“Mentally injured” vs. “mentally ill”: On changing attitudes, removing stigmas

As I will demonstrate below, I make no claim to limiting myself to politically correct terminology. However, here’s an important memo to self: Whenever applicable, use the term “mental injury” instead of “mental illness.”

During the past decade, my work in the realm of workplace bullying has provided an education in psychology and psychiatry. This has included plenty of hanging around those who study, diagnose, and heal the damage caused by psychological abuse at work. It has had a transformative effect on how I look at the law and public policy.

But my informal course of study has been far from thorough or systematic, and consequently I’m still learning the vocabulary. And oftentimes I use the term mental illness when mental injury strikes me as being much more appropriate.

Illness vs. injury

When someone is wounded by a gunshot, do we say they are “ill”? No, we say they are injured.

But what happens when, say, someone experiences violence or bullying at work so terrible that they develop Post-Traumatic Stress Disorder? Well…we’re more apt to say they’re suffering from a mental illness or disorder.

And yet, haven’t they, too, suffered an injury, a psychological trauma? So why do we use terms that unnecessarily stigmatize the person who suffers that injury?

What’s “abnormal” psychology?

While I’m at it, I also find myself questioning the term “abnormal psychology.” Writer and educator Kendra Cherry defines the term this way:

Abnormal psychology is a branch of psychology that deals with psychopathology and abnormal behavior. The term covers a broad range of disorders, from depression to obsession-compulsion to sexual deviation and many more. Counselors, clinical psychologists and psychotherapists often work directly in this field.

Here again, a similar point: So many conditions labeled “abnormal” — such as depression triggered by situations in one’s life — strike me as being natural responses to difficult experiences and setbacks. (And on the extreme end, there’s nothing abnormal about suffering PTSD after doing two tours of duty in Iraq.)

Unnecessarily stigmatizing terms

Over the past decade, some of the most insightful and empathetic people I’ve met include those who have suffered from depression, PTSD, and other conditions triggered or exacerbated by horrible experiences at work.

By contrast — with apologies for my lack of precise terminology  — some of the most screwed up, uptight people I’ve ever met would likely get clean bills of health from therapists or psychiatrists.

Terms like “mental illness” and “abnormal” scare people. They create in our minds a fearful Other. My friends holding doctorates in psychology may have plenty of good reasons to tell me I’m wrong, but I’d really like us to think about how we use these labels.

8 responses

  1. David this is a pet hate of mine the fact that many with PTSD are termed psychologically and or mentally ” ill”. You are absolutely correct in all you have written here. In Australia people with PTSD are INJURED ! They do not have any pre-existing psychopathology ( organic) or psychological pathology illness prior to this “injury”caused by “sever trauma”. I am pleased you have highlighted this. It is, normal, after suffering severe trauma. The psychologist etc know this here in Australia and we are not labelled or diagnosed ill, but injured. Once this is cleared up, better understood, defined and through education, hopefully people will be more aware, the stigma will dissipate and more will seek help. Thank you.

  2. I agree. Someone who has suffered oppressive tactics from their coworkers is not ill, he’s injured. Illness happens when our body gets sick due to some exposure to viruses or any other form if disease. Injury happen when our body/mind is inflicted with some sort of trauma. Workplace Bullying is designed to inflict trauma in the designated target or targets.

  3. There is always a complex interplay of factors when we are dealing with human beings. In distinguishing illness from injury, I find it useful to consider the cause(s) of symptoms….are they internal (genetic, for instance) or external (induced by circumstance or environment)? Few situations are clearly absolutely one or the other, but where external forces are at play (as they are in bullying), one can reasonably assume some causality. A diabetic may have marginal pancreatic function, but expression of symptoms can be manipulated by diet and exercise. An individual may have adequate coping skills under normal circumstances, but all of us will be overcome at some point if subjected to increasing levels of stress!

  4. I think you’re right on target with that difference in language. Many examples of what we now term “mental illness” are probably much more accurately termed “injury.” They’re the result or response to injury of some sort, natural responses to unnatural occurrences.

    I don’t think your friends in the biz of mental health are trying to be obstinate; they’re reflecting the frame through which they view the world. They simply can’t see that the frame itself (a frame they worked hard to fit through) has its own problems and drawbacks. I wonder how we might convince them that acknowledging these drawbacks (a) ultimately provides MORE help to the same clients they work so hard to help and (b) does not undermine their huge efforts to achieve those terminal degrees.

  5. Great BLOG, Mr.Y. Fact is, the connotation of the words indeed are negative among both the general society, and, unfortunately, a great percentage of the medical community as well in this day in age.

    That which is not seen to the nakid eye is still obscure and still questioned, or, negated entirely. Unless one has, for example, a clogged artery, visualized via various means of medical diagnostics.

    We have, indeed come far both in the medical community and society of our acknowledgement, diagnosis and treatment of mental health issues but unfortunately, still have a long ways to go in terms of the stigmatization.

    The human body is a complex entity. Spirit and soul is a huge portion of said entity.

    I foresee the change in greater acceptance and with less negative perspectives to be a long time in coming.

  6. I’m realizing slowly how deep these mental wounds are — I wouldn’t want to compare my experience with a soldier in Iraq or Afghanistan in terms of severity, but I think it is the same basic thing. Words of derision and disrespect are insidiously hurtful and injurious. And it’s amazing that after all I and others have experienced in the workplace, we are the ones still stigmatized as “crazy” which is like pouring salt into a open wound. I will never stop hoping that basic human dignity and respect will prevail on all fronts, but some would say that is “pie-in-the-sky” Recharacterizing the emotional response to workplace bullying as mental injury is a significant step toward acknowledging that it is real, hurtful, and a problem that needs to be addressed instead of ignored or swept under the carpet.

  7. I agree with you that the term “maladaptive” often seems misplaced. Evolution and the survival of the fittest suggest that most such adaptations’ benefits surpassed their costs, at least during much of humanity’s reign. What baffles me is our penchant for characterizing most brain “abnormalities” as “mental” illness, disorders, or injuries. They all spring from electrochemical realities — whether or not we’ve devised halfway-decent ways to map each change, to assess its impact on other physiological systems, or to gauge its action, incidence and scope. Neuroplasticity, for instance, is a fact, as is traumatic amnesia or the Stockholm Syndrome. We know that imagination can foster or abet all manner of outcomes; and that multiple recollections of a particular memory speed its erasure. A protracted case of anorexia nervosa may literally shrink a brain 15%, just as it predisposes one to suicide, often by violent means. Why claim such developments are not physiological — as compared, say, to swelling from encephalitis? Such labels perpetuate social strife, be it in the home or workplace, or elsewhere. Why not admit that conditions above the neck are as corporeal as those below? Justice demands that we bring parity to bear: head to toe.

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