Talking about mental disability

Finding appropriate terms for mental disability is challenging. Over times terms that have benign origins or specific clinical meanings can gradually become pejorative. And the fact that many people with mental disabilities have low social visibility mean that even well-intentioned people may not realise that certain terms now sound offensive.

Statutory language is often entirely out-of-date and/or out-of-step with current clinical or social terminology. Sex with a woman known to be ‘mentally defective’ was still a statutory offence in England until 2004 when the Sexual Offences Act 2003 came into force. The Mental Health Act 1983 referred to people with learning disabilities as having ‘arrested or incomplete development of mind’ and to people with a mental disorder which was not either mental illness of impairment as having ‘psychopathic disorder’ until amendments were made in 2007. And of course Art 5(1) e of the European Convention on Human Rights still allows the state to deprive people of their liberty if they are of unsound mind.

Perhaps we should be slightly forgiving of these flaws since most statutes still treat women as a subset of men (although at least there is nothing to stop Parliamentary Counsel treating men as a subset of women). At the very least with documents intended to be in force for years we can expect interpretation to alter even when the language does not.

A much more insidious problem is not the specific terms used, but the tone used to describe the experiences of people with mental disabilities. Too often policy documents, legal judgments and media reporting presume that to have a mental disability is to suffer and to present a challenge to those around you. I was surprised by para. 30 of the Standards used by the European Committee for the Prevention of Torture when inspecting facilities for ‘psychiatric establishments’:

“Working with the mentally ill and mentally handicapped will always be a difficult task for all categories of staff involved.”

Aside from the inherent generalisation it is also notable that no equivalent statement is made in relation to people detained in police custody, prison, immigration detention centres or juvenile institutions.

I have also been struck repeatedly in reading judgments relating to adults who lack capacity how judges will still refer to people as ‘suffering’ from learning disabilities or autism or dementia. Sometimes the language goes further than this, in Cheshire West and Chester Council v P for example the restrictions placed upon P’s liberty are described as ‘unhappily, the ‘normality’ of his life’.

Obviously both these statements are flawed because they are potentially patronising and certainly presumptuous. No one could wish to belong to a social group defined as ‘difficult to work with’ and few of us would wish to be objectified as ‘sufferers’ and thus objects of pity.

But a further reason for disliking the use of terms such as ‘suffering’, ‘unfortunate’ and ‘difficult’ is that they deny people with disabilities the capacity to define their own experiences. Having had some chronic health problems over the last year I have frequently been struck by the gulf between the aspects of my illness which I find most distressing and those which others perceive as problematic. I have suffered, and at time I have been difficult to be around. But I have also found others who lack insight into my condition difficult to be around, and I have found some healthcare professionals to wrongly prioritise reducing one aspect of my suffering whilst being indifferent to others.

Avoiding the language of suffering does not mean pretending that having an impairment is trivial, that people with mental health needs are always ‘easy’ to work with or that some people with mental disability would prefer not to be identified in this way. But when we are describing the experiences of others adopting a neutral tone makes it easier for us all to listen and learn from the experts.

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