I'm sorry but your condition is serious, there's only so much you can do

Abstract

The meaning associated with the language used in health care undoubtedly has an impression on the way the individual and their condition is viewed. This is no more evident than in the mental health field where symptoms, risk factors, diagnosis, and the ‘expert’ interpretation of thoughts, feelings, and behaviours has a significant influence on people experiencing mental illness as well as clinicians and the wider public. Clearly, many people do encounter challenging, enduring, and at times debilitating states of mental illness; although we should not presume that all individuals ‘suffer’ from the experience of mental ill-health. Indeed, there are those who celebrate it (http://en.wikipedia.org/wiki/Mad_Pride). Much attention is currently focused on the physical health of people with mental illness and, consequently, a multitude of studies, reports, literature reviews, and discussion papers highlighting this issue have saturated nursing and medical journals. Included in this body of published work was a recent special edition of the International Journal of Mental Health Nursing published in 2012 which was devoted to ‘The physical health of patients with severe mental illness’. This cause is laudable, however, a definition of what constitutes ‘severe’ or ‘serious’ mental illness (SMI) is not forthcoming. It is assumed that everyone knows who this group is. These terms also appear to be used interchangeably, but are they the same thing? What is more, when such prefixes are used to describe a mental health condition, it implies that other degrees or even classes of mental illness exist, but one has to wonder where this ends. If there is such a thing as SMI, then conceivably there is ‘very serious’, or ‘extremely serious’, or perhaps even ‘not that serious’ mental illness. It does appear that only people with psychiatric diagnoses such as schizophrenia, bipolar disorder, or major depression are worthy of the labels serious or severe mental illness; but not those with anxiety, panic, or survivors of trauma, for example, which can also be debilitating and significantly impact on physical health. Additionally, what about those individuals with dieting and eating difficulties? This group also seems to be excluded from the SMI and physical health club. Being labelled with a mental illness is sufficiently challenging (and stigmatizing) without adjectives such as ‘serious’ or ‘severe’ being added to further consign the individual to a life of mental ill-health. Consider the message being conveyed: just when you thought that recovery from your mental illness was possible, here is an additional hurdle to overcome; now, try getting out of that one! Furthermore, the diagnostic systems used in mental health are already heavily laden with subjectivity, without more imprecision being added to the mix. We should always be mindful that psychiatric diagnoses are based on a consensus model and therefore represent merely one version of the truth. The problem-based and illness mentality that permeates mental health ‘care’ may be advantageous for a private practice business model, which relies on people remaining in longer-term ‘treatment’ for it to be sustainable. However, in the government-run health sector there is an ample number of individuals seeking support to keep these services busy and viable. Perhaps it is time to question whose interests are being served by this continued emphasis on risk, illness, and disorder, and consider the emancipatory quality of adopting a wellness focus, not only for people experiencing mental ill-health, but also for clinicians who work in this field. We may even find our workload decreases as a result.