Advocating for mental health doublespeak

To the Editor

Annexures to a recent report on clinician adherence to treatment support and discharge planning (West Australian Mental Health Advocacy Service, 2018) included a ‘Language Cheat Sheet’ that proposed a reform of ‘worn out’ and ‘outdated’ clinical terminology with ‘recovery focused’ language. The suggested reforms warrant comment because of their strong evocation of Orwellian doublespeak. A total of 17 of the 57 suggested reforms are presented below in Table 1.

Table 1.

Examples of recommended ‘recovery focused’ replacements for ‘outdated’ mental health terms.

‘Worn out, outdated’	‘Recovery focused’
Tom is relapsing	Tom is unsure about
Tom is lazy	Tom is considering the benefits and costs of
Kelly is manipulative	Kelly is struggling to find effective ways to meet her needs
Kelly is splitting	(Staff) will help Kelly to accept people as they are
Unmotivated	Nathan’s strengths and positives are
Frequent flyer	Nathan is not interested in what services can offer
Entitled	Person has high expectations of self and/or service
Unrealistic	Person is aware of rights and is a strong self-advocate
Denial	Person is trying really hard to get needs met quickly
Grandiose	Person disagrees with diagnosis
Manic	Person disagrees with this explanation of their experiences
Psychotic	Person stated that
Refused	Person disagreed with
Over involved family	Person chose not to/declined
Tom is treatment resistant	Tom prefers not to
Tom is decompensating	Tom finds little benefit from
Long-term schizophrenic	Barriers to change are

Table 1 provides striking examples of ‘doublespeak’ because the meaning of the ‘outdated’ terminology is completely lost in the ‘recovery focused’ translation. For example, ‘is unsure about’ does not in any way convey the idea of ‘is relapsing’, nor does ‘person is trying really hard to get needs met quickly’ convey any idea of ‘denial’. I changed the order of the ‘recovery focused’ items in Table 1 and then asked 20 mental health professionals fluent in English, to find the best match between the 17 ‘outdated’ items and the 17 reordered ‘recovery focused’ items. Two of the 20 participants produced three of the proposed reforms, four produced two, seven produced one and seven did not produce any.

There is cause for concern when a statutory body gives de facto endorsement to a reform of clinical terminology that amounts to thought disorder. Clinicians do not need the addition of Orwellian doublespeak, even if well-intended, to the increasingly Kafkaesque bureaucratisation of public sector psychiatry.