Sometimes people worry too much about using the ‘right’ language. Being genuine and caring is far more important than using the correct terms. Even so, it is often a help to know the key terms and what they mean, especially in the context of setting the tone for the way mental health is discussed in the workplace. Sometimes the language is confusing and people use the wrong words. Knowing the best ways to talk about mental health is one step in reducing discrimination and stigma.
The term ‘acute’ is used in medicine and psychology to describe a condition with rapid onset and short duration (or both). It is distinguished from ‘chronic’, which describes a long term condition that a patient has to learn to live with; it may fluctuate in severity but there is usually no cure.
We’ve all experienced anxiety—nervousness before doing a talk in public or going to the dentist. Now imagine that amplified a hundred times and we begin to get a feel for what an anxiety disorder is like. There are usually physical symptoms (like heart racing, sweating, muscle tension), thoughts or ‘cognitive’ symptoms (like worry, imagining the worst, unable to think clearly), and ‘behavioural’ symptoms (like avoiding frightening situations, fidgeting, changes to appetite or sleep patterns). Anxiety can come in short, powerful bursts (like panic attacks) or can be there at lower levels much of the time. Anxiety is often associated with depression.
Behaviour is the observable actions of a person. Friends and colleagues are most likely to notice changes in behaviour if someone has psychological problems. When discussing mental health matters with a staff member, it is usually best to stick to describing observable behaviour rather than assuming what might be happening underneath.
A serious mood disorder characterised by extreme swings between depression (feeling very low—see depression below) and mania (feeling very ‘high’ and energetic), often interspersed with periods of normal mood.
Psychology is a vast field, covering all aspects of human behaviour from sports to education, from marketing to how we interact with machines. Clinical psychologists have specialist postgraduate training in mental health including diagnosis, assessment, and treatment. They provide psychological (non-drug) therapies.
Cognitive behavioural therapy (CBT):
A combination of cognitive and behavioural therapies, this approach helps people change negative thought patterns, beliefs, and behaviours so they can manage symptoms and enjoy more productive, less stressful lives. It can be provided by a range of appropriately trained health professionals, in particular clinical psychologists, and has a strong body of research evidence to support its effectiveness.
Counselling is a general term that covers a variety of non-specific supportive interventions for people with psychological adjustment problems. It aims to identify the problems a person is facing in his/her life and to help them discover effective ways of dealing with them. Counselling may be provided by a range of professionals including GPs, social workers, psychiatric nurses, occupational therapists, and psychologists.
Delusions are bizarre thoughts that have no basis in reality.
Depression is a mood disorder characterized by loss of interest in previously enjoyable activities, lack of motivation, and intense sadness that persist beyond a few weeks. It is associated with many physical symptoms such as disturbed sleep and appetite. Depressed people often feel exhausted, guilty and can find normal life extremely difficult. Depression is often associated with anxiety.
A term used to describe a particular illness (in this case a mental illness) on the basis of an agreed collection of symptoms. Although diagnosis is categorical (the person either does or does not have the required symptoms), mental health is not like that – it is best seen on a continuum from normal, everyday unhappiness or worry through to crippling depression or anxiety. So just because a person does not have a diagnosed mental illness does not mean he/she does not have mental health issues—good mental health is important for all of us.
The Australian Public Service Commission recognises two definitions:
- The Australian Bureau of Statistics’ Disability, Ageing and Carers: Summary of Findings 2003 definition, according to which ‘… a person has a disability if they report that they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least 6 months and restricts everyday activities’.
- The Disability Discrimination Act 1992, section 4, which states that ‘disability’, in relation to a person, means:
- total or partial loss of the person’s bodily or mental functions; or
- total or partial loss of a part of the body; or
- the presence in the body of organisms causing disease or illness; or
- the presence in the body of organisms capable of causing disease or illness; or
- the malfunction, malformation or disfigurement of a part of the person’s body; or
- a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or
- a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour; and includes a disability that:
- presently exists; or
- previously existed but no longer exists; or
- may exist in the future (including because of a genetic predisposition to that disability); or
- is imputed to a person.
To avoid doubt, a disability that is otherwise covered by this definition includes behaviour that is a symptom or manifestation of the disability.’
Disorder is a general term used to describe a disease or abnormal condition. In the mental health field, it refers to a psychological or behavioural pattern associated with distress or disability.
Hallucinations are experiences of sensations that have no source. Some examples of hallucinations include hearing non-existent voices, seeing non-existent things, and experiencing burning or pain sensations with no physical cause.
A state of emotional well-being in which an individual is able to use his or her thinking and feeling abilities, relate well to other people, and meet the ordinary demands of everyday life.
Mental health problem:
Diminished cognitive, emotional or social abilities but not to the extent that the criteria for a mental illness are met.
Mental illness / ill health:
A state where the person’s mental health is disrupted so that their thinking, emotions or behaviour are affected to an extent that it causes clinically significant distress (more than simply everyday ups and downs) and interferes with their ability to relate to others (family, friends, and colleagues) and their ability to carry out their normal role (at work, as a parent, a student, etc). A diagnosis of mental illness is generally made according to the classification systems of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD).
Paranoia is characterised by feelings of persecution—that others are out to mistreat, harass, or torment the person—in the absence of any objective evidence. It is often a form of delusion and may be accompanied by an exaggerated sense of self-importance. The disorder is present in many mental health conditions but is rare as an isolated mental illness.
Personality refers to enduring patterns of thoughts, feelings and behaviours that characterise an individual. They describe ‘what someone is like’ and are thought to change little over time. Some people may have unhelpful or maladaptive personality traits that create problems for themselves and those around them.
A personality disorder is an extreme collection of maladaptive personality traits that can significantly affect the way a person feels and interacts with the world around them. Personality disorders impede response to treatment and increase the risk of long term disability. In the workplace, diagnosable personality disorders are relatively rare although maladaptive and unhelpful personality traits may be much more common.
Phobias are irrational fears that lead the sufferer to completely avoid specific things or situations that trigger intense anxiety. Simple phobias include fear of spiders, heights, or flying. More complex phobias include agoraphobia (a fear of being in any situation that might trigger a panic attack and from which escape might be difficult) and social phobia (a fear of being extremely embarrassed in front of other people).
Refers to the impact of a mental illness on a person’s functioning in different aspects of life such as the ability to live independently, maintain friendships, maintain employment and participate meaningfully in the community.
A psychiatrist has trained as a medical practitioner and then specialised in mental health. Their work is very similar to clinical psychologists in providing diagnosis, assessment and treatment for people with mental health conditions, but they are also likely to use medication as a major component of treatment.
Psychology is the study of human behaviour, so psychologists work in a wide variety of areas as diverse as marketing, education, human/machine interface designs, criminal justice systems, and industry. Some psychologists specialise in psychological health and well-being (e.g., counselling psychologists), brain and behaviour (e.g., neuropsychologists), or mental health (e.g., clinical psychologists).
Psychopathic (or sociopathic):
This refers to a personality style (a personality disorder), rather than a discrete illness. It characterises someone who is unable to feel empathy for others, has no conscience, a compulsive liar; these people may be very cruel and dangerous, although some are also very successful.
Psychotic (or psychosis):
Psychotic describes a group of illnesses characterised by significantly distorted reality, such as delusions or hallucinations. The most common psychotic disorders are schizophrenia and severe forms of bipolar disorder.
The Disability Discrimination Act 1992 requires employers to change the workplace environment or work arrangements so that a person with disability is not disadvantaged in the workplace, to the extent that these changes do not involve unjustifiable hardship for the employer. This requirement may also exist in applicable State and Territory anti-discrimination legislation.
The term recovery carries many meanings in mental health, although a useful definition is ‘a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.’ (For a more complete description, see <http://blog.samhsa.gov/2012/03/23/definition-of-recovery-updated/>.) Importantly, recovery includes not only a reduction in symptoms but also an improvement in the ability of the individual to lead a normal life including health, work, home life, social relationships and leisure. It does not necessarily mean cure—recovery may mean living a fulfilling life as part of the broad community, while still living with a diagnosis of mental illness.
Relapse is a deterioration of mental health after a period of wellness. Relapses may be triggered by personal circumstances, stress (including workplace stress) or medication changes. It is characterised by an increase in symptoms and disruption to normal functioning.
Schizophrenia is a mental illness characterized by ‘positive’ and ‘negative’ symptoms. Positive symptoms include delusions, hallucinations, and disordered thinking. Negative symptoms include social withdrawal, apathy, diminished motivation, and blunted emotional expression. Schizophrenia is NOT a split personality.
A belief that a group of people that share a particular attribute (like mental illness) should be excluded or treated less favourably than most people. Stigma toward people with mental illness is often caused by misplaced beliefs that such people are dangerous or incompetent.
A ‘substance use disorder’ is diagnosed when a person’s drug use (most commonly alcohol) is causing high levels of distress to the person and/or those around him/her, and is preventing the person from functioning effectively in personal, social or work situations. It is closely related to other addictions such as compulsive gambling.
The specific problems and signs that a person reports (e.g., disturbed sleep, worry, nightmares, avoidance of situations, etc.) are known as symptoms. Each diagnosable mental illness has a pattern of symptoms that have been agreed by experts around the world (so that we can be sure we are all talking about the same thing when we use a term such as depression). Each person is unique, however, and people with the same diagnosis may still experience some difference in symptoms. Words commonly used to describe symptoms of mental illness that may impact on work include:
- Elevated mood: Appearing happier or more excited than normal
- Depressed mood: Appearing sad and down in the dumps
- Flattened mood: Showing little or no emotional response to events around them
- Impaired cognition: Difficulties related to thinking, memory, decision making, concentration, etc.
- Behavioural avoidance: Staying away from activities, situations or people that cause distress or anxiety
- Suicidal ideation: Thoughts about death or that life is not worth living (note – many people have suicidal thoughts without acting on them, but they are a big risk factor)
- Self harm: Behaviour that causes deliberate self injury (e.g., cutting oneself).