How Do We Talk About Mental Illness?

Janet Coburn

Jun 12

Language matters. What we call things matters. Does language shape thought or does thought shape language? Either way, both are important when it comes to brains.

The latest discussion in the debates over language is what to call mental illness (which is what I'm used to saying). Many of the words and phrases that have been in use for years no longer seem quite accurate.

Take mental health, for example. When policymakers talk about subjects like mass violence, they often speak of "mental health issues" and what should be done about them. The thing is, if someone is mentally healthy, nothing really needs to be done about that. But mental illness is a term that doesn't sound so easily addressed. Policymakers are notorious for using language that soft-pedals actual problems. Not to mention the fact that when they talk about mental health, they're usually talking about addiction issues or homelessness (though they still aren't particularly effective in addressing those either).

Mental health is still a better term than "behavioral health." I remember when community treatment centers and insurance programs were called behavioral health plans. Again, there was a lot of lumping psychiatric illnesses and addiction together. It was also wildly inaccurate. It was not the behavior that was unhealthy (the way smoking is). Behavior may have looked like the problem, but it wasn't the cause. Something to do with thought or the brain was. Also, there was no equivalent term "behavioral illness." That wouldn't even make sense.

So. We have mental illness as the term currently most used, with SMI (Serious Mental Illness) often used for disorders like bipolar and schizophrenia. Lately, though, there has been a push to replace those terms with "brain illness." (The companion term is "brain health.") It hasn't caught on yet with the general public, though it's gaining some traction among practitioners, advocates, and those affected by assorted conditions. I've heard some people are frustrated that it hasn't caught on more widely already. They feel the process is going too slowly.

Calling schizophrenia, bipolar, and other disorders "brain illnesses" certainly makes one sit up and take notice more than "behavioral health." And it jibes with the notion that these mental disorders (there's another term) are caused by something going wrong in the brain. This is not without controversy, however. There are those who think that referring to depression or bipolar disorder as "chemical imbalances" in the brain or faulty neurotransmitters (or their receptors) is inaccurate. There are various theories as to what causes these conditions, all the way from childhood trauma to gut bacteria. To me, the most likely scenario is that there's a combination of brain-related factors and environmental influences at work here. Nature and nurture, in other words.

Brain illness is certainly an attention-getting term. That should make it more likely to catch on with policymakers, but I suspect it won't. It's not a comfortable concept and there are no easy-sounding solutions to it. I doubt that it will catch on with the general public either. We still haven't gotten people to move away from crazy, insane, maniac, psycho, or even nuts and stop throwing them around indiscriminately. Hell, we haven't even been able to convince people that psychiatric institutions don't use straightjackets anymore.

Does "brain illness" make these conditions sound more treatable? Is it likely to increase compassion for those who have them? Is it likely to make any kind of a difference? I don't think we'll really know until it penetrates the consciousness of the person-on-the-street. And I have my doubts about when or if that might happen.