of language in mental health.
Changing words is part of the whole politically correct thing. Afro
caribbean is the new Black. Mental illness is a mental health problem.
Mental health is now well being. I may be being a bit anal about this
but by changing the words they are attempting to draw a blank slate on
the concept and start again which sounds great but isn't really.
A recent article in New Scientist by a psychiatrist proposed the idea of
changing the name of schizophrenia on its 100th birthday next year and
there's a campaign against the label of the word schizophrenia.
http://www.newscientist.com/article/mg19626256.200-comment-down-with-schizophrenia.html
The article mentions research about how changing the word affects how
people thing of it is significant and obvious. A study compared terms
like "stress-sensitivty psychosis", "traumatic psychosis", "anxiety
related psychosis" and "drug related psychosis" with the label of
schizophrenia and showed 63% of diagnoses patients had a negative
attitude to the label of schizophrenia whereas a only 16% had negative
attitudes to the other labels. Medical students were also twice as
likely to consider a better outcome for patients with the sub-type
labels. However its something that's fairly obvious. Change the name to
"Care bears" or "hot body" or "hopeful outcome disease" and I think the
results would be even more positive. Who wouldn't want Care Bears or hot
body? The term stress-sensitivty psychosis has little meaning to anyone
outside mental health so its clear that many people would consider it
better than a term they've heard of and has a stigma attached to the
consensus definition. Using words with positive assocations should have
even more beneficial effects.
I know that changing the language is the short term pragamatic solution
though and that's what the evidence cited showed. But when studies show
that people with Care Bears kill more than average or die sooner or
people work out that it means the same thing as that guy in One Flew
Over the Cuckoo's Nest had then people won't want Care Bears any more
and doctors will return to the same expectation of poor outcome.
The writer also noteably left out "paranoid psychosis" which I assume
would be one of the subtypes and an important one. With the splitting up
of the diagnosis the violence and murder rate for this group would be
exceptionally high - possibly higher than antisocial personality
disorder. And again the stigma would return, even with the linguistic
power of the label "Care Bears" to save the day. (I seem to be a little
sardonic today...) In fact I suspect that paranoid psychosis might be
one of the sub types in those studies but it was better to leave the
results in the article to make the point better. "paranoid" and
"psychosis" may have a stigma lower than "schizophrenia" however it will
still be significantly high.
Personally I feel that promoting social contact theory methods in
individuals is the way to change the stigma. What that means is people
who have experienced psychosis or delusions "come out" in public. Its
about people changing the perception of hearing voices and delusions
using the highest form of evidence used by most people: personal
experience. This is about individuals risking stigma and all that come
with it but I feel it will be the lasting way to rid the stigma. It
would be great to have a documentary like Secret Life of a Manic
Depressive to help people on their way. It significantly changed the
public perception of a diagnosis that could be seen as a Kraeplinian
sub-type of schizophrenia, so much so that it distorted the public
perception and made it a desireable state of the human condition.
There's obviously the need for a standard mass-media antistigma program
targeted at the most stigmatised mental disorders.
Alongside that there needs to be some sort of promotion of alternative
stereotypes and research into positives of schizophrenia. In Jung's
Psychological types (if I remember this right) he goes on about
schizophrenia at the extreme of a scale and that extreme is associated
with compassion and empathy or something. I'll have to find the bit and
reread it but its about real positive images to balance the negative
picture and quell the stereotype, rather than some fudge of language
that works for a couple of decades then the word has to be changed again
as is happening with Well being (or positive mental health as it used to
be known). Its about correcting the public perception of schizophrenia
such that they actually understand what it is and what the reality is:
the good and the bad.
Another way could be to censor the media who love to print stories about
psychotic killers, things that cause psychosis and things that prevent
psychosis but very rarely do they print positive stories about schizos.
I don't agree with censorship in any form though I understand that there
are salient reasons why there shouldn't be a free press and freedom of
speech and thought. Openmindedness and liberalism and all the value that
come with those ideals also come with a cost. However I've seen
something recently that might be an acceptable way to reduce the number
of front page stories and headlines about people with a diagnosis of
severe mental illness, most of which are negative stories that reinforce
the public stigma. The Sun newspaper was slapped on the wrist for using
"Schizo" in a head line. Their defence was it was used as a contraction
and my guess is that means they will have to use "schizophrenia"
instead. It sounds ridiculous unless you have an idea of what news
editors can think like. I can hear cries of "that's too many syllables"
from the sesquipedalophobia (fear of big words) news team and that's how
it'll keep stories about people with a diagnosis of schizophrenia off
the front pages.
The social contact theory solution is the one that is best in my opinon
at the moment however it may be a view based on the naivety that social
change can happen through this method. I believe it can but I'm not
sure. I feel it is the right method because it is about the truth of
schizophrenia. Its not about propaganda. Its about balance. Perhaps this
is a view based on previous roles working in information teams but its
also about my own endeavours to understand what the /concept/ actually
meant. In the end making a value judgement on schizophrenia is something
that I am incapable of: the truth is that it is something that exists
but can be looked at as good and bad and good or bad.
Someone else may think it better to wipe the slate clean and manipulate
the definition because the public don't know what schizophrenia actually
is. They just know it's bad. The evidence shows that what its labelled
by medicine can have an effect on the perceptions of doctors and
patients. The treatment of the concept itself, i.e. the value judgement
in the West that it is a medical illness, also needs to change because
studies have shown that local conceptualisations other than the
biomedical model of treatment for schizophrenia may offer better
outcomes, and better outcomes than can be had by changing a word that
will have to be changed again in another twenty years time.
No comments:
Post a Comment