Language and terminology around mental health

In this article, Dr Roz Warden explores language and terminology around mental health.

She explains why the terms we use matter, and examines the underlying assumptions behind them. Preferred terminology can vary within different contexts. Although there isn’t always consensus about which terminology is most appropriate, it’s important to be aware of why particular terms may be preferrable in certain contexts.

Dr Warden completed her PhD at the Centre for the Study of Islam in the UK in 2013. Her research looked at experiences of social work and mental health among British Muslims, with a focus on faith-based mental health support. Since graduating, she has worked for a range of charities and currently works in research, policy and campaigns for a disability and mental health charity.

Mental health and mental health problems

There is growing awareness that mental health isn’t something that only certain groups of people in society have. Just as everybody has physical health, so too do we all have mental health.

The World Health Organisation (WHO, 2018) describes mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

In this definition, mental health is described as more than simply an absence of illness. Having good mental health is linked to an individual’s ability to function in various areas of their life.

The WHO definition also recognises that, just as with physical health, there are multiple factors (or ‘determinants’) that underpin a person’s mental health. These include biological, psychological, and social factors. This is often referred to as a ‘bio-psycho-social’ model of mental health.

It is also important to recognise that what constitutes good mental health can vary within different cultural contexts and according to different value systems. Furthermore, too much focus on defining good mental health as constituting positive feelings or in relation to an individual’s functionality may risk excluding certain groups, including those experiencing inequality or oppression, as well as potentially over-medicalising social injustices (Galderisi et al., 2015).

These complexities in terminology about mental health have related challenges in how we define and refer to mental distress. Terms such as ‘mental illness’ have been critiqued for focusing primarily on biomedical determinants of mental health. Alternative phrases include referring to mental health ‘challenges’, ‘issues’, or ‘problems’. Whilst less medically-orientated, some voices have cautioned against using the lens of ‘problems’ to define what they would see as alternative experiences of mental health (Beresford, 2009).

Authors on Islam and mental health have also commented that the language of ‘mental illness’ may be more associated with Westernised medical and professional contexts, with terms such as majnun (the Arabic term for madness) noted as having been more commonplace traditionally in Islamic societies (Ashencaen Crabtree et al., 2017).

What’s in a name?

We’ll now look at terminology relating to people with lived experience of mental health problems, including those who utilise mental health services. Professor Hugh McLaughlin (2009, p 13), a social work academic, talks about the importance of this terminology:

“The terms we use are not merely dictionary definitions but conjure up differing identities, implying different assumptions and identifying different power relationships”

McLaughlin (2009) highlights several terms which have been commonly used to refer to people accessing mental health services, including ‘patient’, ‘client’ and ‘service user.’ Thinking about the assumptions behind these terms, the term ‘patient’ in this context may be seen as being particularly associated with biomedical understandings of mental health (and is indeed more familiar in medical settings). The term ‘client’, once more common within social work, has been critiqued as is suggested to indicate primarily a ‘passive’ relationship between an individual and an experienced professional. The term ‘service user’ has become more commonly used in recent years. However, limitations have similarly been recognised in that it defines an individual solely through the lens of their interaction with professionals.

People with lived experience of mental health problems, and of using mental health services, have been active in contributing to these debates around terminology. One term which has been gaining wider recognition is ‘experts by experience.’ Whilst still defining people by one aspect of their lives, this term is suggested to address some of the power imbalances implicit in other terminology. It potentially gives more prominence to the expertise of individuals with lived experience, including experience of utilising mental health services.

Including Muslim voices

In a context in which there are a range of differing views about terminology, the importance of engaging with individuals about different preferences is one way of working towards greater inclusivity. This can be particularly pertinent given the stigma that can surround certain terminology around mental health or in contexts where there may not be straightforward translations of concepts from one language to another.

Co-production is an engagement approach gaining increasing momentum due to its focus on seeking to redress power imbalances between those providing or commissioning services and those utilising them.

Whilst there is a lack of consensus about appropriate terminology, including amongst people with lived experience of mental health challenges (Rose and Beresford 2009), being aware of some of the associations behind certain terms, alongside an openness towards different preferences, is important to consider in working sensitively with a range of groups.

In this activity you have gained an understanding of the meaning behind key concepts in the field of Muslim mental health, and holistic understandings of the causes of mental health problems. You have been introduced to the idea that language and terminology in the field of mental health is not uniform and can vary across different professionals and disciplines. We now move on to Activity 3, where you will become familiar with core Islamic beliefs and practices, the Muslim worldview and sources of authority in Muslim communities. In the next step, Maulana Dr Mansur Ali presents an overview of core Islamic beliefs and values.

Over to you

It is likely that you will have come across some of the terminology mentioned above previously. What terms do you prefer, and why?