what we can do to cater to that without alienating our older readers!
That said: it’s never too soon to be learning about stuff that affects us when we’re older—there are lifestyle factors at 20 that affect Alzheimer’s risk at 60, for example (e.g. drinking—excessive drinking at 20* is correlated to higher Alzheimer’s risk at 60).
*This one may be less of an issue for our US readers, since the US doesn’t have nearly as much of a culture of drinking under 21 as some places. Compare for example with general European practices of drinking moderately from the mid-teens, or the (happily, diminishing—but historically notable) British practice of drinking heavily from the mid-teens.
How much turmeric should I take each day?
Dr. Michael Greger’s research (of “Dr. Greger’s Daily Dozen” and “How Not To Die” fame) recommends getting at least ¼ tsp turmeric per day
Remember to take it with black pepper though, for a 2000% absorption bonus!
A great way to get it, if you don’t want to take capsules and don’t want to eat spicy food every day, is to throw a teaspoon of turmeric in when making a pot of (we recommend wholegrain!) rice. Turmeric is very water-soluble, so it’ll be transferred into the rice easily during cooking. It’ll make the rice a nice golden yellow color, and/but won’t noticeably change the taste.
Again remember to throw in some black pepper, and if you really want to boost the nutritional content,some chia seeds are a great addition too (they’ll get cooked with the rice and so it won’t be like eating seeds later, but the nutrients will be there in the rice dish).
You can do the same with par-boiled potatoes or other root vegetables, but because cooking those has water to be thrown away at the end (unlike rice), you’ll lose some turmeric in the water.
Request: more people need to be aware of suicidal tendencies and what they can do to ward them off
That’s certainly a very important topic! We’ll cover that properly in one of our Psychology Sunday editions. In the meantime, we’ll mention a previous special that we did, that was mostly about handling depression (in oneself or a loved one), and obviously there’s a degree of crossover:
The Mental Health First-Aid That You’ll Hopefully Never Need
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