May I Have An Exemption Please? 

What’s in a Term? Considering Language in Our Field
Do you ever think about what you say when someone asks you to describe
SAMHSA’s work or to describe our field? Do you ever use the words mental
health, addictions, substance abuse, prevention, behavioral health, or substance
use disorders? Were you ever asked to explain why you use the words you use to
describe our field or SAMHSA’s work? Since arriving at SAMHSA, I have
been asked to explain or stop using certain words. Obviously, people are
listening closely to find out SAMHSA’s priorities and how I will lead.
Below you’ll see some of the terms I’ve heard about so far. Do they sound familiar
to you?
What We agree On
One thing everyone agrees on, including me, is that nearly every term
we use is problematic. We need to find a way to talk about prevention, health,
disorders, disease, addiction, illness, and recovery so that we can address
the issues and not argue about what we mean. We definitely need to use “people
first” language regardless of how we describe people with symptoms, illnesses,
addictions, or diseases and how we label
their status. No! To clear the air, I have no favorite term or terms. At times in my professional life, I led the charge on “people first” language, and I worked with other advocates to change the words “patient” and “client” to “consumer” when that seemed cutting edge. I stood with individuals who wanted to be called addicts and with persons who just wanted to be called Joe or Jane. I worked with others to embrace the journey of recovery and the many individualized pathways that journey
takes. I argued against the notion that simple behavior change could solve all
this; that our field is the only place in which behavior out of the norm is what
leads to treatment and services more than an individual’s need. I also called
people on their inappropriate use of language such as referring to a policy as
“schizophrenic” or a person as a “lush.” And I will continue to do so.
What really Matters
I know language matters. However, what really matters is that we not get distracted, not fight among ourselves, and not make assumptions about motives or beliefs based on the current language we use. We need to engage in the discussion, but not write one another off when we do not agree. We need to ensure we are respectful of all people, whether they are pro-12 step, anti-psychiatry, service providers, or service recipients. It is what we have in common, not what we may disagree on, that makes us strong as a field. Let’s have a discussion about terms
we use. Let’s try to agree on terms we could use and terms we should absolutely
not let anyone get away with using about our field or the people we serve on their
road to recovery. We need to communicate well together and with others, so we need to understand together “what’s in a term.”
—Pamela S. Hyde, J.D.
Let’s talk . . . Send your comments Let’s have a discussion about the terms we use. Let’s try to agree on terms we could use and terms we should
absolutely not use. Your comments and suggestions are critical as we move this conversation forward. In addition, how can we engage others about this without being disrespectful or making assumptions about bad
intentions?
Send comments to dialogue@samhsa.hhs.gov. We will provide some feedback about what you think in a future edition of SAMHSA News. By communicating well together and with others, we will understand together “what’s in a term.”
Terms I’ve Heard about So Far
On Mental Health
The term “mental health” leaves out mental illness, and
we really need to focus on the latter.
“Mental illness” leaves out emotional well being and the
growing science of prevention.
“Mental health” leaves out substance abuse and/or
addictions while “behavioral health” misconstrues the
disease nature of mental illness and addictions.
On Behavioral Health
“Behavioral health” implies a chosen
behavior, easily stopped if a person
just had enough willpower.
“Behavioral health” focuses too much
on symptomological behaviors that
people cannot control.
“Behavioral health” is a term that
encompasses both substance abuse/
addiction and mental illness/health.
On Substance Use
“Substance use disorders” is too
strong and does not recognize
that a person can be abusing
substances long before he/she
can be characterized as having
a disorder.
“Substance abuse” is too soft and
does not recognize the nature of
substance use disorders or the
importance of prevention.
The medical model of “disease” is
not consistent with the experience
of people who believe they are
simply unique individuals labeled
for not conforming to this world’s
expectations.
On Recovery
“Recovery” is a term for substance abuse or addictions but is not well
defined for mental illnesses.
“Recovery” means abstinence (including prescription medications).
“Recovery” is a journey. Some can be on a path to recovery or in recovery
while using substances, taking medications, or experiencing symptoms
of mental illness such as hallucinations, flat affect, or flight of ideas.
On Individuals
The term “consumer” is demeaning or
does not work for the addictions world.
“Client” suggests a power/
subordinate relationship.
“Patient” is too medical.
“Survivor” is real and yet too political,
as if the system and treatment are