Views & Reviews No Holds Barred

Margaret McCartney: Bad language

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2342 (Published 05 May 2015) Cite this as: BMJ 2015;350:h2342

Stigmatising language in psychiatric settings which may be discriminatory and long-lasting

I wanted to add my voice to the mix, from the perspective of a person who has recovered from "mental illness" and supports family members recovering from the same. I would like to identify language used in psychiatric settings as a negative which in the real world would be seen as a positive and highlight other words which are stigmatising and discriminatory (1) (2). They can sit in our medical notes in perpetuity regardless of their accuracy or relevance to the here and now (3).

"non-compliant" if resistant to taking medication or psychiatric drugs - in the outside world this may be described as non-conformity, signalling an independent spirit and someone who knows their own mind

"anosognosia" or lack of insight if unwilling to accept the prescribed drugs or diagnosis. It may be that a person has the insight to refuse but this is contrary to what the doctor/psychiatrist ordered

"without capacity" if acting in a way that appears unusual or if not wanting to take the medication or if unwilling to accept the diagnosis or course of treatment

"presentation" a word used to describe a person's actions or words or movements when a patient in a psychiatric ward eg the patient presented as confused or agitated. This may be due to the psychiatric medication causing anxiety or because the person has stopped taking their medication and the withdrawal has caused agitation. Therefore the presentation may not be related to a mental "disorder" but a natural reaction to the side effects of medication

"severe and enduring mental illness" a phrase used to describe a patient or person for whom, the psychiatrist thinks, has no hope of recovery or of getting better. It can be a self-fulfilling prophecy. I was told I had this but didn't believe it, in 2003, so I was able to taper the psychiatric drugs - Risperidone then Venlafaxine then Lithium - and make a full recovery by 2004. No further mental health issues since or need of services.

"remission" a word used in psychiatric circles to describe a person who has made a full recovery from "severe and enduring mental illness" despite the lifelong prognosis. I have experienced 3 episodes of psychoses in 62 years 7 months which consisted of, in total, about 6wks in a psychosis (2 of them puerperal, one menopausal), 7wks in psychiatric wards and 4 years on psychiatric medication. Therefore for over 58 years I have been in very good mental health. Yet because I was given a schizoaffective disorder diagnosis/label in 2002 it seems to have priority over any subsequent recovery. And it pops up in the notes of other family members, as in "family history of".

References
(1) Stigma creating stigma: a vicious circle; Sokratis Dinos, BJPsych Bulletin Editorial, August 2014:
http://pb.rcpsych.org/content/38/4/145.full
(2) Too similar, too different: the paradoxical dualism of psychiatric stigma; Tania Louise Gergel, BJPsych Bulletin Editorial, August 2014:
http://pb.rcpsych.org/content/38/4/148.full#aff-1
(3) The other side of the fence: Iatrogenic stigma; Dr Peter J Gordon, Hole Ousia, March 2013:
https://holeousia.wordpress.com/2013/03/18/the-other-side-of-the-fence-i...

Competing interests: No competing interests

10 May 2015
Chrys E Muirhead
Writer; Carer
Cupar, Fife, Scotland