[PDF] Beware the Word Police 5 fév. 2019 Patrick

View - Download Beware the Word Police

Previous PDF

Next PDF

Beware the Word Police

Patrick W. Corrigan, Psy.D.

Frequent calls for changing diagnostic labels to decrease stigma may result in unintended consequences. Con- demning incorrect language by policing word choice oversimplifies the depth of work involved to increase op-

portunities for people with mental illness. This Open Forumreviews three unintended consequences of using scolding

language. Psychiatric Services 2019; 70:234-236; doi: 10.1176/appi.ps.201800369 opportunities for people with mental illness (1). Words may make it worse. Calling a person"schizo"or"psycho"only fans theflames of stigma, leading to prejudice and discrim- ination. Hence, being vigilant to such harmful words, and reacting accordingly, may be important steps in decreasing stigma. I think, however, that this"fix"is fraught with un- intended consequences caused by"word police" - advocates who identify the inappropriate use of terms related to mental illness and scold those who utter them in an effort to stop stigma. This Open Forum reviews three unintended conse- quences of this action. First, though, I clarify concerns about language and stigma. There have been frequent calls for word change with the intention of decreasing stigma around mental illness. For example, psychiatrists have argued for changing the di- agnostic term"schizophrenia"to less stigmatizing alterna- tives, such as Kraepelin's disease or Bleuler's syndrome (2, 3), because the current label evokes prejudice and dis- crimination (4, 5). East Asian professional associations have been especially active agents of diagnostic relabeling to de- crease stigma (6). A survey of Japanese psychiatrists sug- their association facilitated enlightened education about the illness and psychosocial interventions, although this study was reported as part of a larger review and hence lacked specifics about the method (6). Ongoing research is needed to better determine how relabeling decreases stigma. "Stigma"has been tagged as a harmful word in its own right, for its capacity to equate the act of labeling with blaming the person with the label (7). Preferred language, according to this perspective, would refer to the prejudice and discrimination associated with mental illness, rather than the stigma. The Substance Abuse and Mental Health Services Administration has gone so far as to ask that

"stigma"be struck from the government lexicon (8). Onemight think consensus could be reached regarding appro-

priate words. Empirical research, however, has been un- able tofind consistent agreement among stakeholders on the appropriate terms to refer to people with mental ill- ness(9,10).Ithoughtthat"person-first language" - for example,"people with mental illness" - was an especially sacrosanct term that both advocates and researchers alike would endorse to diminish stigma. Surprisingly, however, person-first strategies have been criticized as accentuating the disability label rather than promoting full and unique identity (11). Consider this example of the unintended effects of the word police. I consulted with a well-meaning and energized group seeking to develop an antistigma program in a western state. I met with the members after four prior meetings, and found themselves stalemated."What do we call our- selves?"Some thought the issue was stigma and"mental illness."Others recoiled at"illness,"suggesting that the

medicalizing connotation of the term undermined the per-sonal experienceof mental health challengesand threatenednotions of recovery. They preferred"mental health chal-

lenge."The group further worried that if they could not agree on appropriate terms, how might they correct citizens who might err? Their raison d'être had been derailed by a protracted argument over correct words; they were far away from making decisions that would ultimately correct the injustice of their concern. Word police have hijacked the antistigma agenda and generally adopted one of two tones. Some of them might be benevolent, seeking to enlighten the misguided individual about the appropriate words to use. Others might admonish, scolding the individual who persists in using stigmatizing words. Either way, word police do not see that debates like this bringproductive discussion to a halt. This lackof insight

leads to three unintended consequences.234ps.psychiatryonline.orgPsychiatric Services 70:3, March 2019

OPEN FORUM

Three Unintended Consequences

First, the word police's focus on"just changing terms"mis- represents the depth and persistence of bias and bigotry. As one respondent said,"I don't know what you call it. Schizo- phrenia, Kraepelin's disease, or Bleuler's syndrome. And I don't really care. They're nuts and dangerous and need to stay away from me."Condemning hateful slurs of African

Americans, women, and the LGBTQ community has not

eradicated racism, sexism, or homophobia. Perhaps specific language can be suppressed in tightly controlled settings with vigilant word police (e.g.,"no one in my psychology class may say'schizophrenic'"). But suppression of words in a setting does not correspond to accepting the value that suppression is meant to represent. It just teaches students not to say"schizophrenic'"around their professor. Nor does vigilance in the classroom extend to the university at large or the community beyond. Instead, this policing of words might foster an incorrect sense of the ease with which stigma can be erased: that changing the words is enough. Unfortunately, changing stigma is a much more protracted and difficult task. Second, and of more concern, word police are a major barrier to the essential goals of stigma change. As one ad- vocate said,"I don't really care what people say about me. But they must stop discriminating against me - stop under- mining myworkor independent livinggoals."Erasingwords is not enough. Stigma needs to be replaced with affirming attitudes of recovery and empowerment, which in turn lead to real-world improvements in opportunity. Research has shown the worsening effects of antistigma programs based on a list of don'ts:"Don't talk about'schizos,'"or"Don't say 'crazy,'"or"Don't write about'mentals'!"(12). Of course, these are disrespectful terms worthy of an advocate's protest. But protests to quash these terms rarely change behavior and sometimes lead to rebound effects. Telling someone not to think something may actually increase the prevalence of that thought (12). To make matters worse, the naïve public is likely to dismiss this kind of barrage as political correctness, once again derailing real antistigma efforts. As a result, the work of word police undermines allies. Instead of engaging people in the hard work of prejudice- busting, word police are alienating potential partners. We must keep our eyes on the target. There is little need for us to include like-minded people in the antistigma charge, in- dividuals reading this piece and nodding their heads in agreement. We want to engage those who donotsee the problem. Nor is the target obvious; rare are people who see themselves as bigots waiting to cede their prejudice about mental illness to the use of more respectful terms. We wish health care providers, and legislators, whose decisions are central to goals of individuals with mental illness, in order to replace their stigmatizing attitudes with ideas of recovery and empowerment.We probably have one attempt at it. The public is not an empty vessel waiting toreplace its biases with affirm- ing attitudes. They are juggling other life priorities against additional social justice concerns: immigration, gender roles, poverty, and racial-ethnic discrimination, to name a few. The public also has limited information capacity to absorb the panoply of important messages bombarding them. People cannot consume endless material, regardless of its importance. Scolding the public about language use squanders an opportunity to more effectively eradicate stigma. Third, word police may undermine stigma change at the policy level. Whether the word officer does this benignly or with furor, the assumption is that stigma is corrected when words disappear. In making this process look easy, anti- stigma efforts gravitate to facile interventions such as public service announcements that blast correct words across so- cial media (13). Unfortunately, this distracts policy makers who fund these enterprises from promoting the grassroots, day-to-day work that produces real changes in personal opportunities. Canada seems to have embraced this preferred agenda in its Opening Minds program. Open- ing Minds quickly abandoned the simplefixes of public service announcements condemning taboo words and in- stead invested in local programs (14). These programs mani- fest as education and contact strategies led by people with of recovery and empowerment (1). This approach echoes the conclusions of the systematic review by Lasalvia et al. (5): the use of word change strategies needs to parallel strategic evolution in legislation, services, and public education.

Conclusions

Of course, it is not okay to say"schizo,""psycho,"or"nuts." Research suggests some benefits of changing word usage; therelativebenefits of word change. We want to avoid a false dichotomy that simplifies word change to a risky enterprise that should be avoided altogether. Instead, we want to promote a comprehensive plan that integrates word change efforts with attempts to mold legislation, services, and education into approaches that ultimately diminish stigma. In the process, however, we need to be mindful that readers herein are the choir. Our effort needs to be focused on the members of the public who do not really care about stigma and will turn attention elsewhere when brow- beaten instead of engaged. Perhaps the righteous person might read this and conclude that at least word police do not cede their moral compass. Yet having worked in the stigma world for 20 years, I realize the moral wrongs that define stigma are not black and white. Until they are, I urge strategies that get people into the tent working with us rather than placing barriers on progress. Beware the word police. Psychiatric Services 70:3, March 2019ps.psychiatryonline.org235

CORRIGAN

AUTHOR AND ARTICLE INFORMATION

Department of Psychology, Lewis College of Human Sciences, Illinois Institute of Technology, Chicago. Send correspondence to Dr. Corrigan (corrigan@iit.edu). The author reports nofinancial relationships with commercial interests. Received August 3, 2018; revision received September 13, 2018; accepted October 11, 2018; published online February 5, 2019.

REFERENCES

1. Corrigan PW (ed): On the Stigma of Mental Illness: Practical

Strategies for Research and Social Changes. Washington, DC,

American Psychological Association, 2005

2. Henderson S, Malhi GS: Swan song for schizophrenia? Aust N Z J

Psychiatry 2014; 48:302-305

3. Van Os J: Schizophrenia does not exist. BMJ (Clinical Research

Ed) 2016; 352:i375

4. Maruta T, Volpe U, Gaebel W, et al: Should schizophrenia still be

named so? Schizophr Res 2014; 152:305-306

5. Lasalvia A, Penta E, Sartorius N, et al: Should the label"schizo-

phrenia"be abandoned? Schizophr Res 2015; 162:276-2846. Sartorius N, Chiu H, Heok KE, et al: Name change for schizo-

phrenia. Schizophr Bull 2014; 40:255-258

7. Maio HA: Stigma and public education about mental illness. Psy-

chiatr Serv 2004; 55:834, author reply 834-835

8. Power K: Moving forward. Presented at Moving Beyond Stigma

Forum. Boston, William James College, May 23, 2017

9. Penn DL, Nowlin-Drummond A: Politically correct labels and

schizophrenia: a rose by any other name? Schizophr Bull 2001; 27:

197-203

10. Sheehan L, Fominaya AW, Bink AB, et al: Stigma by any other

name. Psychiatr Serv 2016; 67:1373-1375

11. Gernsbacher MA: Editorial Perspective: the use of person-first

language in scholarly writing may accentuate stigma. J Child Psychol

Psychiatry 2017; 58:859-861

12. Macrae CN, Bodenhausen GV, Milne AB: Saying no to unwanted

thoughts: self-focus and the regulation of mental life. J Pers Soc

Psychol 1998; 74:578-589

13. Corrigan PW: Where is the evidence supporting public service

announcements to eliminate mental illness stigma? Psychiatr Serv

2012; 63:79-82

14. Stuart H, Chen SP, Christie R, et al: Opening minds in Canada:

targeting change. Can J Psychiatry 2014; 59(Suppl 1):S13-S18

236ps.psychiatryonline.orgPsychiatric Services 70:3, March 2019

BEWARE THE WORD POLICE

quotesdbs_dbs45.pdfusesText_45

[PDF] test imc

[PDF] presentation francais facile

[PDF] rétine nasale et temporale

[PDF] schéma du trajet du message nerveux

[PDF] zajal loubnani

[PDF] exercice thales corrigé

[PDF] prédicat cm2

[PDF] prédicat cycle 3

[PDF] prédicat exercices

[PDF] prédicat nouveaux programmes

[PDF] alcools apollinaire pdf

[PDF] prédicat cm1

[PDF] prédicat ce2

[PDF] prédicat exercices cm2

[PDF] le prédicat définition