Mind Your Words! How Language Affects Mental Health Stigma
Here, very briefly, is what stigma does to us: in a recent survey, more than 60% of respondents in Singapore do not seek help when they encounter mental health challenges. In India, this figure is closer to 80%. The numbers are shocking, but not surprising: after all, who wants to see a “shrink”, and then be called “crazy” or “insane” for it?
While there are myriads of reasons why someone might not want to seek psychological help, there may be a linguistic and social reason behind some, unbeknownst to us. “When it comes to language, our brain produces a response to words, a process known as ‘associative activation,’” writes Kristen Fuller. “When we see or hear a word, our brain forms an idea followed by an emotion which often produces an action or reaction.” While that might sound bad, people like Wulf Rössler argue that stereotypes aren’t always negative – you might, in his example, ask the police for directions instead of an old person – because they help us to adapt to a specific situation quickly, and we can adopt the appropriate behaviour in situations. All these happen on a subconscious level, to mean that we aren’t exactly aware of it.
While the example with the police sounds innocuous and helpful to a certain extent, Rössler also points out that in cases of people with mental health conditions, stereotypes can quickly turn harmful: “Stereotypes and prejudice can subsequently lead to discrimination of individuals or a whole group as a behavioural response: ‘Mentally ill should be locked away because they are dangerous and unpredictable’ or ‘We can't employ a mentally ill person because they are unreliable.’”
In those two statements, the words “mentally ill” are linked to “dangerous”, “unpredictable”, and “unreliable”. That’s stigma, right there.
But these word associations don’t just happen on an individual level – they’re also culturally disseminated. Take the concept of “face” in Chinese culture, for example. As Zhisong Zhang writes, because the stigma for depression and anxiety relates to a weakness in one’s personality and having bad thoughts, one might feel a deep sense of shame and a loss of “face”, or dignity, when seeking help or being diagnosed with a mental health disorder. Some, like Rössler, argue that this process of internalising these stereotypes starts when we’re young, and it’s during the onset of the mental health condition that these stereotypes become more relevant to the afflicted person.
And these negative stereotypes and stigmas hurt people. In China, some 80% of psychiatric patients experienced discrimination, while around 35.2% of Chinese mental health professionals themselves admitted to discriminating against psychiatric patients. In Shirlene Pang’s study, 23.8% of Singaporean youths agree with the statement that “mentally ill people tend to be more violent than other people”, while 22.5% agreed with “mentally ill people scare me”.
While there are many ways in which we can all try to reduce stigma, I personally find that being aware of the words we use on a daily basis can be a great starting point for all of us in this journey of being more accepting towards people with mental health conditions. Language, after all, shapes thought, which in turn affects behaviour.
An interesting example can be found in Japan, where in 1937, the official translation for schizophrenia was “Seishin-Bunretsu-Byo”, or “mind-splitting disease” in English. But as time passed, the term became loaded with stigma and people with the condition found it humiliating. Then, a proposal for the changing of the name – to “Togo-Shitcho-Sho”, or “integration disorder” – was made. The result of the change was astounding: according to Zhang, “the rate of informing patients of their diagnosis had risen from 37% in 2002 to 70% as of 2004 [and] the rate of inpatients reporting their diagnosis has also increased from 16% in 1977 to 55% in 2014”.
We don’t need to change the names of every single mental health condition out there to start, though. It can be as easy as saying that someone “has OCD”, instead of saying that they “are OCD” because, simply, there’s more to a person than their mental health condition. Saying that a person is their condition also reinforces self-stigma: they might feel shame, or be even more self-conscious of their own identity. Others might also say that one “suffers from” something, but that also suggests that people with mental health conditions can’t lead full, rewarding lives.
Being mindful of the implications of certain words helps too: praising someone who is mentally healthy “mentally strong” can suggest that people with mental health conditions are “weak”; someone else “getting clean” might imply that they were “dirty” to begin with; an “unsuccessful” suicide attempt equates death with success. “While changing cultural values is not plausible,” writes Pang, “changing the view of mental illness as a mark of shame may be important for interventions.”
Trust in one’s social network, as Zhang notes, empowers people with depression, and mediates self-stigma. Singapore’s National Volunteer and Philanthropy Centre also agrees that peer support complements clinical support, and communities are able to become more impactful when people are able to have more conversations about mental health. It’s time we talk about mental health, appropriately; it’s only then we get to have more open conversations.
References:
https://www.psycom.net/mental-health-language
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007563/
https://mentalstateoftheworld.report/wp-content/uploads/2021/05/Rapid-Report-2021-Help-Seeking.pdf
https://bmjopen.bmj.com/content/7/10/e016432