The Evolving Language of Mental Health

Like it or not, language changes. Are you keeping up with the vocabulary shifts on sensitive topics?

When I wrote recently about the unknown risks of soaring melatonin use in children, I touched on its potential application for some mental health conditions. In the process, I offended a reader with this passage:

While there can be benefits to physician-supervised melatonin use — such as treating specific, diagnosed sleep disorders or mental health disorders like ADHD and autism — much remains unknown, including whether the supplement continues working with repeated use.

Can you find the offending word? (Seriously: Look for it, as an exercise in linguistic awareness, before you read on.)

Since publishing that story, I’ve learned a lot about the language of mental health conditions — nuances I was a little clueless about — after one reader took me to task on a single word choice. In the comments, Medium member Elanor Rice wrote:

This is a great article full of helpful information that I hesitate to criticize, but as an autistic individual, I must point out that neither autism nor ADHD are mental health disorders. They are neurological conditions that can affect mental health (since we’re living in a world that was not designed with us in mind and disregards our needs every second of every day). The misconception that autism and ADHD are mental illnesses instead of minority neurotypes does nothing but pathologize and stigmatize us as individuals while taking the onus completely off society to better accommodate us.

Like any writer, I’m prone to bristling at criticism. But not in this case. Rice’s polite rebuke urged me to consider that I’d been unwittingly insensitive. Before I reacted, I wanted some additional perspective to better understand her important quibble.

Embracing the fluidity of language

Like any writer worthy of the badge, I know I don’t know everything. In fact, I believe some of the best and most accessible non-fiction writing happens when the starting point is “I don’t know anything.” Even when we come to understand a topic well, over the course of months or years, the realities changes.

Linguists teach us about the wonderful, inevitable and sometimes frustrating fluidity of language, the unstoppable force of popular usage to determine formal style and meaning — what’s acceptable and what’s offensive, what’s considered proper, universal, colloquial or crass.

Language change can happen slowly, almost imperceptibly, as with impact gradually becoming a synonym for both affect and effect (unfortunately a done deal), or they/them and other options replacing age-old personal pronouns (still in process).

Other times language evolves overnight, especially now with the internet and easy global communication. The launch of a single social media platform almost instantly gave an entirely new meaning to the word tweet. And who doesn’t LOL now and then, BTW?

You can resist the change or embrace it, but change will happen. It always has.

Shakespeare is said to have invented many words that are in common use today, including critic, lonely and swagger. If you were unaware of this or feel uncomfortable about it, you can thank Shakespeare for giving you words with which to describe your reactions.

The vernacular of mental health, like any subset of our vocabulary, is changing rapidly. We writers need to be aware of the changes while they are underway and be sensitive to the causes and motivations of the change, and then be thoughtful about when and how to incorporate natural evolutions of words and meaning into our writing. As an editor, I still resist the use of impact when a writer just means effect or affect, but the effect of that shift in word meaning is relatively inconsequential. The consequences of using ill-chosen words when writing about mental health can be highly impactful.

Here’s what I did

Before I responded to Elanor Rice, I did a little cursory research. It quickly became clear that there’s no widespread agreement — between or even among patients and healthcare professionals — on how best to describe many mental health conditions.

Even the AP Style Guide, relied on by journalists for suggestions on how to handle just about any word or topic that needs defining beyond what’s in the dictionary, could be considered a bit out of step on mental health word choices (though not without extensive, thoughtful entries on the topic).

In alignment with the psychiatric profession, the latest edition of the AP Style Guide (2022–2024 edition) refers to ADHD, autism and depression as disorders. The guide also includes a lot of nuanced suggestions for how to write about these conditions, including avoiding dehumanizing “the” terms like the mentally ill, favoring instead people with mental illnesses.

But does a person with autism or ADHD really have an illness? A lot of people with these conditions might agree with that characterization. A lot refuse to think of it that way.

So while I find the AP Style Guide indispensable — every writer should have a copy — in this instance it felt insufficient. It’s a guide, after all, not a bible.

So I emailed John Kruse, a psychiatrist and Wise & Well writer, to admit my ignorance on the subject, note the obvious disagreements and confusion, and ask him to help me understand how terms like illness, disease and disorder are typically used in the medical profession, and how they should be used by writers and the rest of us.

Instead of a short answer, Kruse wrote an essay: Coming to Terms With Mental Health Labels. Here’s a snippet:

I’ve seen how diagnostic labels that summarize a meaningful collection of linked symptoms can enhance my understanding of a patient. These labels can also aid individuals in comprehending their thoughts, feelings, and actions, as well as nourishing a sense of belonging. Our diagnoses also furnish general predictions about future behaviors, and can steer us towards appropriate treatments. But we need to make sure that the terms we use don’t cause individuals or groups harm.

Rather than share too much of Kruse’s nuanced conclusions and advice here, I encourage you to read his entire essay. If you are a writer or editor who ever touches on mental health issues (or a person who discusses mental health with family, friends or colleagues) you’ll be glad you did. The essay offers insights we can all learn from as the language of mental health evolves in unpredictable, inevitable and important ways.

The bottom line goes way beyond mental health topics

I waited until Kruse’s essay published, then I went back and thanked Elanor Rice in the comments on my article, simultaneously appending the following note:

Important note from the author: In the comments, Medium member Elanor Rice took issue with this article’s characterization of autism and ADHD as mental health disorders. So I did some research. In the mental health profession, conditions like autism, depression and ADHD are often referred to as illnesses, diseases or disorders. But many people — not just Elanor — dislike using those diagnostic labels to describe their mental states. So as editor of Wise & Well, I asked psychiatrist John Kruse what terms we writers should use, and which to avoid. He responded with a thoughtful and informative essay. Terms that can be helpful for patients and mental health professionals are not always welcome, Kruse writes. He then offers superb advice that we can all lean into in writing or discussing mental health conditions in a way that respects the evolution of language and patient preferences. Moving forward, Kruse’s essay will inform my writing and my editing, and therefore all future articles on Wise & Well. I’ve left this article as originally published so readers can learn from it, as I have.

I’ve shared this entire process and outcome here in the Writer’s Guide because it illustrates three basic but little-discussed tenets of good and responsible writing:

• We writers and editors must be sensitive to the evolution of language — words matter, even if change ruffles our feathers. We have to balance the expected use of language by strict grammarians and hoity-toity word mavens with what’s accepted and useful, what’s helpful or hurtful.
• Criticisms from readers can be launch points for learning. Readers can be a source of change and wisdom (and even story ideas).
• We must be on constant lookout for what we don’t know, proactive in responding to valid criticisms, and when we get it wrong or recognize fresh nuance, we must be eager to make changes to our existing stories and our future writing.

I hope I’ve handled all this in a productive manner. Rather than stress over the criticism, I sought to learn from it and improve my writing and editing, while giving you something to ponder, too.

Thoughts? Questions? Chime in!

Cheers, Rob

This article first published in my Writer’s Guide newsletter on Substack, where you can subscribe to get weekly articles like this in your inbox and learn about my coaching and mentoring services.