To Fight Mental Health Stigma, Words Matter

Destigmatizing Language Seen as One Key to Better Treatment

Stigma kills. That was the undeniable message from three influential scientists in a recent commentary in the journal Neuropsychopharmacology. 

The directors of three of the National Institutes of Health — Nora D. Volkow of the National Institute of Drug Abuse, George F. Koob of the National Institute on Alcohol and Alcoholism, and Joshua A. Gordon of the National Institute on Mental Health — called for a “shift in mindset” around mental health and substance use. To break down barriers to better treatment, they argued, we must change the way we talk about these conditions.

“The words we use…can impact the likelihood that people will seek help and the quality of the help they receive.” 

~ Volkow, Gordon and Koob, in Neuropsychopharmacology 

Stigma Poses Barriers to Treatment

Nationally, more than a third of people with serious mental illness do not receive treatment. Nor do nearly 90 percent of people with substance use disorders, defined as addiction to alcohol or other legal or illegal drugs. In Vermont, about 6 in 10 adults with any mental health condition are receiving treatment. In addition, three-quarters of Vermonters with a mental illness say they have personally experienced stigma.

Stigma is one of several factors that can prevent people from seeking and receiving treatment, the authors said. They called on researchers, clinicians, and care providers to “help reduce stigma by carefully choosing the words they use to describe mental health conditions and addictions and the people who are affected by them.”

Person-Centered Language to Fight Stigma

Person-centered language means using wording that “reflects that the disorder or illness is only one aspect of a person’s life, not the defining characteristic.” An example is referring to someone who has schizophrenia as “a person with schizophrenia” rather than a “schizophrenic.” In the same way, use “a person with alcohol use disorder” rather than “an alcoholic.” Referring to people with substance use disorders as “abusers” or “addicts” should also be avoided. This follows a long-standing trend across medicine. 

In addition, the authors said to avoid terminology that “implies a negative value judgment,” especially around suicide. 

“For example, when referring to suicide, care should be taken to say ‘died by suicide’ rather than ‘committed suicide,’ since ‘commit’ connotes criminality or sin. Suicide attempts should also not be described as ‘successful’ or ‘unsuccessful’ (or ‘failed’). Instead, use ‘survived a suicide attempt,’ just as one might describe an individual who has survived cancer or a heart attack.”

Self-Stigma Delays Treatment

When stigma becomes internalized – sometimes called “self-stigma” – it can be particularly damaging, Volkow and her colleagues said. People who feel self-stigma are far less likely to seek help. They may have low self-esteem and self-worth. They may be more prone to use unhealthy coping strategies. Their social relationships may suffer. They have a harder time recovering from mental illness. Psychiatric symptoms may worsen, and suicide risk increases. 

“Carefully considered language” is only one part of breaking the cycle of stigma, the authors acknowledged, but it is one in our immediate control. “Appropriate terminology can encourage a person-centered framing of the condition, one that implicitly reinforces that affected individuals deserve compassion and care and that signals what science has shown to be the case: that in many or most cases, mental illnesses and substance use disorders can be treated or managed, and that people can hope to achieve recovery.” 

Learn More and Find Resources on Stigma

Read the commentary in Neuropsychopharmacology.

Read about a new exhibit at Burlington International Airport, Shattering Mental Health Stigma: ‘Deconstructing Stigma’ Exhibit at BTV Aims to Change Perceptions.

The American Psychiatric Association website page, “Stigma, Prejudice and Discrimination Against People with Mental Illnesses” defines stigma and how it makes it harder for people to get help.

“9 Ways to Fight Mental Health Stigma” from the National Alliance for Mental Illness offers actionable examples for how to destigmatize language and thinking around mental health.

Break the Stigma is an organization dedicated to fighting negative attitudes and beliefs toward people who have a mental health condition.

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Blog written by Brenda Patoine on behalf of VCN/Vermont Care Partners for COVID Support Vermont, a grant funded by FEMA and the Vermont Department of Mental Health

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