Jul 28, 2016

mental health

From Cllr James Baker's website
Want to bring out the pedant in me? Invite me to help fight the stigma attached to mental health. Then watch me shout: "There is no stigma attached to mental health! There is a stigma attached to mental illness!"

I have these little shoutings fairly regularly these days--because I live in England, the home of mental health stigma.

From the Corpus of Global Web-Based English (GloWBE):

It doesn't matter which preposition you use, if it's a stigma and there's mental health nearby, it's probably British:

Yes, yes, some of those mental healths will have nouns after them like problems or professionals, but in BrE, most of them don't. For instance, for the 12 British stigma around mental health examples, only two follow up with problems or issues. For the others, it is just mental health that carries the stigma:

Now, when people ask me to give money for cancer or child abuse, I object that I don't want cancer or child abuse to have my money. Simple pedantry for pedantry's sake, because I'm 100% confident that the people collecting money really mean that it's money to fight cancer or child abuse. And so I thought it was with the British and mental health--they're saying it that way, but they obviously mean 'the stigma about not having mental health' rather than 'the stigma about mental health'. But it's phrased so often in this way in BrE that I wonder: maybe they didn't obviously mean that. Maybe there is a stigma about mental health. There seems to be a stigma about talking about one's own mental health, and there is (relative to American sensibilities) a stigma against pursuing mental health (e.g. seeing a therapist).

I'm being a bit facetious here, but the phrasing does go with the stereotype of the British stiff upper lip. A stigma about admitting to any mental state at all...

When I looked into mental health and mental illness a bit more, I was surprised to find that the number of mentions of mental illness were about even in BrE and AmE (in GloWBE still). But the British mention mental health much more:

Why? A clue is in the number of nouns that follow mental health. The green parts in these tables are the phrases that are statistically much more American (left) or much more British (right):

Many of the BrE ones have to do with how the National Health Service is structured, but also you can see here ways of not saying mental illness: mental health problem(s), mental health difficulties, and even mental health illness(es). AmE has some odd ones (from a pedantic point of view too): mental health symptoms (do we ever talk about symptoms of physical health? No. Illnesses have symptoms, not health) and mental health benefits (if the meaning of benefits here is the same as in disability benefits, then it's a benefit for not being healthy).  (Note stigma shows up again in the BrE list.)


  1. In defence of us Brits, we don't like tospeak of mental illness. It's a sort of euphemism to speak of mental health instead.

    I think there's some grammar involved as well. Illness is generally used an a COUNT noun: an illness, several illnesses. The abstract expression is ill health. Few of us could name a range of mental illnesses with any confidence. There's still a general sense that schizophrenia means 'split personality'. And we're not sure whether depression counts as an illness or not. And personality disorders don't seem to be illnesses, although they do seem like instances of ill health. Most of the terms that I'm familiar with probably denote symptoms rather than illnesses

  2. Besides, we speak of and revere our National Health Service, although it is designed to address our illnesses.

  3. I think a lot of it has to do with 'political correctness" and trying to avoid words that could be seen as negative. It doesn't seem appropriate anymore to describe someone as 'mentally ill' or even as having a "mental illness". Often you hear health professionals merely say "Mr Smith is mental health", which sounds nonsensical but the meaning is clear.

    Off topic, but it's a big no-no in BrE/Britain to say 'handicapped' - we say 'disabled', yet there does not seem to be an issue with 'handicapped' in AmE/America. Even the word 'disabled' is sometimes skirted around in Britain too.

  4. I'm so tempted to say "how neurotypical to say mental health is not stigmatic!" but I would just be teasing.

    I do understand what you're saying when I stop and read the phrase slowly, covering the words so I read them one at a time but if I read the whole phrase at normal reading speed I'm thoroughly culturalised to read "mental health" and understand "mental health problems" so it does make sense to me and doesn't ring my pedantry bells. I suspect this is similar to what David Crosbie is pointing out.

    On a side note, when do these phrases start appearing. I have a memory of it from late childhood/early adolescence so maybe 1980 where mental health professional and so on became the new terminology in the last round of attempting to destigmatise mental health problems. However, that might be memory being bad and/or increasing maturity and coming to use the correct terms instead of some of the crueller and immature language children use. But I remember "the funny farm" and "the looney bin" and so on from childhood and I guess formally "the lunatic asylum" which has certainly disappeared from formal use.

  5. That's "... when do these phrases start appearing?" Sorry, late night and hurrying before I start work.

  6. Euphemism as a defen{c/s}e is humorous in its own way, since Americans get hell from British folk for euphemi{s/z}ing too much. :)

    I think Eloise is right about'programmed to think of mental health in terms of problems' (paraphrase), but what seems to be the case is that that's a more British thing to do.

    For other disabilities, there are other some other posts. I'll add the 'disability' tag to the bottom of this post so that they're easy to click over to.

  7. Interestingly, unlike Eloise I [BrE, mid-50s, not a health worker] do not really read "mental health problems" when I see "mental health" (although I recognise that that is sometimes what the writer meant). I interpret "stigma of mental health" almost literally: as "stigma around mental health or otherwise". In other words, I see the problem the campaign is addressing as not mental illness (there are other campaigns or charities to address that) but the fact that we don't discuss our own or others mental health (even though we often discuss our own or others physical health).

    It is only this article that has introduced me to the possibility that I am misunderstanding the intention of the speaker who really is collecting money to fight mental illness, not society's unwillingness to discuss it!

  8. Thanks, Graham. That goes along with what I semi-tongue-in-cheek proposed in the post. I think Eloise is in North America, so my going along with her is probably two North Americans trying to make sense of something foreign. Your reading gives me more confidence that I might have been right in the first place (though I wasn't willing to state that interpretation too forcefully).

  9. P.S. (Offtopic) I strongly suspect that my use of others without an apostrophe above is regarded as an error. My defence is that in my mental grammatical model, others (in this usage) is a possessive pronoun like his, hers and its. I acknowledge that that is probably not standard English and can only apologise for any interruption to your reading flow caused by my failing. I do wonder, though, if I am unique in this usage.

  10. No, I'm British, Welsh to be precise, although I've lived in the North of England all my adult life. I'm just young enough to not quite count as "mid 50's" but I'm of an age with Graham.

  11. Lynne, euphemism deserved a bit of teasing if it's just to save the embarrassment of the speaker . It's a bit more serious and defensible when the speaker is worried about the embarrassment of the hearer or reader.

    If I wanted to express the concepts of mental illness or mental illnesses to an unknown audience or readership, I would prefer to write/say psychiatric disorder or psychiatric disorders.

    I actually like that use of mental heallth as a PREMODIFIER. As a hearer/reader I automatically translate it as psychiatric. It took me a while to see what you found strange in mental health illness.

    Health is like temperature — only the other way round.

    Temperature is essentially a scale, but the word can be used to denote a state.
    e.g. She's got a temperature

    Health s essentially a state, but the word can be used to denote a scale.
    e.g. How's your health?, health matters, the National health Service, a health check ...

  12. Eloise

    But I remember "the funny farm" and "the looney bin" and so on from childhood and I guess formally "the lunatic asylum" which has certainly disappeared from formal use.

    Those places were often called mental hospitals, so the terms is unacceptable for modern psychiatric facilities. As substitutes psychiatric hospital, psychiatric clinic, psychiatric services etc can sound forbiddingly technical. I'm not sure I've heard mental health hospital but all the other sound better as mental health clinic, mental health services etc.

  13. Sorry for the mis-identification, Eloise!

  14. If I (AmE) heard "Mr Smith is mental health," the meaning would be anything but clear. I would think it was a garbled version, perhaps, of "Mr. Smith is mentally healthy." But when I was young (about 40 years ago) I would hear "mental" used as short for "mentally ill." "Mr. Smith is mental" would have meant he is mentally ill. I haven't heard that construction in a long time, though.

  15. Benefits and coverage being American is, as usual, a little point of difference having nothing to do with linguistics and everything to do with insurance. I think it's less about "benefits for being mentally unhealthy" and more just like "dental benefit"/"eye care benefit" -- i.e. things that insurance may or may not cover, and they're telling you whether the plan does anything in those areas, without making a distinction between illness, preventative treatment, etc.

    Whereas "disability benefits" really does mean things you get only if disabled.

  16. Steve Dunham, 'mental' as slang for someone having (or stereotypically acting as if they had) a mental illness or disability was part of the playground vernacular in my BrE (northern England) childhood in the 1970s. I think it's still around, but only in very informal contexts and probably not acceptable in polite society.

  17. @ellarien: That use of 'mental' was common when I was young (southern England, 60s) but it had a more general meaning. Anything stupid or silly could be mental -- a movie, for example, or a plan.

    My own folk etymology is that it came from mental hospital (there happened to be one not too far from where I grew up). What kind of people go to a mental hospital? People who are mental, of course.

    I hadn't heard the word at all in the US until Mike Myers made it a habit with one of his characters (Ed Grimley?) on Saturday Night Live. Myers is Canadian with (I think) a British father.

  18. Antimony: you're right about the benefits. I'm out of the habit of thinking about them! Have struck through the offending line in the post.

    'Mental' meaning 'mentally ill' is indeed probably BrE to start with. The OED's first example is:

    1927 D. L. Sayers Unnatural Death iv. 41, I gather she was a little queer towards the end—a bit mental, I think you people [sc. nurses] call it?

  19. Off on a tangent, but there's a word in a window on my high street that's seems to mean the opposite of what it says, like the phrase ‘mental health’.

    A local hairdresser’s has a sign saying ‘Unisex’ but it caters for both men and women. The prices are different, so they can't claim that is why it says 'uni'. Do you think it should say ‘Bisexual’?

  20. So, help this AmE reader. Does "Mr Smith is mental health" mean Mr. Smith has a mental illness, or that he is mentally healthy, ie, perhaps that he "is [the very picture of] mental health"? I would definitely lean toward the latter interpretation without the benefit of this post, but it sounds like I would be wrong! David L is right that Mike Myers used "mental" on SNL, but it was as Wayne from Wayne's World. Ed Grimley was played by Martin Short.

  21. Giddy, to me it means Mr Smith works in mental health, say in a hospital. Mr Smith is mental health, Ms Jones is urology and Dr Singh is Ears, Nose and Throat.

  22. Giddy, when I wrote "Mr Smith is mental health" I meant "Mr Smith has mental health problems" or "Mr Smith has a mental health condition".

    However, Paul's interpretation would also be correct, depending on the context.

    I've worked with the health service and if I heard someone referring to a colleague by saying "Mr Smith is mental health" the meaning would be apparent - he is a mental health worker/professional - but it would possibly invite the joke "I thought so. He seems to have a few issues".

  23. No problem Lynne. You could have said something really bad, like saying I was English after all! :)

  24. Giddy, like so many things I would take it on context. If Mr. Smith appeared to be a patient, which is how I took it, then he's a patient in that area i.e. 'he's got a mental health condition', just like Mr. Smith is cardiology would be 'he's got a heart condition' and so on.

    If it was a meeting of health care professionals and Mr. Smith was a senior nurse perhaps or a clinical psychologist (otherwise it would be Dr. Smith as psychiatrist) I'd assume he was the representative from that clinical specialisation.

    It's like a common usage of tea that Lynne's somehow missed in her blog. If I'm chatting transatlantically in a text chat and say "I'm going to make tea" people who know me well now understand that means what they think of as dinner because I don't bother to tell them I'm going to make a cuppa. But until they're used to me, it causes confusion. With a Brit, face to face or in IMs not so much. The fact they know the word can have two meanings and are in the same time zone doubtless helps but the context cues work better too.

  25. Eloise: Is that revenge for calling you 'North American'? "somehow missed in her blog"?

    I quote me:

    " They [British people] say things like I have to get home and make the children's tea, by which they mean their evening meal. In my experience, tea, when referring to a meal, is used by my friends mostly to refer to simple meals they make for their children or themselves in the early evening; a dinner party, for example, would not be referred to as tea. "



  26. I had a relative who required several stays in mental hospitals. We referred to her visits as "going to the spa".

  27. I wouldn't stoop so low!

    I did see the high tea post. It doesn't seem to address the potential confusion between making tea (for my lighter evening meal, I have a bigger dinner) and making tea (as in a cup of the hot beverage)? It definitely confuses close to 100% of my American friends until they learn I don't tell them in chat conversations every time I go to put the kettle on and make tea because they don't notice the gap in the chats, but it doesn't seem to confuse many British friends whether I tell them about tea of the kettle-on variety or not.

    Although it's very definitely tangential I'm wondering what contextual cues we use to make that clear, beyond time of day, or perhaps we Brits just accept the ambiguity a little more and wait to see what the other person does to make it clear. But I was prompted there because of Giddy's comment where I realised the original sentence just isn't clear although all the meaning that makes it so is from the context, just like making tea is horribly ambiguous with the dual meanings of tea in BrE. It had also just cropped up in a chat with a new online American friend.

  28. Eloise

    I wonder whether the problem lise not in the word tea but in the word make.

    There are many rival verbs one can use with meal-name objects:
    get MEAL ready,
    see to MEAL,
    do MEAL,
    rustle up MEAL,
    prepare MEAL
    Personally, I'm much more likely to say any of these then make MEAL.

    I'd guess that your American friends understand you if/when you say make lunch or make breakfast. The unambiguous name of the meal is a clue — well, more a dead give-away.

    With tea, there's no such clue. Your close British friends don't need a clue because they know you're daily timetable and your speech habits. Less intimate British acquaintances can imagine both aspects because they know other people who do or don't prepare a meal at back-from-work time. But your American friends are — well, clueless.

    Personally, I never say make tea unless it means 'make a pot of tea'. More narrowly, I usually mean 'make the expected pot of tea'. If the hearer wasn't necessarily expecting it, I'd usually say make some tea.

  29. David,

    You could well be right that I'm very idiosyncratic in my usage. In speech I use some of those forms but they're all a bit different in what they mean and that's wildly off-topic.

  30. Eloise

    Why not just say that it's me that's idiosyncratic? Or let's just say that we're different.

    Yes, those expressions — plus AmE fix MEAL, which I hadn't thought of — can all mean different things. Nevertheless they can — in context — refer to the same thing.

  31. Because I'm comfortable being the idiosyncratic one?

    Or, as I have been known to phrase it. "I'm normal. The rest of the world is decidedly odd."

  32. *Ahem*, could we get back on topic, please - you know how Lynne hates it when we discuss things on the wrong page.

    I wanted to point out that when we have a health problem, mental or otherwise, our (in the UK) first port of call is usually the Health Centre....

  33. Anonymous in New Jersey31 July, 2016 01:45

    I read that sign and almost immediately understood what was meant. There was just a fraction of a second where I actually thought that it said "illness" rather than "health", however. If not for that stumble, I might have wondered if a word (problems, issues, etc.) had been left off at the end. Is this one of the ways in which such phrases become generally understood to have a particular meaning? I'm pretty sure that there are lots of similar phrasings in AmE, even if I can't think of an example at the moment.

    CaptainSiCo wrote: it's a big no-no in BrE/Britain to say 'handicapped' - we say 'disabled', yet there does not seem to be an issue with 'handicapped' in AmE/America. Even the word 'disabled' is sometimes skirted around in Britain too

    "Handicapped" – with the exception of when referring to parking spaces reserved for people with disabilities, is a big no-no in my circles, too. In my new(ish) job, I work in a department that has had several people with disabilities, and I was utterly shocked to hear old-timers refer to them as "handicapped". Prior to that, I hadn't heard the term used to refer to people since the 1980s. (I also know a few people who don't like "disabled", but they are far fewer.)

    – AiNJ

  34. Professionals carefully choosing their words must surely be affected by the legal framework. According to Wikipedia our Lunacy Act wasn't repealed until 1959, although earlier that century Parliament had passed a Mental Deficiency Act and a Mental Treatment Act.

    The big change in 1959 was a Mental Health Act. Then in 1983 a law was passed making huge changes to the field, and was also called the Mental Health Act

    The Mental Health Act (1983) and its subsequent Amendments provide the template for psychiatric services. It provides for the treatment not of mental illness or mental illnesses but of mental disorders. The NHS website seems to take mental health disorder as the standard term, amended to more user-friendly terms such as mental health issues and mental health problems.

    As I suspected, the list of disorders for which treatment is offered include
    symptoms such as anxiety, stress and panic — and isn't psychosis a symptom?
    behaviours such as addictions , personality disorders, self harm, eating disorders
    reposes to the world such as phobias, post-traumatic stress, SAD (seasonal affective disorder)

    I tend not to think of any of these as illnesses.

    Depression is an interesting term. Messages to the public stress that it is 'a real illness' — because so many of the public tend to think otherwise.

    Yes, they list terms like schizophrenia and bipolar disorder, which I think most of us are more ready to classify as illnesses — but these are a minority.

  35. I'm not an expert in the terminology, but I think technically speaking there are a range of psychoses but it's a psychiatric condition (as opposed to being caused by anything else) in which you get hallucinations or delusions. Some types of cancer, quite a few types of poisoning such as ergotine and other things can produce transient or lasting hallucinations for example but they're not psychoses because they're not psychiatric conditions. The other big group is neuroses where you have a psychiatric disorder without the hallucinations and delusions, although it can include a lot of really debilitating things like phobias, OCD etc.

    Although it's not a precise analogy, in physical health terms it might be useful to think of the difference between "medical" and "surgical" specialities that crudely split on whether you use a scalpel or not.

    So psychosis isn't a symptom, not in technical usage, it's a collection of diseases and disorders for categorisation purposes - and it's useful because you broadly divide treatments into anti-psychotics and anti-neurotics. There are a lot more drugs in the former and rebalancing of brain chemistry (with variable success) and a lot more talking therapies in the latter (with actually quite good success in a lot of the conditions).


    This is a post to check the Subscribe to Post Comments function

  37. As a former administrator, my instinctive reaction (if I heard an NHS professional say "Mr Smith is mental health") would be that it's a way of saying "Not my department, try mental health", whether staff or patient; but that doesn't settle the question of whether the department concerned should be seen as dealing with mental illness or promoting mental health.

    I'm not sure what the mental/intellectual process is that causes these elisions of meaning (or is it a sort of "mission creep"), but I have recently sent a few slightly sarcastic emails to the people dealing with the publicity for a forthcoming exhibition on slavery, since they mention the case of a chieftain's son "wrongly enslaved" - as though anyone could be rightfully enslaved!

  38. BBC Radio Four has started a new series of its regular programme All in the Mind. The oft repeated explanatory description is that it's concerned with

    the brain, psychology and mental health.

    1. That doesn't seem odd to me. They probably cover mental health and the lack of it.

      I tweeted this recently, but will repeat it here for posterity. My 8-year-old was describing a kid with problems in her class and her summary was: "I think he's got mental health".

    2. I think the emphasis is overwhelmingly on ill health.

      This week's programme had a slot on how the non-specialist public misuses 'mental health terms'. All the words discussed related to mental illness or other mental disturbance.

  39. On BBC Radio Four Woman's Hour today, a woman wanted to express the idea of her state of recovery after mental illness.

    The phrase mental health just wouldn't communicate that idea. The words she chose instead were:

    mental health wellness.

  40. Another observation...

    In a Sky News interview, Theresa May turned to the topic with these words

    Money is going into mental health. But it is always wrong for people to assume that the only answer to these issues is about funding. Yes, there [are] some issues there and we have been looking at those and addressing those. But actually if we look at the issue of mental health in this country, I think it’s more about the stigma that still attaches to mental health. (my emphasis)

    The BBC anticipated a reaction such as Lynne's and reported

    Mrs May will unveil plans to tackle stigma around mental health conditions. (my emphasis)

    Well yes, but it's not exactly snappy, is it?

    The phrase mental illness isn't totally unsayable — not yet, anyway. Mrs May actually uses the phrase later on, but it's evidently not a wording that politicians like to spring on us cold.

  41. From a BBC News website article last week, quoting a young woman who has suffered from depression.

    "I will hands up say I struggle with mental health issues." (Fine, I think.)

    "There is no shame in mental health."

    "People say we can't see mental health, but I don't agree. The photos above show how gradually mental health has physically affected me. (From left to right)." (Photos show decreasing happiness of expression and increasing dishevelment from left to right)

  42. I encountered this usage in the wild for the first time this week. In a recent episode of the podcast 'The Movies That Made Me' -- well worth a listen! -- a British actress was discussing a Latvian film about 'the history of mental health that runs through [the filmmaker's] family', noting that ‘this mental health...was largely going ignored’.

    As an American who used to live in the UK and who has had mostly British co-workers for many years, I still find this usage jarring.