Should we be thinking about trauma-informed language?
This will be no surprise to folks who know me well, but I’ve been prompted to think about words during this morning’s sessions at the Trauma Matters TheMHS Summer Forum.
Naturally, this is something that we consumers/survivors often do. Language is the vehicle for creating meaning – and the loss of meaning is central to our experiences of madness. Language is also what’s used to give us labels that can change our lives, and words are used to breach our human rights. A word like ‘insight’ or ‘capacity’ can be devastating. Incidentally, some people are still stuck on the idea that a focus on language is just ‘political correctness’. Actually, it’s about not hurting people, which kind of matters in mental health.
So, what’s struck me this morning?
Objectification: I’m a person, not a case
An old ‘favourite’ popped up a number of times: ‘cases’. Not everyone is bothered by being referred to as a ‘case’ rather than as a ’person’, but many get the shudders every time we hear this one. I guess the word ‘case’ is a way to demonstrate clinical objectivity, however what this actually does is to make the people we work with feel less real, less human. How does this sit with Prof Helen Milroy’s reminder this morning, that what we actually need, in becoming trauma-informed, is to become more compassionate?
As a consumer/survivor, being called a ‘case’ certainly makes me feel objectified. This is a problem for trauma-informed practice because one of the impacts of many traumas is having had our humanity stripped away, being objectified into a thing that others can do with as they wish.
Power: Who wants to be managed?
There’s a rotten little word that often follows ‘case’, and also came up this morning: ‘manage’. We can have ‘case managers’ (apparently this means something different to staff who work at the airport loading suitcases).
I don’t know about you, but I’m pretty sure that most of us don’t want to be managed by health services and clinicians. Personally, I want to be supported. The idea of management is particularly problematic because key principles of trauma-informed practice include providing choice and enabling empowerment – whereas ‘management’ implies that one person has more power and authority other the other. While this is technically true in mental health services, it is the opposite of helpful from a trauma lens. Perhaps it’s time to shift towards language that reminds us of the need to be supporters, facilitators, collaborators…
Simplistic pathologising: Is ‘mental illness’ delusional?
I thought I’d go for a big one to close with. Prepare yourself: ‘mental illness’. Yes, I’m going there. Why not? For this brief moment I have the power of the keyboard, and apparently we all think empowerment is a great thing.
So, how much longer can we continue to speak about ‘mental illness’ while we increasingly understand that these experiences are almost always a consequence of trauma and/or life adversity? In all my years of working with other consumers/survivors, I have never once worked with someone whose madness didn’t make absolute sense in the context of their lives. If we’re serious about trauma-informed practice, I’d suggest that, sooner or later, we have to rethink whole paradigms like this.
As consumers/survivors, we often speak about the emotional damage of being told that our experiences are an illness. The problematic implication, for us is the message that the root of our distress and differences lies within ourselves, within our genes or some incomprehensible, vaguely articulated and poorly evidenced disease process. Worse, the concept of illness implies a physical, biochemical solution: like pills. While medication can be helpful for some people, in some situations, some of the time, I am not aware of anyone who has ever healed from trauma by popping pills. I am aware of many consumers/survivors who have experienced new and terrifying traumas from being forced to take pills they don’t want. Instead, we heal by understanding our emotions, finding empathy, connecting and belonging, unpacking our identity, and a whole lot more.
If we have to stay in this medicalised language space, at the very least it seems to me that ‘injury’ is a far more accurate description than ‘illness’. Trauma can cause terrible injuries, in many complex ways. Sometimes I like to play with the acronym of MESSI, partly because that’s a great description of my life and my madness. MESSI stands for ‘Mental, Emotional, Social & Spiritual Injury’. And this concept feels far more inclusive of trauma, and less damaging, and more open to many different kinds of healing responses. It’s not perfect though, but I guess it’s an invitation to think differently, and to work differently.
Whatever words we use, as we increasingly speak about trauma-informed practice, we need to be conscious that words are not neutral – they can hurt. We need to think about using words that promote the principles of trauma informed practice, words that embody respect, empowerment and healing.
