Sunday 23 March 2014

Fighting slurs on mental illness

Derogatory language referring to mental illness and intellectual disabilities abounds. It hurts mental health patients. Let’s stop such usage.
By Chong Siow Ann, Published The Straits Times, 22 Mar 2014

RECENTLY I came across a radio documentary called The Rhetoric Of Cancer which was broadcast on the BBC World Service. The presenter, Andrew Graystone, was a cancer survivor. He observed that the “language of warfare has dominated cancer discourse” and that “today it’s commonplace to speak about battling cancer, fighting cancer, even kicking cancer”.

Such language is disconcerting to Mr Graystone – partly because, as he ruefully commented, he is “not really the fighting kind” and partly because there wasn’t much that he could do to fight his cancer. “Like most cancers, mine was out of reach. I couldn’t see it or touch it. I couldn’t operate on myself or prescribe medication. My chief aim was to live well with cancer, and then hopefully to live well without it.”

The language of disability

I’M NOT sure if any of my patients feel the same way about their mental illness. But I now suspect that some do, and are too polite to point out the unhelpfulness of my occasional pep talks, laced as they often are, with battlefield metaphors.

The use of such militant language, while common in medical fields like cancer and infectious diseases, is actually rather uncommon when people talk about mental illness and intellectual disabilities. Here, the language is usually much more negative and disparaging.

Derogatory language referring to mental illness and intellectual disabilities abound in everyday conversation, print, broadcast, social media, movies and other popular entertainment.

Take for example what researchers in Britain found when they asked a large sample of 14-year-old school students for words or terms that they would use to describe someone with mental health problems or illness. Of the 44 words that were most frequently occurring, three quarters were strongly negative – words like psycho, spastic, crazy, mental, weird, loony, and mad.

They are even used by people who ought to know better. Some time last year, French politician Pierre Lellouche described the British Prime Minister’s plans for the European Union as “autistic”; while an article in an august British broadsheet described Britain’s attitude to politicians’ wives as “schizophrenic”.

Following the last of the US presidential debates in 2012, a political commentator referred to President Barack Obama as a “retard” in her tweet.

The careless and cavalier use of psychiatric nomenclature is not just inaccurate. It obfuscates the understanding of mental illness.

Slurs also both offend and reduce people with mental and intellectual disabilities to stereotypes, and into objects of ridicule and derision.

Most people who use such language might protest that it is merely a means of referring to behaviour that is bizarre or out of character. There is no intention, they may argue, to refer specifically to those with mental illness or intellectual disabilities. They might even throw their hands up and moan about the excesses of political correctness.

Such terms, however, are profoundly hurtful to people who have to live with these problems.

Given the pervasiveness of mental illnesses – an estimated one in four in the general population has some sort of mental illness – it is also likely that those who misuse psychiatric nomenclature are offending people that they know.

Loneliness and exclusion

LURKING behind such language is a certain attitude, prejudice or ignorance. Its use stigmatises people with mental and intellectual disabilities.

And there is a more serious consequence. It excludes people with disabilities from the opportunities and activities that most other people take for granted. These include studies, employment, career advancement, friendships, romantic relationships, and even medical and psychiatric treatment.

A nationwide survey called Mind Matters was launched last month to gauge people’s beliefs and attitudes that will aid recognition, management and prevention of mental illness in Singapore.

“The hardest thing about having an intellectual disability is the loneliness,” writes John Franklin Stephens, a Special Olympics athlete with Down’s syndrome in the Denver Post. “I can only tell you what it means to me and people like me when we hear it (he was referring to the word “retard”). It means that the rest of you are excluding us from your group. We are something that is not like you and something that none of you would ever want to be. We are something outside the ‘in’ group. We are someone that is not your kind.”

This exclusion can start early in life. A survey of 546 teaching staff in Britain found that 88 per cent of teachers and 96 per cent of teaching assistants had heard students using phrases which stigmatise people’s mental health problem. Research shows that 20 per cent of children have a mental health problem in any given year. The common use of these negative terms, which may also be accompanied by explicitly expressed negative emotions and behaviour, is hardly going to leave a mentally unwell young person unscathed.

Children with autism as well as those with attention deficit hyperactivity disorder (ADHD) are far more likely to be bullied (subject to teasing, name-calling and even assault) in school. It is, therefore, not surprising that young people are far more unwilling to seek help when mentally unwell so as not to draw more attention to themselves.

Many would rather try to cope on their own, sometimes with dire and tragic consequences.

There are a number of sources from which children pick up such language. One unlikely source is the seemingly innocuous children’s television shows. One British study found that out of a sample of a week’s children’s television, 59 out of 128 programmes contained one or more references to mental illness.

Children’s programmes in the United States and New Zealand also reportedly include a high rate of negative references to mental illness. “If thought corrupts language, language can also corrupt thought,” wrote George Orwell. “A bad usage can spread by tradition and imitation, even among people who should and do know better.”

As mature adults and parents, we ought to know better and do better. We ought not to tolerate the use of such language in the same way as we do not put up with any language that is offensive to another’s race, religion, gender or age.

It is all part of that difficult enterprise of raising children. Among the things to be nurtured in them are the things enumerated by the 19th century American novelist Henry James: “Three things in human life are important. The first is to be kind. The second is to be kind. The third is to be kind.”

The writer is the vice-chairman, Medical Board (Research), of the Institute of Mental Health.

Use words with care

I THANK Associate Professor Chong Siow Ann for his illuminating take on the insidious, yet pervasive, use of language carrying negative connotations against mental illness ("Fighting slurs on mental illness"; last Saturday).

The misuse of professional psychiatric terms in everyday conversations trivialises serious conditions and creates stigma against the mentally or intellectually disabled.

As easy as it is to be careless with our words, few realise what a great disservice we end up doing to those suffering from mental illnesses.

The same also applies to terms associated with physical disabilities. It is common to hear people casually describing themselves or, worse, others as "blind" or "dumb", or use the terms as a means to criticise.

It may not be immediately obvious to some, but in doing so, we impinge on the dignity of those who live bravely with these conditions.

My valued colleague was afflicted with polio when she was 10 months old. Today, she can walk only with the aid of callipers and crutches. But she is anything but "crippled". She lives alone, does everything herself, and drives around in her specially equipped vehicle. She is, in fact, more "abled" in the way she lives with her physical challenges than many able-bodied people I know.

Such people are an inspiration and it is not kind to use words that derogate their worth and significance.

Language is a powerful communication tool and the ways we choose to use it play a significant part in determining its effects, positive or negative, intended or otherwise. To avoid the harmful repercussions, mutual respect should be a larger consideration in the way we communicate with one another. What it will take is a little more thoughtfulness and empathy.

Before we toss around loaded words in our everyday conversation, whether in person or online, it is imperative to consider if these are words to be used with sensitivity and within the correct context. This way, we can better avoid hurting feelings and perpetuating unhelpful stereotypes due to little else but our own negligence.

William Wan (Dr)
General Secretary
Singapore Kindness Movement
ST Forum, 28 Mar 2014

'Positive' words paint unrealistic picture of disabled community

THE Disabled People's Association agrees with Dr William Wan in asking for greater sensitivity ("Use words with care"; last Friday). Words can not only hurt but also shape mindsets and perpetuate stereotypes.

We should also be aware of the downsides of using words and phrases like "brave", "inspiration", "extraordinary", "overcoming one's disability" and other supposedly positive terms to describe people with disabilities.

Such sentiments are usually expressed by the non-disabled.

Do people with disabilities really regard themselves as courageous, inspiring, or examples for others to emulate? Is it possible that many of them reject such labels and perceptions as patronising?

Most persons with disabilities see themselves as ordinary people leading ordinary lives. They do not feel they are "suffering from" their disabilities; these are simply a natural part of them, much like their ethnicity, blood type and eye colour. Nor do they think they are doing anything out of the norm.

Contrary to popular belief, a blind person or wheelchair user does not live his life "bravely"; a deaf person - like me - does not "overcome" communication barriers even if he does well at work; an academically successful student with autism is not more deserving of being hailed as a role model than a non-disabled student who does equally well.

Such accolades, though well-intended, reinforce the idea that persons with disabilities are overachievers who defy great odds to succeed in life. This is certainly a heartwarming notion, but it also paints a misleading view of the situation.

The disabled community, as a whole, is held back by mainstream society because of physical, institutional and attitudinal barriers around them.

What persons with disabilities want, and need, is not to be discriminated against because of their disabilities, but to have equal rights and fair treatment in all aspects of life.

These, and a realistic picture of the community, would help more to improve their lives.

Alvan Yap
Advocacy Executive
Disabled People's Association
ST Forum, 1 Apr 2014

Nothing wrong with celebrating extra effort in overcoming obstacles

I DISAGREE with Disabled People's Association advocacy executive Alvan Yap's assertions ("'Positive' words paint unrealistic picture of disabled community"; April 1).

It is indeed commendable for people with disabilities to overcome their difficulties. Accolades for such extraordinary efforts do not, in any way, detract from societal efforts to assist people with disabilities.

I am not sure what is Mr Yap's idea of "equal rights and fair treatment" for people with disabilities.

If people with disabilities can perform better or as well as able-bodied people in certain jobs, but are discriminated against purely because of their disabilities, then they have not been accorded equal rights and fair treatment.

However, if there are special requirements associated with the position - for example, the need to demonstrate the use of equipment - that make it unsuitable for people with disabilities, and the company is unable to make special provisions, it would not be considered discrimination.

In general, mainstream Singapore society does not discriminate against people with disabilities.

In fact, it can be said that Singapore has been gracious in going the extra mile to "level up" people with disabilities.

Whether we are able-bodied or disabled, we will face all sorts of "roadblocks" in the course of our lives. There is nothing wrong with celebrating and acknowledging the extra effort made in overcoming these obstacles. We should be gracious in acknowledging accolades.

Colin Loh
ST Forum, 9 Apr 2014

Don't be oversensitive to labels

DISABLED People's Association advocacy executive Alvan Yap asked if many of the people with disabilities would reject labels such as "brave", "inspiration" and "extraordinary", perceiving such terms as patronising to them ("'Positive' words paint unrealistic picture of disabled community"; April 1).

I had a serious stroke almost four years ago but have since regained 90 to 95 per cent of my previous abilities through sheer determination and hard work. I guess that qualifies me as a person who is disabled.

Let me say that I do not mind hearing those words, then or now. In fact, it will further encourage me to try and regain the remaining 5 to 10 per cent of my abilities.

Whether I see myself as courageous, inspiring or an example for others to emulate is not important. What is important is that others are appreciative of the effort that I have put in, and I am gracious enough to accept their appreciation.

This is similar to giving simple but multiple recognition to those who have done their jobs well.

In the past, there were some who said that giving too much recognition might numb the people who receive it, such that they become indifferent to it.

However, after working for so many years, I had not heard of anyone who was sick of getting too much recognition.

One should not be oversensitive to good or bad remarks or labels. Think positively. Give the benefit of the doubt to others, at least for the first two times to each of them.

Steven Lee Thien Poh
ST Forum, 9 Apr 2014

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