BY REBECCA HEILWEIL, editor-in-chief
In 1788, Benjamin Rush, a signer of the Declaration of Independence and father of the American psychiatry movement, wrote in a letter, “Habitual drunkards are beyond the influence of reason, but young men will feel its force upon this subject and act accordingly.” He added, “In the year 1915, a drunkard I hope will be as infamous in society as a liar or a thief.”
Nowadays, calling someone a drunkard would no doubt seem dated, and maybe even comical. Equating alcohol dependence with criminality or dishonesty would be seen as extraordinarily harsh. Surely, the term “drunkard,” at the least as a diagnostic label, is out-of-style. Ultimately, the word is probably inappropriate, especially for serious modern discourse. Society has moved towards using different language, for reasons ranging from political correctness to diagnostic necessity, to describe an unhealthy pattern of substance use. This is natural; this is expected.
But while we might have a clear view of the inadmissibility of “drunkard” as a useful evaluative, there is a diverse debate concerning what language out to dominate, and define the norm, of our mental health conversations.
The movement towards political correctness has shaped the way we talk about sexual assault, military trauma, race relations, and other social concerns has no doubt also affected the approach to mental illness discussions. Largely seen as originating on liberal college campuses, the struggle to balance free speech and concerns of potentially alienating stigma has saturated American intellectual debates, making its way to NPR, the Washington Post, and other major news outlets. Some feel suffocated by the seemingly ever-changing rhetorical rules; others find them necessary, and appropriate.
A useful example is the one with which I began. I described this mental disorder as “unhealthy pattern of substance use.” This was the least political choice I could find, ironically, to open a piece largely standing against what I often think feels like censorship. The language I could acceptably use is both infinite and constricted. Calling someone an alcoholic feels like going too far; does that not define someone by their mental illness? Isn’t that what I’m against? Meanwhile, writing that someone has alcoholism seems slightly better. Still, others would prefer different language. Who am I to draw the deciding line? That’s seems too presumptive, and too much responsibility.
Perhaps, there are those who clearly have more authority than I, a nineteen-year-old with ostensibly no professional mental health experience. The Diagnostic and Statistical of Mental Disorders (DSM), for instance, is the standard for defining mental illness and disorders in the United States. In the most recent DSM, DSM 5, “alcohol abuse and alcohol dependence, [are combined] into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.” (The DSM addresses changes in terminology, here). *Meanwhile, there are organizations that do not follow the DSM standard. Mental health journalists often don’t. Neither do politicians.*
This is part of a new movement to define mental illnesses on spectrums, rather than with binaries. This gives physicians more fluid diagnostic tools. However, others will contend that the most significant change, here, is the switch from “abuse” to “use.” This is less stigmatizing.
And this sentiment isn’t just trite. A recent Vice article made a strong case for increased awareness of mental health rhetoric. stigma gets a bad name in social arguments. Many don’t find it helpful. Does it mean anything? It’s seen as an intangible sort of contention, one that oppositions find incredibly difficult to engage. After all, being “stigmatized” can mean different experiences, lacking static definition. But stigma is also real, right?
The article referenced a 2007 study, which found that “‘help-seeking by mentally ill young people may be improved by interventions that address both their lack of factual information about mental illness, and those which reduce their strong negative emotional reactions towards people with mental illness.’ The study also found that the kids used words like ‘disturbed,’ ‘nuts,’ ‘retard,’ and ‘div’—among others—relatively frequently.” (There is also an interesting discussion to be had about “reclaiming” and the mental health world, a topic I plan to explore later.)
People can die because they fear labels. People don’t get the assistance they need, fearing a world that isolates them because of their identity and illness.
Yet, I wonder whether the reason the subjects of study felt stigmatized was not because of the words used, but because of the likely cruel and aggressive intent behind those words. Had bullies been using something more sanitized, students would likely feel just as bad. I question whether changing languages in intellectual and clinical discussions of mental health really deals with the stigma and pressures many find so problematic.
I also worry that we’re running out of words to describe ourselves. I like my broad diversity of vocabulary. When I’m sick, I want to identify as sick. I am suffering. Calling it anything else feels inaccurate, inefficient, and limits my ability to describing how bad I can truly feel. (But, at the same time, these debates need to be utilitarian. Things aren’t just about me).
I am also concerned that space for discussions about language takes away from policy barriers that create quantifiable harms to populations struggling with mental illness, such as mental health parity. I worry that these rhetorical rules are a form of discursive barriers to entry. I worry that they serve as a form of privilege, where those who have not had experience. Sometimes, movements to constantly redefine our lexicon can feel like a bridge to nowhere. What happens when we can’t say substance use disorder? I am scared to run out of words.
Words, after all, are our most basic, fundamental expressive tools. Following the discussion of mental health narratives and story-telling last week, I thought language, the unit of written experiences of mental illness, deserved analysis. They can be gorgeous, traumatizing, illuminating, and blinding. After all, that’s what makes this discussion so necessary.
In the end, I think Sara Bareilles, in one way or another, gets it right. “You can turn a phrase into a weapon…be the backlash of somebody’s lack of love. Or you can start speaking up.” Our words are, at their core meaning, their intent. We have power when our words are brave.
Rebecca Heilweil is the co-founder and editor-in-chief of Beautiful Minds Magazine. Art by Alexander Atienza.