By Dr. Kate McGraw
Jan. 11, 2023
Graphic by the Psychological Health Center of Excellence
Pause for a moment and think about a time you were called by a name you didn’t own or want to acknowledge, or labelled with an identity you felt ashamed of or embarrassed by, whether those labels came through well-intentioned teasing, benign neglect, or a mean-spirited attack. We’ve all probably had an experience at some point in our lives when we felt misunderstood, perhaps even rejected by someone before they got to know us, simply because a label was attached to us and served as a false definition of ourselves to others who didn’t know us at all.
Language is a powerful tool.
The words we choose to describe mental disorders and substance use disorders have real and measurable impact on both the individuals who are struggling with these conditions, and the rest of society1.
The act of using language to express our thoughts and feelings links our well-being directly to the words we choose. Language can be used to include or exclude others, create healthy teams or degrade them, build someone up or break someone down. We use words to describe others, and within that act of labeling we hold tremendous responsibility for the impact of our words on the well-being of others.
Institutions can unknowingly contribute to misuse of language and perpetuate stereotypes and damaging concepts through policy and traditions, long after the efforts of science have extinguished the myths. Even healthcare providers are not immune to the impact of our own preconceptions regarding groups of patients. Mental health patients often unintentionally suffer from provider prejudice, which may impact subsequent patient diagnosis, and further influence triage, provider responsiveness, or even access to care2. Unfortunately, the Department of Defense is not immune to the use of stigmatizing language in policies when discussing matters related to mental health.
Over the past decade, the Psychological Health Center of Excellence reviewed every policy across the DOD related to mental health3,4 to identify all instances of stigmatizing language, make recommendations to improve such language where relevant, and advocate for changes to correct terms that were likely stigmatizing. These efforts are part of a larger DOD initiative to enhance the overall health of the force by reducing the stigma surrounding mental health treatment and care-seeking, encourage service members to seek help early for mental health challenges, and reassure the community that most service members return to a successful career after interventions for mental health are completed. In order to make real gains, there is still more work to do to better shape the language of the DOD as we talk about mental health.
On Nov. 7, 2022, Deputy Secretary of Defense Kathleen Hicks signed an historic memorandum directing the DOD to conduct a comprehensive review of all policies to ensure recommended language changes were incorporated, and all new policies followed the recommended guidelines for person-centered de-stigmatizing language. In her memorandum, Hicks said, “We should do everything in our power to encourage [service members’] help-seeking behaviors to ensure we have a fit and fighting force. This should include identifying and eliminating stigmatizing language related to mental health in Departmental policies that may serve as unintentional barriers to mental health help-seeking.”
This unprecedented step to require a comprehensive policy review sets the expectation from senior leadership that we must improve awareness of the power and impact of our words on the mental health of others. It also underscores how important it is for the military community to embrace and support service members and their families who struggle with mental disorders or substance use disorders by using inclusive language, words that are respectful, encouraging, and supportive in order to help those who may hesitate to seek care.
If you or someone you love or care about is experiencing mental health crisis, dial 988 for immediate help.
References
- Volkow, N.D., Gordon, J.A. & Koob, G.F. Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacol. 46, 2230–2232 (2021). https://doi.org/10.1038/s41386-021-01069-4
- Kohrt, B.A., Turner, E.L., Rai, S., Bhardwaj, A., Sikkema, K.J., Adelekun, A., Dhakal, M., Luitel, N.P., Lund, C., Patel, V., Jordans, M.J.D. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers. Soc Sci Med. (2020) doi: 10.1016/j.socscimed.2020.112852
- Vidales, C.A., Smolenski, D.J., Skopp, N.A., Vogel, D., Wade, N., Sheppard, S., Speed, K., Hood, K., & Cartwright, P. (2021). Assessing the dimensionality and construct validity of the military stigma scale across current service member. Military Psychology. doi: 10.1080/08995605.2021.1997501
- Campbell, M., Auchterlonie, J.L., Andris, Z., Cooper, D.C., Hoyt, T. (2021). Mental Health Stigma in Department of Defense Policies: Analysis, Recommendations, and Outcomes. Mil Med. doi: 10.1093/milmed/usab471
- Deputy Secretary of Defense. (2022). U.S. Department of Defense. Review of Policies to Eliminate Stigmatizing Language Related to Mental Health. Memorandum for Senior Pentagon Leadership Defense Agency and DOD Field Activity Directors.
Dr. Kate McGraw is the Chief of the Psychological Health Center of Excellence. A former U.S. Air Force missile officer, her work as a DOD clinical psychologist both in uniform and as a civilian has furthered research, clinical practice, programs, and policy in the areas of women's mental health, ostracism, implementation science, sexual assault, suicide prevention, and sleep.