“People these days use terms like ‘depressed’ and ‘anxious’ too easily. It’s becoming a joke.”
I am sure that most of us have heard something along these lines. There is constant scrutiny and policing of the usage of psychological terms (or psychiatric terms). As a psychologist, I am often questioned and asked to share my opinions on this subject. Finally, I decided to pen down my thoughts on this matter, if only to serve as a reference for future conversations. In this blog, I will address the accusation of misuse or overuse of psychiatric terms, possible reasons for it, the consequences, and suggest ways to manage this.
I firmly believe that any exploration undertaken without properly understanding the problem is time wasted. So, this is where I would like to start. We have an accusation that people loosely throw around psychiatric terms without considering the semantics or the weight these terms hold. This is considered a problem as it might lead to desensitisation, invalidation, or negation. Some of the contested terms are:
Anxiety, Depression, OCD, PTSD, TraumaAlmost immediately, I wonder if people hold different meanings for these terms. My phenomenological relation with these terms as a psychologist might differ from that of a high-school student or IT professional. To me, these terms can hold the following meanings:
Psychological disorders that are poorly defined and understood
A person’s subjective experience of their mental states
A mood, state of mind, or affect
An adverse experience, either in the past or ongoing
Placeholder terms used as a means of expression
From my perspective, I consider it acceptable for people to hold different meanings. However, I acknowledge that I am unaware of what these might be and that my assumptions will probably be incorrect. What I am most interested in is knowing the meaning the user holds. Hence, I would wish to follow up by asking for elaboration or clarity. This might be because I hold the opinion that language is always subject to the influences of culture and society. The contested terms are not exempt just because they have been claimed by psychiatric and psychological communities. Language is in constant flux. People can use the same words to mean different things in different contexts.
Let me cite a research study to add to this discussion. In the Scandinavian country of Sweden, researchers Lindholm and Wickström interviewed high-school students to explore their use of psychiatric terms (1). This was on the back of the finding that young people were often misdiagnosed when using rigid medical models that misinterpreted their use of psychiatric terms in everyday contexts. The study found that young people freely constructed new meanings for these terms and employed them in various contexts. For example, ‘anxiety’ was used to mean feeling low, having a lot to do, uncertainty, pressure to conform or succeed, feeling overwhelmed, fear of failure, and conflict. The young people argued that this served to normalise or devalue the seriousness of psychiatric terms. However, they acknowledged the difference between their meanings and psychiatric definitions or disorders (contrasted by the usage of terms like 'real anxiety' or 'real depression'). The authors concluded that young people served to shift these terms from the realms of diagnostic categories to dynamic cultural categories. Thus, these terms find appropriateness in wider contexts and hold multiple meanings.
I acknowledge that not everyone shares this view or needs to. For someone who strictly considers psychiatric terms as loaded, serious, or disorders, the act of using them outwith these categories might seem sacrilegious. From their perspective, a person not demonstrating the 'appropriate' symptoms should not use these terms to describe themselves. If done so, they are assumed to be acting with nefarious motives such as exaggeration, attention-seeking, or deception. Another common accusation is that such usages might be invalidating or insensitive to an individual with the actual disorder. Consider someone living with complex trauma due to domestic abuse. For them, using the word 'trauma' to describe a loud phone call that violently startled a person to wakefulness might be invalidating, minimising, or belittling.
The complexity then lies in constructing a social reality where both meanings can co-exist. It does not come easily though. Sharing a reality might require us to step away from our perspectives to meet another's. It is further complicated if the other perspective is contradictory or challenges ours. Successful navigation requires acceptance, compassion, and in some cases, a stance that is contradictory to our beliefs. To accept another's relationship with language requires us to let go of our existing relationship with the language, albeit momentarily and contextually. This is definitely a tough ask.
Another issue that presents itself is one of desensitisation or neglect. There is a fear that increased exposure to psychiatric terms might make society apathetic. Maybe we would not think twice before ignoring someone who claims to be anxious or minimise the experience of someone with trauma. Maybe we would create a society where ignoring and disregarding another's experience is the norm.
I would argue that what we are dealing with here is the role of empathy and responsibility in society. When an individual is attempting to share their inner experiences, we do not have to disregard them based on our assumed semantics. I wonder if these terms are mostly opportunities presented to help us reach out, be curious, and explore with another - 'What does anxiety mean to you?', 'Can you tell me more?', 'I wonder how this manifests on an everyday basis'. An individual's lack of linguistic flexibility is not an excuse to deny them an opportunity to be listened to, acknowledged, or validated. When someone says that they were traumatised by the phone ringing at 7 am disturbing their much-needed sleep, lean in. Explore this experience with them. Support them to find nuanced, alternate ways to describe their experience. Try to go beyond the presented value of these words. More importantly, we should try to not allow our feelings of linguistic specificity and elitism to intrude on the process of empathy. Only after accomplishing these do we gain the right to start a conversation about 'appropriate and fair' usage.
To address the issue that people might be using these terms to seek attention, I ask, 'So what?'. We all need attention and support from time to time. We are social beings, aren't we? There is enough evidence in Science to prove that we actively co-regulate each other. If a person is attempting to express themselves and seek support, I think it is unempathetic to judge their means of expression without attending to the undertones. At its core, we have a person trying to express themselves but failing to do so appropriately or accurately, or is doing so in a way that contradicts our preconceived notions. Are they not deserving of support then?
Now, I am not claiming that all uses of these terms should go unchallenged. We should have conversations around appropriateness and attempt to inform people if their use is problematic. A clear example is the following:
"I get super OCD about clothes lying around the room"
It is essential to challenge cases where these terms are used to appropriate a disorder, invalidate lived experience of people with the issue, or normalise inappropriate use. Sometimes, psychiatric terms are even used as insults. We must always contest and confront when this is the case. A common insult is calling someone 'autistic'. The clear implication here is that the user considers people with autism to be sub-par. Such usage is harmful, insensitive, exclusionary, and incorrect. There should be no compromise in our stance during such scenarios.
To conclude, the terms in contention do not belong to any particular community, and neither are they inert. As with any other words, they are subject to the influences of culture and society. People are free to use these terms and often do so as dynamic cultural categories and not as diagnostic categories. When these terms are employed, we must strive to be curious about people's unique phenomenological experiences and exercise empathy. If these terms are used to degrade, minimise, or insult, we have a responsibility to challenge, contest, and attempt to change opinions.
References
Lindholm, S. K., & Wickström, A. (2020). ‘Looping effects’ related to young people’s mental health: How young people transform the meaning of psychiatric concepts. Global Studies of Childhood, 10(1), 26–38. https://doi.org/10.1177/2043610619890058