The words used to talk about mental health

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By Max Guttman

Without question, all of us involved with the mental health system, treatment or peer advocacy, and those with a vested interest in the health and wellness of our friends, use language to talk about, explain, articulate or just commiserate about subjects involving mental health, health, and the world at large. The words used to talk about mental health matter.

Both personally and professionally, I pride myself on the language I use to talk and disseminate information about mental health. In clinical practice, I indeed think about the words I use to talk about mental health issues. In peer work, I try to connect with others meaningfully by aligning my language with my colleagues’. I relate to them through common use of wording and examples. While I never believed in using buzzwords or the word of the day, I do believe that the words we choose to relate with others have a powerful impact on how others perceive our meaning and intentions.

I am reminded of a particular afternoon in which my housing caseworker performed a home visit. To give a little background, I called my housing caseworker to complain about a volatile neighbor situation. The building superintendent and my caseworker spoke to each other, and the super filled the caseworker in on my history in the apartment since I moved in a few years ago. When my caseworker arrived that evening, she said, “I’m going to do a walkthrough”. Then she went about peering around my place.

No trust or respect

Instead of trying to resolve the issue through advocacy, my caseworker went looking for problems. And an even bigger issue to me was that she made up a term, “walkthrough”, to justify her behavior and take a second look at the state of my apartment. I felt like a prisoner having his or her cell searched. I had no idea my apartment was in the agency’s new division of corrections and psychiatric rehabilitation. Indeed, there was no trust between my worker and me, and certainly no respect or belief in my own reporting when I talked about my recent health progress and general status of things in my life.

I’m also reminded of two days ago. I made a similar mistake as my housing person had done with me in the previous case example. I hadn’t seen a particular friend in quite some time. This friend and I do check-ins with one another and generally share our status, health and otherwise, over the phone. Both this friend and I had been generally healthy since we’d become friends. There had been very little negative reporting besides some brief illnesses (i.e. common colds) and so forth. My point is, the system we put in place to check in with each other had never been tested for a real problem or issue.

Everyone is different

From time to time, I would go ahead and stop by her home if there was loss of contact for weeks or I felt she needed my support. However, two days ago, I made the golden mistake in peer support and trust between friends. My friend said very clearly that she was fine. Something in my gut said otherwise though. Given my history and illness, in which I report that everything is A-O-Kay but am in fact in crisis and do not realize it, I always tell my friends to go ahead and visit, call the police, do whatever they need to do to get me connected to services. But everyone is different. We all have different needs and different expectations on how we want to be treated in a crisis.

My friend wasn’t in crisis, however, and the only thing that told me to check on her was a gut feeling that I couldn’t even justify in meaningful language. Indeed, I went ahead and told this friend, “I am going to eyeball you and check in with you at your house”. Wait a minute? Pause, Max. What is eyeballing? Did I just pull the same crap my housing manager did with the term walkthrough? My friend said, “What’s ‘eyeball’?”

“This is what the system does…”

Now both my friend and I have been in mental health treatment for years and know what I was trying to say. But the fact that I choose this particular word instead of something more respectful, descriptive and accurate was extremely upsetting to my friend, who said to me, “This is what the system does…” I was so blown away by that statement that I needed days to reflect. In my own haste, passion, love and clumsy approach, I behaved in the same manner the system had to my friend for decades. I had become someone I never wanted to be. In a split second it had seemed to my friend that my entire ethics had shifted.

When I met up with this friend again, I apologized, and we joked around. But the seriousness of this boundary transgression was visible to both of us. I suspect we are going to be more mindful of how our language and behavior are perceived by each other in the context of making sure our motives and intentions are congruent with our word choice and actions.

Years ago, I made a similar mistake. I shared the lived experience of a member of the team I was serving. I’m vocal about my own experience and history but when a timely conversation presented itself, I shared a colleague’s experience. I thought my client and peer would benefit from this, but I was totally wrong. My lived experience is something that I own. I do not have ownership over the experiences of other people. This was a clinical error, too. The client I shared the story with was also on my team, and we all shared the same clients.

The golden rule

This client and peer used this information to act out and throw a barrier up in his own treatment. The information was also used to manipulate the team, split, and cause a whole lot of borderline problems. Indeed, I’d broken the golden rule amongst peers. I felt the fallout among my team professionally and between myself and my peer.

The whole affair reminds me of the mistake I made a few days ago. By invalidating the experience and respect of my friend by not listening to her when she said, “I’m okay”, and not respecting the lived experience of my colleague, I minimized their power to be themselves and who they were without fear of transgression. Ultimately, by putting my narrative ahead of, or before, the person’s needs as an individual, I exercised power over that person despite my intentions as a friend and peer.