The Importance of Language in Promoting Community Inclusion

Over the past fifty years, as mental health systems have changed so to has the ‘language’ used to talk about mental illnesses, people with psychiatric disabilities, and treatment and rehabilitation options available.   Although changes in language have been slow – both in the professional community and among the general public – it is critical that such changes continue.  Old patterns – using terms like ‘the mentally ill’ or ‘psychos’ or ‘the chronics’ and referring to ‘the looney bin’ and ‘the shrink’ and ‘the funny farm’ tend to demoralize providers and consumers alike, but have their most profound impact on the way in which consumers feel about themselves and their future.   Here we talk about the importance of language in promoting community inclusion, the paramount importance of the drive to use ‘people first’ language in both professional and popular written, verbal, and media exchanges,  and how language change occurs.

What is “People First” language?  

The growing emphasis on the importance of using ‘people first’ language – referring to people with mental illnesses’ rather than ‘the mentally ill’ or to ‘an individual with depression’ rather than ‘the depressive’ acknowledges, before any other reference, the person hood of an individual. Beyond any label that one can attach to a person, and beyond any reason someone has for attaching that label (selfish or unselfish, prejudiced or unprejudiced) is the person. It is to that person we must learn to relate, not to any imposed label. It is still sadly true that the field of disability, and even more specifically the field of mental disabilities, continue to use common grammars tend to insist that people are their disability.  People first  approaches suggest a world of alternative possibilities.

Why is language important in Community Inclusion? 

In part, language reflects beliefs. In general language reflects the beliefs of the society in which a person resides.  The people who control the use of language, consciously or unconsciously hold power over people deprived of language, even over how others will refer to them.  Thus, embedded within language are the rudiments of discrimination, maintaining negatives beliefs and isolating people with differences.  In this way, language undermines community inclusion outcomes (isolating people from jobs and homes and all types of community experiences) and undermining the individual’s self-determination.

How does language change occur?

At times, language change does arise, contesting commonly held beliefs. This language may or may not successfully challenge those beliefs, but often provides the impetus to change. Currently, language in the mental health field is in flux. There are several specific reasons for this: 1) people in the mental health professions are reacting to past prejudices; 2) consumers who have experienced the historical language of mental health are publicly self-identifying, and responding to the effects the language of the mental health system has had on them; 3) a partnership is developing between people in the mental health professions and people who have directly experienced mental health services, leading to discussions of self-determination, and of setting mutual goals of how to accomplish language change; and 4) mental  health systems are themselves in flux, moving from immense, institution-sized facilities to small, community based programs, requiring still more new language.  The issues surrounding the ongoing changes in language are complex:

  • Isolation breeds fear: A group without the ability to self-define is left to the prejudicial definition of a society. About that which we do not know we often develop negative stereotypes. America’s policy of segregating people with mental disorders into large, isolated mental institutions has lead to a folk culture of what it is like to live with a mental disorder. Folk beliefs have a basis in reality, but are often exaggerated beyond specific context.  Like all illnesses, mental illnesses exist in vastly varying degree, but as presented in folk culture one encounters only an extreme. Stereotypes are expressed on a daily basis in the media, in the form of drama, in novels, poetry, as well as in professional literature, for folk culture affects all.
  • Complexity breeds confusion. The reality of mental illnesses and the infinite variety in the types and degrees of mental disorders is only recently coming into public view, as new generations are presenting mental illnesses in the same manner as physical illnesses, addressing all the inherent variety.  At the same time, however, pharmaceutical companies, marketing directly to the consumers of their products, are educating the public. Advocacies representing single-named illnesses, for example bi-polar disorder, are acquainting the public with the specific needs of a specific disorder, and through the power of naming are encouraging acceptance.

How can we promote Best Practices in language use? 

There are a number of broad guidelines to use so that consumers and providers use more effective and less damaging language:

1) name the individual illness, rather than labeling the person (i.e. a person diagnosed with paranoid schizophrenia rather than a diagnosed paranoid schizophrenic)

2) avoid generic stereotypes (i.e. “the” mentally ill is a generic stereotype, there are many mental illnesses)

3) recognize that people with disabilities have many differences: what they most often have in common is the prejudice and discrimination they face, particularly when described by the media

4) modeling a behavior (i.e. using people first language, integrating process) is a powerful tool.; and, finally,

5) proactive involvement of people in the profession – involving persons with a psychiatric disability to use their voice in the writing of grants, editing of articles, participation in advisory board panels, etc.  And you can turn to the following website for help with language concerns:

Thanks go to Harold Maio for his help with this section of the website.