Anxiety has been systematically stigmatised for many decades and has historically settled for discriminatory lexicon. Words like, ‘loner’ ‘weirdo’ ‘loonie’ are all words that we have been bought up with to be perfectly acceptable terms. Stigma is not only an element that people with anxiety experience, but the extent to which it has permeated our language, is to be quite honest, wholly unacceptable. It may be argued that it is the practice rather than language that matters; however, our inner dialogue is made up of language. So, I want to discuss the language that is used to create shame and stigma.
We were all bought up with the saying, “sticks and stones can break my bones, but words can never hurt me”,but this isn’t entirely true. Words are emotionally charged and are a barrier for seeking guidance and a motivator for making discrimination acceptable.
The term’ anxiety disorders’ creates this illusion that we need to fix the anxiety, we don’t. There is nothing wrong with having anxiety, we just need to make sure we have coping mechanisms that can help control our anxiety when it is high, we are feeling overwhelmed or it’s triggered.
There have been events in my life that have meant I’ve lost my home and belongings. This has resulted in me having very little attachment to material items (apart from books obviously). Going deep with my anxiety has taught me to rebuild and refine my life several times. I don’t care about climbing the corporate ladder, or having lots of money, I care about people, I don’t want to let anyone down or hurt someone feelings. I care about my little girl and doing right by her, I care for my family, I care for my better half.
This reminds me of Susan Sontag’s (1978) critical theory, in which she challenges the victim-blaming in the language that is often used to describe illnesses and those who suffer from them. Sontag says that the most transparent and most truthful way of thinking about illness is without recourse to metaphor.
In her book “Illness as Metaphor”, she writes;
“Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, as least for a spell, to identify ourselves as citizens of that other place.”
This is my point with language around anxiety, the word ‘disorder’ creates the premise that we belong to ‘that other place’. When, in fact, anxiety is a perfectly adaptive reaction to a situation that our brain is telling us that we are in danger.
Language creates a stigma; the stigma then leads us to believe we should be ashamed of our anxiety and the symptoms associated with it.
Twenty years ago, the Social Anxiety Disorder Coalition (SADC) launched an awareness campaigned that was plastered on the back of buses and billboards across America with the ghastly slogan, “Imagine you were allergic to people”. This is an example of how wording creates a negative stigma of people who have anxiety. Are people with anxiety allergic to people? Are people contagious? But it turns out SADC were in partnership with the almighty drug giant GlaxoSmithKline, which had just released the drug that treats anxiety. I mean it works, doesn’t it, you can imagine people who experience anxiety thinking “Am I allergic to people? Please pass me this first magic pill that can cure me of my allergies”. Just to make it clear, I am not suggesting people with anxiety shouldn’t have anti-anxiety medication. I am saying it should only be used as a temporary measure. At the same time as the root cause is investigated, and coping mechanisms are developed.
Let’s unpick this word disorder a little more- currently there is no diagnostic process for anxiety that is fool-proof. The DSM does not provide a clear point that anxiety crosses the point from being a regular everyday reaction to an irrational disorder. Furthermore, at what stage can neurotic thoughts be explained as a chemical imbalance in our beautiful brains instead of it being part of our personality.
Currently, society tells us the former is ‘fixable with some drugs’ and well the latter being that we are just big weirdos and we should be avoided at all cost.
In 2011, the current chair of the DSM was asked by a journalist if the line between human response to fears (anxiety) and having a diagnosable disorder might not be as clear cut as the DSM suggests. The response was “I don’t know”, and even confessed that there are no biological markers for anxiety.
Just to point out some further flaws in the DSM’s diagnostic guidelines, research has found that two different psychiatrists using the same diagnostic tool, only have a consistent result of 32% of the time.
Being considered as ‘disordered’, impacts fundamental parts of our personal identities, like our relationships, work performance and educational outcomes. How we talk about this experiencing anxiety plays a positive and influential role in the recovery process. Identifying someone as an ‘anxious person’ implies that is all the person is, that this diagnosis defines them. That the disorder is more important than the actual person.
I mean, hello, that is a living, breathing fantastic human being, that person should always come first. Instead, we should be describing it as ‘an individual who experiences anxiety’, this can help to allow for other parts of their identity to still exist. Allowing us to achieve a more holistic and accurate view of the experience of people with anxiety.
Round 2- let’s unpick the word ‘suffers’, when related to anxiety and mental health, while it is reasonable that we should acknowledge the impact it has on us. We also need to be careful not to imply that a diagnosis equates to a long-life sentence of suffering.
I am well aware some people may have contrasting opinions about language that are worthy of reflection, some people will find the label of disorder useful, as it may ease their anxiety that they are not responsible for their illness or that there is a reason they feel the way they do. Furthermore, having a label is essential for accessing benefits in the UK.
I want to return to the analogy that I’ve given before about the old brain and the new brain. Our ‘new brain’ is relatively young and immature in its development terms, and it tends to be lazy. It only becomes involved when prompted to do so, and our ‘old brain’ has developed over millions of years. It includes fundamental skills that we share with animals. This is the part that helps us lead our regular lives. It is always rapidly thinking and looking to make simplistic causal connections (so that we can get the impression that the first narrative we told our self is true). This is particularly important when it comes to language. Research shows that our ‘old brain’ effortlessly takes charge in producing a response to words. This is called “associative activation”, a word brings an idea, and an idea triggers many other ideas. It will keep making connections between all those ideas by resurfacing old memories, which recall our emotions; this can then trigger different reactions. This cascade of activity happens with no conscious control, and it produces a cognitive, emotional and even physical response. This means we make an unconscious response to words, and we don’t even realise we are doing it.
It’s not just about the diagnoses that is important.
1 in 5 of us experience anxiety, so being respectful and thoughtful in our language associated with anxiety will help the people around us as well. It would do wonders for our brain’s “associative activation”.
Another point about language and anxiety is that certain words are specific to people who experience depression and anxiety and that they use language differently than the general population. Some people who experience anxiety tend to use negative language to describe their emotional states, and they also tend to use more personal pronouns, as they have experienced the rumination and social isolation. Furthermore, research has found that there was one consistent language marker to those struggling with anxiety, and that was ‘absolutist words’. Absolutist words are words that convey magnitudes or probabilities, such as ‘always’, ‘nothing’ or ‘completely’. I’ve lost count at how many times I have said; I am ‘always’ anxious. So, I cannot say I was surprised when I read about this research. I remember when things seemed absolute, “I was stupid,” or “I have absolutely nothing good in my life”. It took me a long time to stop myself from using absolutist language, which had probably started because I had been told I was disordered or weird a million times. Every time I heard myself use it, I forced myself to revise what I had said both in my mind and then aloud.
It’s an integral part of recovery from using absolutist mental state and admit that everything isn’t a disaster when we believe that it is. Life isn’t always binary, it’s not always black and white. Life isn’t just sadness or happiness. Sometimes life can happen in the middle, in the grey areas, in between the extremes of utopia and hell on earth.
Research conducted by Harvard University in 2013, found that saying ‘I’m excited’ aloud could reappraise anxiety as excitement, just like Tiger Woods does when he reframes his anxiety. Further research comes from the University of Pennsylvania, they put volunteers into different anxiety provoking situations, such as; singing karaoke in front of strangers; public speaking; completing an IQ test under time pressure. But before each activity, they spoke aloud a sentence to themselves: “I feel anxious” “I feel calm” or “I feel excited”. All participants wore heart-rate monitors and, this was displayed to them prominently during the experiment to make them aware of their bodily symptoms. The results were again in line with Woods and Harvard University’s research: People who told themselves that they felt excited not only felt more self-confident but also performed better, objectively measured, at all the tasks — singing, public speaking, even arithmetic. The opposite was true for those who said, “I feel anxious”. This research discovered that saying “I am excited” made people adopt a challenge rather than a threat mindset. Those in the category of singing for an audience started to see it as an opportunity for success rather a failure. Saying these words; “I am excited” in the face of nervous arousal switches our brains and helps us to create an opportunity mindset. This increases our dopamine activity (dopamine is our happy neurotransmitter found in our brains), giving us a boost of our feel-good chemical, in turn, sharpening our performance in maths, singing or in playing a game of golf.
This is the power of language; we have the ability to conjure a new mental context for ourselves, changing one emotion into another. To improve our perception of events, we must change the language that we use.
It can be seen repeatedly in the discourse that surrounds anxiety. Where facts become irrelevant and language weaponised. Yes, I am going to drag Orwell into this — the ‘newspeak’ that is used by Orwell, is the same language that is used by companies to get us to buy into the fact that we are ‘disordered’. The language that is used is intentionally simple and restricted. They reduce complex political mental health issues to catchy slogans.
From the day we start learning about ‘wellbeing’ or ‘mental health’, we need to learn to ask ourselves the questions, what does this mean for me?
We should have a preventative method and learn to recognise what we need, what it feels like to give ourselves self-love, what do we need right now?
We need to re-complicate the debate that surrounds mental health discussions. Such as, when polemical arguments are thrown at us, we need to understand why they have latched on to this binary thinking. Ask them questions, what makes you think this? Where did you learn about this? Be interested and not confrontational, only by learning to reengage people’s thinking can we disengage negative language.
Every single person who has anxiety will tell you that they have ruminated over questions- such as am I mentally ill? Am I disordered in some way? Or even defective? Strange? Weird? Will I always be this way? Does this mean I am not resilient? Will the medication make me become like a zombie? Or we try to absolve ourselves from all blame with the chemical-imbalance debate, ridding us of all the guilt we experience that we could do better and be more effective humans. The list goes on, and the existing medical theories fail to answer them.
People are traumatised by language that is used for negative afflictions, if we really care about people, and want to help them, we should change the vocabulary and the approach.
So, let me assure you right here; we are not disordered or defective. We are perfect the way we are.