Guest Post: The Language Problem in Mental Illness: A Threat to Progress, Compassion, and Understanding

“Of course everyone has challenges in life, but not everyone has a mental illness. That shit is hard.”

I wish I could remember the name (or at least user name) of the wise soul who fired that rebuttal into the Twitterverse in response to one of the many attempts that I’ve witnessed to downplay, oversimplify, or even reframe another person’s lived experience with mental illness. Mental illness is different for everybody, but what I like to call “the language problem” makes is very difficult to move past, what I thought, was this fairly self-evident and uncontroversial statement.

Let me explain.

The language problem in mental illness is very much an extension of humans’ imprecise use of language in general. Definitions and intent are necessary to construct meaning; otherwise, communication between becomes challenging, if not downright impossible. This problem is compounded when discussing mental illness, because it is hard to find another illness where this problem is encountered. Even in this introduction, when I describe mental illness as an illness, there will be people who challenge it. Indeed, a person can have poor mental health and not have a mental illness, but what delineates the two? Is it symptom duration? Quantity? Severity? The presence or absence of a formal diagnosis? The person’s choice (or lack thereof) to identify with the mental health community? The four quadrant model of mental health is based on this very distinction.

I define the language problem, at its base, as the ability for two people, both describing a poor mental health experience, to use the same words and terms, diagnostic or otherwise, and have remarkably different experiences – and both be right. Using DSM-IV-TRcriteria for Major Depressive Disorder, for example, Zimmerman et al. (2015) showed that there are 227 possible ways to meet the symptom criteria for diagnosis – though only170 combinations occurred in practice.[1]I am not a diagnostician, and do not believe that the DSM is the only way to categorize mental disorders; but using this one example, how close are we to describing depression, let alone understanding, adequately treating, or curing it, if you can be diagnosed with it in 170 (227) different ways? (As an aside, I suspect the wide variation in antidepressant treatment response rate stems from the equally wide variation in symptoms subsumed under the overarching construct of ‘depression,’ but I digress.)

I’ve always admired the work of Therese Borchard, and in one of my favourite pieces on the subject, she  writes: “I wish people knew that depression doesn’t happen in a vacuum and is part of an intricate web of biological systems (nervous, digestive, endocrine, respiratory), that depression is about the gut as well as the brain, the thyroid and the nerves, that we would have better health in this country if we approached depression with a holistic view.”[2]

Stated another way, your depression is not my depression. Similarly, your anxiety is not my anxiety. Your schizophrenia is not my schizophrenia. There was a time when all mental illness was classified as either “hysteria” or “melancholy.” At least we’ve added a few more terms to our vernacular since 6500 BC. At least we’ve become a little more precise.

The brain is the most complex organ in the human body; theoretical physicist Michio Kaku even called it “the most complicated object in the known universe.” In 2019, we all have to get along with the language we have, until something more precise comes along to aid in our understanding and treatment. In the mean time, be compassionate, and seek understanding. Progress will follow. It’s already happening.

And just remember: everyone has challenges, but not everyone has a mental illness. That shit is hard.



Derek Chechak (August 2019)

Dr. Derek Chechak is a manager employed with the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, and a sessional instructor with the School of Social Work at Memorial University in St. John’s, Newfoundland. He is a Registered Social Worker, having earned his BA in Psychology (2008), Bachelor of Social Work (Honors; 2008), and Master of Social Work (2009) degrees from King’s University College at Western University, and his PhD in Social Work (2015) from Memorial University.

Dr. Chechak`s experience includes over ten years of experience in community-based health care, specialized mental health care including forensic social work and assertive community treatment, work in the developmental services sector, and a clinical leadership role for an employee assistance provider. He is a published peer-reviewed author in the areas of workplace violence, workplace wellness, workplace health services, social work value conflicts, alcohol regulation, and mental health case management.

Dr. Chechak is also the sole proprietor of #FixWorkFirst, a consulting service that helps employers foster workplace wellness using a comprehensive foundation based on workplace health assessments, a multifaceted approach to addressing areas of concern, and a focus on psychological health and safety.

He is also a person with lived mental health experience, who openly shares his experiences living with treatment-resistant depression and chronic anxiety since 2006.

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