Each year during Mental Health Awareness month, the internet is flooded with hundreds of thousands of posts. People from around the world share their stories; they share a raw and emotional insight into what living with a variety of different mental health problems feels like. There are heartbreaking stories, many tragedies which expose the failure of society and mental health services. Equally there are stories of triumph and victory and of survival and hope, which perfectly epitomised the resilience and courage countless people display – every single day.
During this month, individuals with no history of mental health problems take to the internet to share messages of support and solidarity. Hashtags like #mentalhealthmatters and #suicideprevention take over and it seems like everyone had been affected in some way, directly or indirectly. And all of a sudden our experiences, fear and emotions are legitimised. And what happens in the months that follow? As quickly as the revolution begun, it seems to end. Pockets of rebellion continue, in small and unsystematic ways, but mostly, we are once again silenced. There is a return to conventional uses of social media – miraculously, it’s as though the world is healed, and we resume scrolling pictures of sunny places, coffee and morning workouts. The culturally imposed silence once again descends over us, like a huge black curtain. We realise the darkness that we are forced to live and survive in, is very much still looming. So why is it that the legitimacy of conversation can change overnight and then change back? Why are campaigns such as Mental Health Matters so effective and yet, so quickly forgotten? How do we ensure mental health awareness and campaigns aren’t just trends that come and go with the hashtags that describe them?
There is an intrinsic and powerful link between language and attitude. Whilst campaigns temporarily legitimise conversation, they don’t create lasting shifts in the words used to describe mental health across social, cultural and economic settings. As mental health awareness month draws to a close, we sadly hand back words to their default meanings, connotations resurface, stigma increases and in the end, very little is different. For words to mean something different, they must be used differently, not just once annually, but all of the time. As children grow, the language they learn communicates significant meaning in relation to cultural beliefs, attitudes and identities. Therefore we cannot segregate language learning from cultural learning. As children learn to speak, the words inevitably carry codes and meanings that are embodied in the culture associated with the language. This raises an interesting discussion – if language has been pivotal in creating the infrastructure which upholds negative stereotyping surrounding mental health problems, does it have a role to play in reversing these attitudes?
To understand how we begin to reverse the damage, we have to understand how language has shaped our attitudes toward mental health and the stigma that surrounds it. As a starting point, the language used to describe mental health problems is almost always negatively connoted. For instance, the word ‘mental’ creates an image of an inherently unstable and potentially dangerous person. The word ‘psycho’ creates a picture of a serial killer, like the image purported through countless books and movies. Equally condemning associations are true for many words used to describe mental health problems such as schizophrenia and bipolar disorder. The terms frequently present mental health problems as untreatable disorders or illnesses that imply individuals are incapable of contributing to or partaking in society. The terms depression and anxiety also hold negative connotations of individuals who are unable to function, work or socialise. Obviously, many of the above negative connotations are inaccurate, individuals with various mental health problems function within society and contribute to families and communities every single day.
Words used to identify mental health problems are no longer simply descriptive medical terms, they carry stigma with them. This creates the first major obstacle to truthfully and openly discussing mental health – we cannot use language to identify conditions or symptoms – without the attached meanings – the stigma. It becomes impossible to promote honest dialogue – we are asking people to label themselves, not just medically or symptomatically, but to use words which, for years, have carried the burden of cultural ignorance and socially imposed judgement. This is why the end of a campaign promoting awareness so frequently signals the end of the discussion entirely, there are no structures in place to maintain open conversation.
Another major issue is that many medical terms have become common day language, thus their true meaning and importance is fundamentally and continually undermined. Culturally, we frequently use phrases such as ‘I’m so depressed about the weather,’ or ‘I’m a little OCD about this.’ The incorporation of mental health problems into our everyday conversations has desensitised us. It evidences a complete disregard for those to whom the words apply. We would shrink in horror if physical disabilities were discussed with as much disregard as mental problems are. ‘Are you sick in the head? God, you are a psycho.” This kind of language infiltrates our television, reality shows, dramas, comedy, films, it is not even unfamiliar in the workplace. It is so well embedded into our culture and behaviour, studies into children’s television evidence terrifying levels of reference to ‘mental’ or ‘crazy’ characters. Mostly these characters are presented as one dimensional personalities who are totally devoid of positive characteristics. Rarely are mental health problems presented as difference as opposed to disability. This is tragic particularly because many studies have actually explored the link between ‘madness’ and genius, with a disproportionate number of individuals suffering from mental health problems flourishing in the creative arts fields. In history what has been referred to as mad is so frequently later referred to as revolutionary, or simply a different lens through which to view the world. Our language is deeply rooted in the cultural philosophy that difference is madness and vice versa. This is entirely flawed; we should strive to create a system in which the individual difference is recognised and catered for, not ridiculed.
The language of mental health has been completely hijacked, it’s casual use and the negative connotations it carries have become major barriers in individuals acknowledging or seeking help for mental health problems. A number of studies have explored the link between illness perceptions and health outcomes. Negative perceptions of illnesses, which may be the result of internalised beliefs regarding how mental health problems are perceived, are shown to negatively impact an individual’s willingness to utilise health care or adhere to treatment plans. In addition, these negative perceptions of mental health problems can also lead to emotional suppression, countless studies have correlated suppressing emotions with increased anxiety and depression, physical symptoms such as stress and a reduced ability to actually process or recover from lingering negative feelings. Recently, the movement against toxic masculinity has promoted an increasing awareness of the devastating consequences emotional suppression has had on men.
Additionally, it is important to note that ‘healing’ isn’t always the ultimate goal regarding mental health problems. Emotion acceptance as opposed to emotion suppression is indicative of the fact that not all differences are there to be resolved. It reflects a commitment to creating a society in which different individuals have equal opportunity to flourish as opposed to all individuals becoming the same. The absence of a culture which promotes emotion acceptance is therefore indicative of the fact that society is still unwilling to celebrate differences, the categories of acceptable and unacceptable are still rigidly defined.
If this is the cultural framework within which we are raised, we are increasingly likely to deny mental health disorders and reject available help. Truth would require words, and in a society like this one, words aren’t free, they come with hidden charges of stigma and fear. We become immensely conflicted - we inevitably internalise the connotations – when we want to describe our feelings or their impact, we are forced to label ourselves, there is no language which we have access to that can tell our experiences without demonising ourselves. By stealing our words, society is denying our basic right to ask for help or to connect to one another by sharing our experiences.
With these barriers in place to tackling stigma – simply pronouncing that we are free to discuss our mental health doesn’t resolve the underlying cultural problems which prevent such discussions. Within the parameters of society and the deeply embedded connotations of these words, open conversation may simply subject us to more labelling, more stigma. Challenging the meanings behind these words requires a certain number of voices or personal stories which openly discuss mental health problems in order to dispel the myths upon which the stigma depends. However, the first people to share their stories will face the most severe stigmatisation, because as a society, our understanding of these words is yet to be challenged or reformulated. This is why the Mental Health Matters campaign was a good way to start the process of challenging the language we use to describe and understand mental health, but it is not nearly enough.
So what needs to be done in order to promote lasting changes in societal attitudes toward mental health problems? We need to create safe spaces which challenge negative labels and acknowledge the healing power of words, Judith Herman’s book ‘Trauma and Recovery’ perfectly encapsulates the value of this. Herman explains that a number of mental health problems, such as PTSD, depression and anxiety, can be the result of traumatic events. The consequences on individual identity are severe. What frequently results is a kind of fragmentation or dissociation where the individual has lost some capacity to integrate the memory of overwhelming life events into their life story. Therefore such traumatic memories lack verbal narratives and context, they are encoded through vivid sensations and images, with great physical, psychological and emotional consequences for an individual.
Herman continues, the mourning or grieving of traumatic life events is necessary, without it individuals can remain stuck and incapable of moving past depression or personality disorders which are the result of fragmented identities which were created during traumatic experiences. An inability to find a safe space to express these griefs or to truly feel and process them creates a sense of disassociation, individuals use thought suppression or denial as coping tools instead, with devastating consequences in the long run. This prevents the traumatic experience from being integrated into our life story and becoming part of the past, thus the individual feels more internally fragmented and disconnected from others. Without access to neutral language to retell their stories and the safe spaces in which this can happen, society prevents individuals from following the natural healing processes which are essential for promoting trauma recovery.
It is apparent that another tragedy of the culturally imposed silence with regard to mental health problems is that it maintains a lack of societal understanding or awareness and further ostracises and isolates those who suffer because others are unable to connect with their experiences. Unfortunately, sufferers are therefore placed in the agonising position of choosing between expressing their own experiences (which is essential for healing) and remaining in connection with others (which is also essential for healing). In other words, the culturally imposed silence and disregard for mental health problems makes different aspects of recovery almost mutually exclusive.
Many books regarding mental wellbeing mirror these concepts. ‘Six pillars of Self Esteem’ by Nathaniel Brandon, identifies self- acceptance and integrity as crucial for individual well-being. Self-acceptance “entails our willingness to experience...without denial or evasion, what we think, what we feel.” The inability to accept ourselves fully may be the result of not wanting to identify with mental health problems as a result of stigma. Therefore, the stigma that language carries exacerbates the difficulties of living with mental health problems, not only must we deal with symptomatic effects but also with the internal conflict as a result of rejecting parts of ourselves society does not deem acceptable. Brandon also describes Integrity as an essential aspect of self esteem - if individuals are not able to authentically discuss their difficulties or struggles, because society is not acknowledging of them without judgement - then we deny parts of our identity. This lack of authenticity can result in great cognitive dissonance.
Society’s hostility towards mental health problems has clearly made the above processes of connection to others and self acceptance substantially harder, therefore undermining individual’s abilities to effectively cope with mental health problems. Because open discussions are so hard to foster and even harder to sustain within this paradigm of negative attitudes toward differences, we can see individuals increasingly depending on nonverbal means of healing and connection. We can already see the drive towards trying to process what language has prevented us from discussing, through alternative means, the steady increase in our attraction to activities such as yoga, mindfulness and adult colouring book are examples of these. Expression of our difficulties through art is becoming increasingly popular; spoken word, lyrical dance, theatre and graffiti have all been used to tackle these sensitive issues. The medium of art allows for a more open discussion of mental health problems; certain discussions become acceptable, they appear more exploratory in nature as opposed to definitive. These are ways to present our innermost struggles in a way that society is willing to accept – art. Within those constraints, mental health is less judged, less threatening, it appeases society and what it wants from us.
But a reliance and dependence upon these outlets alone is dangerous. The burden of systematic change is too great for one individual or community to bear. Not everybody can find acceptance or healing through art, or some output driven means of self-expression that society deems acceptable. Some people just want to talk, and there is nowhere to do it. Self-care is becoming increasingly individualistic and increasingly dependent upon people’s own resourcefulness – the obvious drawback being, resourcefulness, initiative and discipline are some of the first casualties of mental health problems.
The increase in the use of the word ‘safe space’ and it’s commonality to day to day activities reflects a pressing issue, society isn’t safe and we are well aware of it. Society feels dangerous, because continually and repeatedly our inherent desires for authenticity and honest human connection are undermined by social media expectations and a culture of objectification and commodification of individuals. Life requires us to ‘sell’ ourselves daily. Increasingly, the problem is being dealt with by trying to create physical ‘safe spaces’ – youth clubs, therapy rooms, mindfulness centres where individuals get a momentary reprieve from the permanent drama we are forced to act in. But inevitably, these safe spaces are always confined within four walls, we can talk freely, within them, never beyond them. It’s paradoxical, instead of promoting authentic vulnerability, it simply increases our awareness of how much it is lacking. Individuals cannot be compartmentalised. We can’t be vulnerable here but strong there, honest here, deceitful there. The cognitive dissonance it festers is unsustainable. One hour a week of therapy cannot substitute the loss of a supportive culture. We keep trying to find safe spaces in rooms, what if they could be in people? What if language and the culture it represents was so transformed, that we didn’t have to isolate/compartmentalise our authenticity. What if our individual commitment to using words more sensitively, more appropriately was enough to create a society in which mental health problems could be openly discussed, understood and supported.
To facilitate a lasting change in the meaning of our language we need to create spaces where these negative connotations are challenged, platforms which enable people to discredit the stereotypes, but to do so without great personal cost to themselves. We need to become safe spaces for one another, we must sensitively select the words we use and carefully decide how to use them. As the meaning within the words changes, we won’t need campaigns to strive for more open conversation, talking will be the natural human reaction to wanting to integrate all of ourselves, to live as one whole person, authentically showcasing all the wonderful and the difficult aspects of our lives and honouring that they co-exist.
Outside of ‘mental health awareness month’ it is hard to keep being honest and being authentic because the official timeframe for open conversation has ended. But this is when the conversation must continue. If we revert to silence, then nothing changes, words go back to their meanings, mental health problems are the slaves of stigma and cultural ignorance once more. But if we hold our words up – take those old labels, and decorate them with the beauty of our vulnerability, then slowly, we can revolt against the structures we have been confined to. Language shapes culture and culture shapes language. As we begin to use challenge the conventional understanding of our words, our understanding and acceptance of ourselves and one another will grow. When conversations are authentic, language reinvents itself and society itself becomes the flourishing safe space we are all in desperate need of.