Lost in translation? Language and stigma in psychiatry
- Goda Tikniūtė
- Jun 11
- 6 min read
Interview with Professor Rūta Petrauskaitė
The theme of this issue of the journal - lost in translation - automatically brings us back to the field of communication, of conversation. The topic of stigma is particularly sensitive and important in public communication on psychiatric topics. It is a stigma that comprehensively undermines mental health, the accessibility of mental health care to the end user, and the quality of life. It also affects our job satisfaction as mental health professionals, which means the quality of our work and life. In the public sphere, stigma is felt most acutely through language. Today, I have invited Professor Rūta Petrauskaitė, a linguist and habilitated doctor of Humanities, to talk about the power of language to increase or decrease stigma.
Goda Tikniūtė: To what extent is language a reflection of reality (in this case, stigma), and to what extent does it have the power to create it?
Rūta Petrauskaitė: No matter how rich the means of expression might be, humans are often at a loss for words to adequately describe a given situation. And sometimes there is a reluctance to describe people and circumstances in a kind and objective way, sometimes even with the aim of humiliating and insulting. Stigma is then deliberately created. Even if the intent is not malicious, but the use of language (especially colloquial language) is unconscious and unaware of possible outcomes, stigma can be created or maintained.
Sometimes the stigmatising meaning of words is 'hidden', 'passively aggressive', and the stigmatiser often does not recognise or is simply unaware that he or she is stigmatising someone. This can be explained by the fact that there are two pathways of information reception – one very specific, conscious and slow, and the other fast, non-specific, automatic, necessary for survival, quick to react, emotional, largely subconscious. We tend to accept the associations evoked in this way automatically, uncritically.
Yes, indeed. This second way is often associated with 'labelling'. This is the phenomenon where, for the sake of simplicity, a complex phenomenon or object is identified by highlighting only a few of its characteristics. In other words, it is given an inaccurate name, or rather a nickname, which replaces the objective content, because, as is often the case, the name is taken for granted and the real content behind it is not pursued any further. Even worse, the name is spread and stays for a long time, misleading the gullible around the stigmatised and making him very uncomfortable.
But is it possible to objectify stigma? On what basis can it be reliably stated that a phrase/word is stigmatising?
One way is to look at the response of those who are stigmatised if they are directly addressed and identified as such. However, people are often nicknamed in absentia, thereby creating a negative perception of those around them. If we restrict ourselves exclusively to the stigmatising language, it can be identified by the negative connotations that emerge when comparing several ways of naming, negative and neutral, e.g.: confined to a wheel-chair - uses wheel-chair, homebound - child who is taught at home. Alternatives to negative namings have emerged alongside the notion of inclusive language and the desire to choose words carefully, to use phrases that are common but not stigmatising, and to focus on a person in the namings rather than his or her diagnosis, thus individualising the interlocutor and avoiding a generic labelling (e.g. disabled). Different namings evoke different effects, while describing people. And it is not only lexis, words but also grammar is important, e.g. the most offensive labels are usually nouns, e.g. a fool, while adjectives are less offensive because they only refer to a characteristic, not a person, e.g. stupid. A naming is even less offensive when it describes a specific action, e.g. acted stupidly/unwisely, thoughtlessly. Today it is hard to believe that there could have been an institution in Vilnius at the end of the 19th century that was officially called Madhouse. The stigmas attached to mental health, as it is known today, were not taken into consideration at that time.
At what levels of language can we talk about stigmatisation?
The levels of medical scientific terms and everyday colloquial language as two “opposite” poles. Terms, if they are only used to refer to a diagnosis and not to a person (e.g. diagnosed schizophrenia vs. schizophrenic), are neutral, whereas everyday words can be both negatively connoted, offensive (e.g. schizo), and non-stigmatising, (politically) correct towards the subject matter in question, especially towards the people. This is the level of inclusive professional and everyday language.
Are we still in the process of forming the third level, that is inclusive language? What is the relationship between these levels of language? Is there a possibility of “getting lost in translation” while moving from one level to another?
Formal medical language and everyday colloquial language are far apart, like water and oil - they do not mix. It is too early to say anything about inclusive language as its manifestations in texts and speech need to be studied. Nevertheless, it is possible to hypothesise that cases of misunderstanding and general miscommunication are possible, if only because of the desire to rename negative things as positive, or at least as emotionally neutral, e.g. stop using problems and to replace this noun by another, challenges. Such a replacement can lead to an inaccurate reflection of reality.
What is inclusive language in the context of psychiatry? What characterises it?
It is well known that most everyday words that have the stem psych- have negative connotations, which makes people shy away from seeking professional help or talking about this taboo topic with their loved ones. The proposed solution is to normalise the language and the way people talk about the subject and to overcome the stigma of mental illness. This could be done by using inclusive language, in particular by adhering to its basic principle of putting the person first rather than the diagnosis.
Inclusive language is characterised by euphemisms, when words or phrases that appear unpleasant, obscene, offensive, intimidating, revealing a secret or otherwise unacceptable reality are replaced by other, more acceptable words or phrases. Usually it is done based on ethical or other reasons. As regards euphemisms, it is necessary to refer to their temporary nature, since, after having a softening function for a while, they eventually acquire a negative connotation of their own and are replaced by new euphemisms, e.g. insane asylum - hospital for the insane - psychiatric clinic - mental health centre. Acronyms and other shortenings are also used as euphemisms, with the stigmatising word dependencies being replaced by the more sleek phrase substance use disorder, which is further disguised by its being collapsed into the combination of the first letters SUD. Such a wording tells the uninitiated nothing.
“Language is known to be affected by the universal principle of economy - short words and phrases are used much more often than long ones.”
How to avoid getting lost in inclusive language, what are the challenges?
Inclusive language risks replacing short one-word titles with knee-jerk phrases and these with acronyms. Acronyms are part of the professional jargon, incomprehensible and, if spoken, usually inexplicable to non-specialists. This can create a risk of misunderstanding. Excessive care in the choice of words and phrases can also make communication very difficult and frustrating for the interlocutors. Therefore, a general friendly atmosphere is considered to be more important than specific names. The person-first principle leads to very long phrases and more complex (and often illogical) wording, e.g. mentally ill is suggested to be replaced by someone with mental ill-health, committed suicide - died by suicide, took their own life away, attempted/completed suicide, alcoholic - person with alcohol use disorder. Language is known to be affected by the universal principle of economy - short words and phrases are used much more often than long ones. Thus, it is unlikely that the proposed longer phrases will take hold unless they are acronymised. Finally, we should remember that adequacy in naming is the primary purpose of a language. Therefore, before use inclusive language, we should ask yourselves: aren‘t we distorting reality too much when we change our language to one that is not offensive?
So. What to do?
I suggest that we should start by consistently examining the language used by professionals of the mental health and addiction care and by patients and their relatives. After all, these people talk and get along quite well. I have no doubt that there are good examples of inclusive language in the language used in specific situations that do not make communication more difficult. In addition, various methods should be used to identify the evaluative connotations of the words used, in order to identify words that are offensive, unacceptable to many people and therefore unusable. But above all, it is important to use language consciously, with the aim of making it as inclusive and person-centred as possible, while at the same time not ignoring the general laws of language - adequacy, clarity and brevity. □
