The language used in mental health systems is highly contested. People justly fight over whether to be labelled terms such as patients, consumers, survivors, or just as people. Likewise, clinicians and managers are careful in the words they choose so the documents, promotional materials and interactions with patients give a false and thin façade of compassion.

Language is highly contested in many politicised spaces such as health care and in mental health particularly, there have been valiant efforts to transform how we talk about mental illness and recovery. Changes in language can lead to change in practice or can merely constitute lip service. There are language guides now that are useful for reducing clinician reliance on stigmatising and harsh descriptions of symptoms and behaviours. Two column tables compare the old terms with terms that should be used in their place. The change in language may lead positive changes in practice or may just be a new shorthand masking the ways of old.

Clinical terms and many rules of the modern asylum are deliberately punitive or have the unintended impact of being weapons of hurt to patients and carers. Labelling patients as ‘manipulative’, ‘dependent’, ‘treatment resistant’, ‘intrusive’ or ‘isolative’ are cruel labels for patients observed in a challenging and artificial ward environment. The terms form patterns of discursive violence that have been enshrined in the clinical disciplines and legitimised through patient clinical notes. Discursive violence such as this intimidating and insulting language about patients as harmful written and verbal discourse that has been called out by groups within mental health consumer and recovery movements but still persist.

Recovery-oriented language has in a handful of settings succeeded in encouraging or mandating the replacement of inappropriate language with language of acceptance, hope, respect and uniqueness. This change in language is powerful even if it lacks substance. Still, sometimes clinicians use these new phrases as euphemisms and when they read or write these terms, perhaps they mentally translate these phrases back to what they really mean within the old paradigms.

The term ‘trauma-informed care’ has also been perversely co-opted. Intended to minimise or manage the traumatisation of patients, trauma-informed care is more often a meaningless buzzword. On some occasions, trauma-informed care masks highly coercive and traumatising practices. Next time you see the term ‘trauma-informed’, ask about involuntary treatment, seclusion, restraint or substituted decision-making. You will likely find that most hospitals and mental health services are more trauma-inducing than they are trauma-informed. Trauma-informed, recovery-oriented practice are too often a public façade slapped onto posters and public documents but are rarely backed up by effective practices that reduce traumatisation or foster recovery.

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