While discussions around mental health are more common now, the terminology used is still a contentious topic. Should individuals seeking help be referred to as patients, clients, or consumers? Should we use “person-first” terms, like person with autism, or “identity-first” terms, like autistic person? Should we use diagnostic labels or avoid them? These concerns often provoke strong emotions. Some argue that the term “patient” suggests passivity and subordination, whereas “consumer” might imply it is a mere transaction, similar to purchasing an appliance. Supporters of person-first language believe individuals should not be defined by their conditions, while proponents of identity-first language argue that these conditions can provide meaning and connection.
Those who favor diagnostic terms see them as helpful descriptors, while critics fear that such labels can confine individuals and misconstrue their issues as mere pathologies. Many of these debates are rooted in concerns about stigma and the medicalization of suffering. Ideally, the language we choose should not portray individuals experiencing distress as flawed or shameful, nor should it present everyday life challenges in psychiatric terms. Our recent research, published in the journal PLOS Mental Health, explores how the language describing distress has changed over nearly 80 years. Here’s what we found: General terms like mental illness, psychiatric disorder, or psychological problem have largely avoided scrutiny in discussions about mental health language.
These categories encompass mental health conditions as a whole. Many terms are currently in use, each combining an adjective with a noun. Frequent adjectives include mental, mental health, psychiatric, and psychological, while common nouns encompass condition, disease, disorder, disturbance, illness, and problem. Readers might encounter every blend of these terms. The terms and their components carry different connotations. Disease and illness are the most medical-sounding, while condition, disturbance, and problem may not necessarily relate to health. Mental suggests a clear opposition to physical, while psychiatric hints at a medical specialty. Mental health problem, a more recent term, is arguably the least pathologizing. It suggests something to be resolved rather than treated, does not mention medicine directly, and carries positive health-related connotations, contrasting with illness or disease.
This shift may be an example of what cognitive scientist Steven Pinker calls the “euphemism treadmill,” where language continually evolves new terms to temporarily avoid the negative implications of those they replace. English linguist Hazel Price indicates that mental health is increasingly replacing mental illness to steer clear of the stigma associated with the term. In our PLOS Mental Health paper, we analyze historical changes in the frequency of 24 general terms: every possible combination of the listed nouns and adjectives. We investigate how often each term appeared from 1940 to 2019 across two substantial text datasets representing English-language books and various American English sources, respectively.
Both datasets reveal very similar results. The figure illustrates the relative popularity of the top ten terms in the larger dataset (Google Books), with the 14 least popular terms grouped together. Several trends emerge. Mental has consistently been the most commonly used adjective component. Mental health has gained popularity recently but remains infrequently used. Among nouns, the use of disease has declined, while illness has become more prevalent. Despite disorder being the official term in psychiatric classifications, it hasn’t gained widespread public use. Since 1940, mental illness has become the most favored general term. Although various alternatives have emerged, its popularity has steadily increased. Our study highlights significant shifts in the popularity of these terms, but do these changes have an impact? The answer might be: not much.
One study found that people perceive mental disorder, mental illness, and mental health problem as referring to essentially the same things. Other research suggests that labeling a person with terms like mental disease, mental disorder, mental health problem, mental illness, or psychological disorder doesn’t change people’s attitudes towards them. We don’t yet know if there are other effects of using different general terms, but existing evidence suggests they are minimal. Recently, some writers have proposed using distress as an alternative to traditional terms.
Distress lacks medical implications and focuses on a person’s subjective experience rather than whether they meet an official diagnosis. The term distress is used 65 times in the 2022 Victorian Mental Health and Wellbeing Act, often in the context of “mental illness or psychological distress.” This suggests distress is a broader concept similar to, but not quite identical with, mental ill health. But is distress as destigmatizing as intended? Apparently not. One study found it was more stigmatizing than alternatives. The term might shift focus away from the suffering of others by amplifying it.
Mental illness is still the most popular general term, and its popularity continues to rise. Research indicates that different terms have little or no impact on stigma, and some terms intended to reduce stigma may have the opposite effect. We suggest embracing the term mental illness and ending the proliferation of alternatives like mental health problem, which may create confusion. Critics might argue that mental illness imposes a medical perspective. However, philosopher Zsuzsanna Chappell disagrees. She argues that illness refers to a subjective, first-person experience rather than an objective, third-person pathology, like disease. Understood correctly, the concept of illness emphasizes the individual and their relationships. “When I identify my suffering as illness-like,” Chappell writes, “I seek to establish a caring interpersonal relationship.”