The other day, my best friend asked me if a person could or should refer to mental illnesses as “diseases” or whether there was another way to talk about them. I wasn’t sure and was inspired to do some research to turn it into a blog post. I have bipolar disorder and I’m not really sure what the proper terminology for it is. I usually refer to it as my “illness” or my “disorder”. The word “disease” just doesn’t seem right. But I wanted to get solid proof that my gut feeling was right.
Why did this question intrigue me? I know that the language we use matters. It might seem like a trivial distinction, but it doesn’t stop there. Which words and terminology should we use to describe mental illness in general? Which phrases are respectful and helpful and which phrases just perpetuate the stigma around mental illness? Keep reading to see how I explore the nuances of these questions.
First, I knew that I needed to learn the difference between an “illness” and a “disease”. This may seem pretty basic, but I was never taught the answer to that question nor ever bothered to learn it. Before I turned to Google, I asked my twin sister, an incredibly intelligent and insightful woman with solid medical and health knowledge. Without skipping a beat, she answered “A disease is more specific and established, whereas an illness is more general with possibly unknown causes. You could say that someone who has seizures has some sort of neurological illness, but if they don’t know what exactly causes it then they can’t diagnose a specific disease.”
That made sense to me, but I wanted to do some more research to see if I could build a more solid answer. According to the people behind “Dummies.com“, an illness is a “catch-all term that refers to a feeling or condition of not being healthy”, whereas a disease has “measurable symptoms”. This is definitely aligned with what my sister told me. As usual, I love reading content from this company because it is simple and straight-forward. However, I was curious about finding a more academic or medical perspective. According to a medical anthropologist named Cecil G. Helman, a disease “refers to abnormalities of the structure and function of body organs and systems.” Cecil argued that they are “named pathological entities” that are able to be “specifically identified and described by reference to certain biological, chemical or other evidence.” Additionally, diseases can be seen as “universal in their form, progress and content.” Herman also argues that illness “refers to the subjective response of the patient to being unwell” and that it refers to the patient’s experience of their ill-health.
I investigated even further into other terms and found that the definition of a disorder is “a disturbance of function, structure, or both, resulting from a genetic or embryonic failure in development or from exogenous factors such as poison, trauma, or disease.” And a syndrome is “a combination of symptoms resulting from a single cause or so commonly occurring together as to constitute a distinct clinical picture.”
So this is all starting to paint a clearer picture of health definitions and terminology in general, but what about mental illness specifically? Can it be referred to as a disease? My first instinct, armed with these new definitions, is no. Because mental illness does not have a defined cause, at least currently. However, many mental illnesses do have a set of defined symptoms, so that makes me lean a little towards yes as well.
In her article, Kirsten Weir puts forth the idea that “classifying mental illness is a more subjective endeavor. No blood test exists for depression; no X-ray can identify a child at risk of developing bipolar disorder.” However, she also includes the idea of Eric Kandel, who argues that “all mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases.”
I also read an article by Patrick W. Corrigan and Amy C. Watson, who argue that “the public needs to be taught that mental illness is a chronic disease from which people can recover—a disease not unlike diabetes.” Mental Health America, a charity in the U.S, refers to mental illness as a disease. However, the editor-in-chief of Current Psychiatry argues that “the state of knowledge points to |mental illnesses as| disorders and syndromes rather than diseases.”
I guess the answer to whether a mental illness is a disease or an illness isn’t quite clear-cut. However you refer to mental illness, you should keep in mind that people with these disorders and illnesses are real people with real health issues that deserve to be recognized. Words matter.
Well-known health journalist Andre Picard wrote that “Negative stereotypes and prejudicial attitudes help create an environment that can dissuade people from getting help, impact their medical treatment, interfere with their ability to get work, undermine their human rights, destroy relationships with family and friends, and even push people to take their own lives.”
We all have a role to play in ensuring that people with mental illness feel comfortable, safe and supported in our community. One of the easiest ways to do this is by paying attention to our language. Language is an extremely powerful tool to convey and spread an idea within a large group of people.
This is something that I struggle with, but a significant example is the positive trend of referring to someone taking their own life as having “died by suicide” rather than “committed” suicide. Committed has a negative, almost criminal, connotation that essentially assigns fault or blame to the individual without seeking to understand their story. Also, joking that you are going to “kill yourself” because you are frustrated, bored or upset is definitely not cool. Same goes with miming that you are shooting yourself in the head or hanging yourself.
I also struggle with using incredibly ableist language, such as referring to people as “crazy” or “insane”. Instead of using stigmatizing language like that, we should try to think about what we mean when we use these terms and find alternative solutions. Some ideas for substitutions to calling someone crazy or insane include saying that someone is illogical, not making sense or absurd. Think about their behaviour and be specific. Is the reason you are calling them crazy that they are always changing their mind quite rapidly? Then say “Bob is always flip-flopping on his ideas.” There is a great list of additional ideas on the blog “What Privilege?” .
When we write or speak about a person with mental illness, we need to focus on the person and not the illness. Doing so ensures that they are seen as a whole, complex human who is not defined by their illness. This includes using person-first language, saying “Kelly lives with schizophrenia” not “Kelly is a schizophrenic”. Think about it this way. Let’s take a physical illness like breast cancer. You wouldn’t call them a “cancer”, would you? Sounds almost absurd, right?
Another language issue that bothers the heck out of me is when people use mental illnesses as adjectives. It irritates me so much when people refer to the weather as being bipolar. Katy Perry even does it in her song “Hot N Cold”. I only noticed that a few weeks ago and was shocked at first. I then realized that these words are so ingrained in our popular culture and was discouraged about the work required to change the way people speak. But I’m going to try as hard I can and this blog post is a start. Cultural shifts in language are certainly possible. Let’s take the “r-word“, which was extremely prevalent in everyday language and conversations when I was in high school over a decade ago. It was essentially used to mean “stupid”. People started to realize that this word was extremely hurtful and disrespectful to people with disabilities. When the well-known band “The Black Eyed Peas” created a song called “Let’s Get Retarded”, the backlash was so strong that it was changed to “Let’s Get It Started”. This truly shows the power of people to make change.
To someone without a mental illness, these language issues might seem trivial and harmless. But they directly contribute to creating a society that makes light of mental illness, perpetuates the stigma around mental illness, and treats people with mental illness as second-class citizens. The language we use when we talk about mental illness directly has an impact on how seriously it is taken by our society. Earlier, I mentioned that mental illness is not necessarily seen as a “disease” because the causes behind it are unknown. The stigma around mental illness prevents people from seeing it as a legitimate health issue and therefore people are less likely to decide to research it. We need more research behind the causes so we can improve treatment and quality of life. If we can smash the stigma through changing our language, this might help.
People might also get angry at these suggestions that they need to change the way they speak. That’s because they have internalized these practices and words as acceptable language use. I’m telling you now that I am not blaming you or saying you are a bad person. It’s a societal issue that will take a lot of group effort to change. If you have an open-mind about changing your own behaviour, other people will be inspired to do the same.
Who’s with me?