What Is the Right Language?

Our ordinary language has always had colorful terms to describe emotional and mental disorders.  “Vapors” was particularly popular in the late nineteenth century, soon succeeded by “nervous breakdown” and “crack-up.”  Other terms included “lunacy,” “bonkers,” “mad,” “mental,” “unhinged,” “loopy,” “bananas,” and so forth.  Now we have added “stress” and “burnout” at one end of the spectrum, and “freak outs” at the other.

Never a real diagnosis, nervous breakdown “always struck most doctors as inexact, pseudoscientific and often misleading,” according to an article in The New York Times.  “But those were precisely the qualities that gave it such a lasting place in the popular culture, some scholars say. ‘It had just enough medical sanction to be useful, but did not depend on medical sanction to be used,’ said Peter N. Stearns, a historian at George Mason University.”  (See, “On the Verge of ‘Vital Exhaustion’?”)

Today, however, members of the general public seem to feel increasing pressure to diagnose themselves with professional accuracy.  Are we Bi-polar?  Do our children have ADHD?  Or just ADH?  Are we depressed?  Perhaps it is just an Adjustment Disorder?  Moreover, patients not only want to know their exact diagnoses, they also often seek to prescribe and find their own medications on the internet.

But mental health professionals themselves are not always happy with the categories and codes they are required to apply to patients by insurance companies.  An exact nomenclature implies a degree of certainty that seems often unwarranted.  So they have cultivated a certain skepticism and detachment.  Yes, they use the terms.  They have to in order to help patients get the services they need, but they are also aware of the danger of believing in them too firmly.

The paradox is that just as the authority of professional knowledge is increasing with the general public, supplanting the informal language of popular culture, the authority of mental health professionals is eroding.  The public increasingly appears to believe in the certainty of the diagnoses professional are required to provide while losing access to the detachment and skepticism of those who have learned to question their usefulness.

The decline in the authority of professionals is widespread, not just confined to the field of mental health.  The irony is that the public is losing confidence in their judgment at just the point we are coming to understand that much of the value they have to offer to others is not in what they know but in what they know they don’t know.