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Language and Interpersonal Dynamics With Psychosis

Learning how to talk about mental health struggles can be a really difficult process, especially if you haven’t gone through them.

Learning how to talk about mental health struggles can be a really difficult process, especially if you haven’t gone through them. There are different languages for talking about mental health. Clinical language can be the most commonplace whereas human experience language is a growing language. Learning both languages can be essential in knowing how to talk with people when they’re struggling.

I remember earlier on it was really commonplace for clinicians to use clinical language to describe what I had been going through. As I’ve progressed I’ve moved further and further away from clinical language, although I’ll sometimes use it in writing about my mental health experiences to give people some sort of context. One major component we teach resident doctors at McLean Hospital is how to speak both languages, these being clinical language and human experience language. Clinical language can be seen as a power language, and it can be damaging to hear your most traumatic life experiences being talked about scientifically. When there are power dynamics within conversations this can regenerate past traumas and can be incredibly damaging.

I’ve seen many family members use this language with loved ones and this usually comes across as stigmatizing to their loved one. American culture is imbued with expert mentality and many times people use clinical language to sound like experts and to get people to listen. However, this usually pushes people away. In physical medicine it can feel normalizing that a provider knows the terminology for all the medical ailments you might be experiencing but with a mental health ailment, it can feel incredibly dehumanizing. Having had schizoaffective disorder for fifteen years, the most essential component to the illness is that it’s been a thought disorder. Through journaling, I’ve been able to dismantle myriad thought webs by deconstructing meaning around traumatic experiences and reconstructing it in healthier ways thus alleviating symptoms and improving my mental and emotional health and functionality.

There are times where family members could see behaviors or thinking patterns that seemed to be “a part of the illness”. However, with the illness being a thought disorder it was simultaneously who I was as a person. There were some moments where I could distinguish symptoms from who I wanted to be, however, it mostly feels one and the same. As I’ve improved mental health wise I could see in retrospect how my personality and my social interactions might have been deemed symptomatic but in the moment that insight is not available to me even if I can see it in other people.

This being said it’s really important to be aware that if you’re commenting on someone’s social interactions as symptomatic that these symptoms and the person someone currently is acting as is who they are, even if it wasn’t who they were before experiencing their mental health episodes and struggles. This is why it’s really important to accept people as they are and to not use clinical language to conceptualize how someone is acting or interacting with you, especially if they are a loved one. There’s a lot of stigma within using clinical language to describe who someone is or how they are acting and it’s something to avoid altogether. There is also a lot of otherness and the undertone that someone’s personality and essentially their being as a human and their mind is something that needs to be scientifically fixed is a terrible notion to project at someone.

A different way of talking about people when they’re struggling is by using human experience language. For example, I used to have a belief that I was a messiah who was going to save the world. The clinical term for this belief is a delusion, however, if when I was really struggling and someone told me my beliefs were delusions it would have felt incredibly invalidating and strongly damaging, which I’ve seen happen to countless other patients I’ve worked with. The belief that I was a messiah who was going to save the world was constructed from a number of thoughts that were reactions to serious trauma I had been through. This belief system of saving the world was a defense mechanism from all the mental and emotional pain I had been through in my episodes. I mention this because you may be able to see how if you were to challenge a belief system that was making me feel safe from serious trauma by using clinical language to describe it, I would immediately snap back and yell, which is also really commonplace when providers try to provide clinical language to experiences that feel real to someone.

Challenging the beliefs that were keeping me safe would only feel dangerous to me. The other important component to this as well is that when I felt I was a messiah I wasn’t in a place where challenging this belief would have had any positive results and it would not have changed those beliefs either. Therefore, using clinical language to challenge something that meant a lot to me would only further distance people from me. Usually in mental health care, we put the priority and the onus on the connection with the person who is struggling and using clinical language breaks down those connections. We know that if someone doesn’t trust we have their best interest in mind we’re not going to be able to help them in any way, which isn’t what we want. We also know that if we don’t have a connection to people that they most likely aren’t going to listen to anything we have to say no matter what it might be we’re trying to help them with. This can be exactly the same within family dynamics.

Again with pathologizing someone’s life experiences, this creates self-stigma and also challenges a number of thinking patterns and beliefs that might be in place that help someone to feel safe. Challenging someone’s mental health is challenging who they are as a person, which also feels like an affront. When someone has a broken arm it can be easy to accept they need medical help. However, when you’ve been through trauma and your thinking and emotions are in really problematic places it feels disparaging to be told you need medical help with your personality and with your thinking. There’s an immediate hierarchy that gets created and for me there were feelings of inferiority as a person.

As I made progress in my mental health journey, I realized I had been through a lot of trauma and the belief of thinking I was a messiah, dysfunction interpersonally, difficulty speaking, anxiety, emotional pain, and emotional swings were reactions to that trauma. Knowing this helped me to not take personally all the burdens of mental illness.



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