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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How to be kind to yourself (without going to a day spa)
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“I have to be hard on myself,” Sarah told me in a recent telehealth psychology session. “I would never reach my potential if I was kind and let myself off the hook.”
I could empathise with this fear of self-compassion from clients such as Sarah (not her real name). From a young age, we are taught to be kind to others, but self-kindness is never mentioned.
Instead, we are taught success hinges on self-sacrifice. And we need a healthy inner critic to bully us forward into becoming increasingly better versions of ourselves.
But research shows there doesn’t have to be a trade-off between self-compassion and success.
Self-compassion can help you reach your potential, while supporting you to face the inevitable stumbles and setbacks along the way.
What is self-compassion?
Self-compassion has three key ingredients.
1. Self-kindness
This involves treating yourself with the same kindness you would extend towards a good friend – via your thoughts, feelings and actions – especially during life’s difficult moments.
For instance, if you find yourself fixating on a minor mistake you made at work, self-kindness might involve taking a ten-minute walk to shift focus, and reminding yourself it is OK to make mistakes sometimes, before moving on with your day.
2. Mindfulness
In this context, mindfulness involves being aware of your own experience of stress or suffering, rather than repressing or avoiding your feelings, or over-identifying with them.
Basically, you must see your stress with a clear (mindful) perspective before you can respond with kindness. If we avoid or are consumed by our suffering, we lose perspective.
3. Common humanity
Common humanity involves recognising our own experience of suffering as something that unites us as being human.
For instance, a sleep-deprived parent waking up (for the fourth time) to feed their newborn might choose to think about all the other parents around the world doing exactly the same thing – as opposed to feeling isolated and alone.
It’s not about day spas, or booking a manicure
When Sarah voiced her fear that self-compassion would prevent her success, I explained self-compassion is distinct from self-indulgence.
“So is self-compassion just about booking in more mani/pedis?” Sarah asked.
Not really, I explained. A one-off trip to a day spa is unlikely to transform your mental health.
Instead, self-compassion is a flexible psychological resilience factor that shapes our thoughts, feelings and actions.
It’s associated with a suite of benefits to our wellbeing, relationships and health.
A one-off trip to a day spa is unlikely to transform your mental health.
baranq/ShutterstockWhat does the science say?
Over the past 20 years, we’ve learned self-compassionate people enjoy a wide range of benefits. They tend to be happier and have fewer psychological symptoms of distress.
Those high on self-compassion persevere following a failure. They say they are more motivated to overcome a personal weakness than those low on self-compassion, who are more likely to give up.
So rather than feeling trapped by your inadequacies, self-compassion encourages a growth mindset, helping you reach your potential.
However, self-compassion is not a panacea. It will not change your life circumstances or somehow make life “easy”. It is based on the premise that life is hard, and provides practical tools to cope.
It’s a factor in healthy ageing
I research menopause and healthy ageing and am especially interested in the value of self-compassion through menopause and in the second half of life.
Because self-compassion becomes important during life’s challenges, it can help people navigate physical symptoms (for instance, menopausal hot flushes), life transitions such as divorce, and promote healthy ageing.
I’ve also teamed up with researchers at Autism Spectrum Australia to explore self-compassion in autistic adults.
We found autistic adults report significantly lower levels of self-compassion than neurotypical adults. So we developed an online self-compassion training program for this at-risk population.
Three tips for self-compassion
You can learn self-compassion with these three exercises.
1. What would you say to a friend?
Think back to the last time you made a mistake. What did you say to yourself?
If you notice you’re treating yourself more like an enemy than a friend, don’t beat yourself up about it. Instead, try to think about what you might tell a friend, and direct that same friendly language towards yourself.
2. Harness the power of touch
Soothing human touch activates the parasympathetic “relaxation” branch of our nervous system and counteracts the fight or flight response.
Specifically, self-soothing touch (for instance, by placing both hands on your heart, stroking your forearm or giving yourself a hug) reduces cortisol responses to psychosocial stress.
Yes, hugging yourself can help.
http://krakenimages.com/Shutterstock3. What do I need right now?
Sometimes, it can be hard to figure out exactly what self-compassion looks like in a given moment. The question “what do I need right now” helps clarify your true needs.
For example, when I was 37 weeks pregnant, I woke up bolt awake one morning at 3am.
Rather than beating myself up about it, or fretting about not getting enough sleep, I gently placed my hands on my heart and took a few deep breaths. By asking myself “what do I need right now?” it became clear that listening to a gentle podcast/meditation fitted the bill (even though I wanted to addictively scroll my phone).
Lydia Brown, Senior Lecturer in Psychology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Older, Faster, Stronger – by Margaret Webb
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The author, now in her 60s, made it her mission in her 50s to become the best runner she could. Before that, she’d been a keen runner previously, but let things slip rather in her 40s. But the book’s not about her 40s, it’s about her 50s and onwards, and other female runners in their 50s, 60s, 70s, 80s, and even 90s.
There’s a lot of this book that’s about people’s individual stories, and those should certainly be enough to prompt almost any reader that “if they can do it, I can”.
A lot, meanwhile, is about health and exercise science, training methods, and what has worked for various later-life athletes, including the author. So, it’s also partway instruction manual, with plenty of reference to science and medical considerations too.
Bottom line: sometimes, life throws us challenges. Sometimes, the best response is “Yeah? Bet” and surprise everyone.
Click here to check out Older, Faster, Stronger, and become all those cool things!
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Never Enough – by Dr. Judith Grisel
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We’ve reviewed books about addiction before—specifically about alcohol, at least. This one’s more general in that it covers different addictions.
On the other hand, it’s also more specific, in that it covers them from the author’s field: neuroscience.
…and experience too. The author had a plethora of addictions (the serious kind), got sober, and then undertook to study neuroscience. Her hope was to help others avoid, or escape from the same as‚ what she went through.
Dr. Grisel (as she now is) takes a methodical approach in this book. She works her way through the addictive mechanisms of a broad selection of common drugs, explaining each.
The focus here is on neutral explanations, rather than the propagandizing scaremongering that failed at least one generation. Why each drug is alluring, what it really does do—and the neurological price it exacts, down to the molecular level.
She also covers risk factors for addiction; genetic, epigenetic, and environmental. There’s no “if you were stronger”, or “these people made bad choices”, so much as… Many addicts were, in effect, sabotaged from before birth.
That doesn’t mean that to become addicted or not is just fate, but it does mean… There but for the grace of factors completely outside of our control go we.
Why is this useful to us, be we a reader without any meaningful addiction (we’re not counting coffee etc here)? Well, as this book illustrates and explains, many of us could be one (more) mishap away from a crippling addiction and not know it. Forewarned is forearmed.
Bottom line: almost all of us are, have been, or will be touched by addiction in some way. Either directly, or a loved one, or a loved one’s loved one, or perhaps a parent who gave us an epigenetic misfortune. This book gives understanding that can help.
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Staying Strong: Tips To Prevent Muscle Loss With Age
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Dr. Andrea Furlan, specialist in physical medicine and rehabilitation with 30 years of experience, has advice:
Fighting sarcopenia
Sarcopenia is so common as to be considered “natural”, but “natural” does not mean “obligatory” and it certainly doesn’t mean “healthy”. As for how to fight it?
You may be thinking “let us guess, is it eat protein and do resistance exercises? And yes it is, but that’s only part of it…
Firstly, she recommends remembering why you are doing this, or because understanding is key to compliance (i.e. your perfect diet and exercise program will mean nothing if you don’t actually do it, and you won’t do it enough to make it a habit, let alone keep it up, if the reasons aren’t clear in your mind).
Sarcopenia comes with an increased risk of falls, reduced physical capacity in general, resultant disability, social isolation, and depression. Of course, this is not a one-to-one equation; you will not necessarily become depressed the moment your muscle mass is below a certain percentage, but statistically speaking, the road to ruin is laid out clearly.
Secondly, she recommends being on the lookout for it. If you check your body composition regularly with a gadget, that’s great and laudable; if you don’t, then a) consider getting one (here’s an example product on Amazon), and b) watch out for decreased muscle strength, fatigue, reduced stamina, noticeable body shape changes with muscle loss and (likely) fat gain.
Thirdly, she recommends more than just regular resistance training and good protein intake. Yes, she recommends those things too, but also getting enough water (can’t rebuild the body without it), avoiding a sedentary lifestyle (sitting leads to atrophy of many supporting and stabilizing muscles, you know, the kind of muscles that don’t look flashy but stop you falling down), and getting good sleep—vital for all kinds of body maintenance, and muscle maintenance is no exception (there’s a reason bodybuilders sleep 9–12 hours daily when in a gaining phase; you don’t need to do that, but don’t skimp on your 7–9 hours, yes, really, even you, yes, at any age).
Lastly, she recommends continuing to learn about the topic, as otherwise it’s easy to go off-track.
For more information on all of the above and more, enjoy:
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Want to learn more?
You might also like to read:
- Protein: How Much Do We Need, Really?
- Resistance Is Useful! (Especially As We Get Older)
- Resistance Beyond Weights
- HIIT, But Make It HIRT ← this is about high-intensity resistance training (HIRT); confusing the muscles like one confuses the heart in HIIT, which thus yields improved results
- Sleep: Yes, You Really Do Still Need It
Take care!
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The Path To Revenue – by Theresa Marcroft
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So many books about start-ups skip right over the elephant in the room: survivorship bias. Not so for Marcroft! This book contains the most comprehensive and unapologetic treatment of it we’ve seen.
Less “here’s what Steve Jobs did right and here’s what Chocolate-Teapots-For-Dogs-R-Us did wrong; don’t mess up that badly and you’ll be fine”… and more realism. Marcroft gives us a many-angled critical analytic approach. In it, she examines why many things can seem similar in both content and presentation… but can cause growth or failure (and how and why), based on more than anecdotes and luck.
The book is information-dense (taking a marketing-centric approach) and/but well-presented in a very readable format.
If we can find any criticism of the book, it’s less about what’s in it and more about what’s not in it. This can never be a “your start-up bible!” book because it’s not comprehensive. It doesn’t cover assembling your team, for example. Nor does it give a lot of attention to management, preferring to focus on strategy.
But no single book can be all things, and we highly recommend this one—the marketing advice alone is more than worth the cost of the book!
Take Your First Step Along The Path To Revenue By Checking It Out On Amazon!
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Life Lessons From A Brain Surgeon – by Dr. Rahul Jandial
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In the category of surgeons with a “what to put on your table to stay off mine” angle, this book packs an extra punch. As well as being an experienced brain surgeon, Dr. Jandial also does a lot of cutting edge lab research too. What does this mean for us?
This book gives, as the subtitle promises, “practical strategies for peak health and performance”—with a brain-centric bias, of course.
From diet and nootropic supplements, to exercise and brain-training, we get a good science-based view of which ones actually work, and which don’t. The style is also very readable; Dr. Jandial is a great educator, presenting genuine scientific content with very accessible language.
Bottom line: if you’d indeed like to look after your most important organ optimally, this book gives a lot of key pointers, without unnecessary fluff.
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