Can we please STOP talking about "mental health"?

What words do you suggest we use instead, Corinna?

Maybe "mental" is really "emotional" and "health" is really "status." As someone who believes in the power words carry (both negative and positive), I am intrigued by thinking some new ones are needed in this context. 

Can you hear a counselor, or an ER doctor, asking: "Tell me about your emotional status--where does it hurt?"

And can you see a person responding with, "Well, I've been doubled over with stomach pain for several hours, but I'm also very worried about how my son and I are fighting a lot since I filed for bankruptcy...."

A few times in conversation I have use "mental wealth". I don't know how it's going to work in the field.

I would suggest avoiding articles that say, "we need more mental health care."

I would suggest using the Frameworks institute's guide on trama conversations. Their research is high quality. Minimize genetic info, use shared values. Use metaphors. 

In general, human experience language works fine for mental health discussions. "Scared, freaked out, woozy, sad," anything that is NOT a clinical term. Try it and see. Don't use any clinical terms related to emotional distress for 1 week and see how the possibilities open up.

Can you provide some examples of metaphors, shared values, and a link to the guide on truama conversations, Corinna?

Good question, Jane. Good, informed discernment on this topic could lead to a new and better way for communicating needs and treatments in the realms of people who are experiencing distress and are interacting with others who may offer some sort of relief through the kind of compassion that is only possible when an exchange of value has occurred. (For "exchange of value" I mean when two people communicate in a way that is even--where Person A is able to say what they feel on a foundation of honesty and trust and where Person B witnesses them with clarity, minimizes the vulnerability of the situation with love and ends the exchange with a feeling that the situation has improved. Whew!)

That stuff is already linked above in the Frameworks institute guides.

I think asking  how we change the language to support trauma informed discussions is a reasonable request. I also believe a good place to start is examining how we talk to each other ... 

I perused much of the toolkit and found this particular PDF especially helpful in thinking about how to shift the language to better support an open dialogue with the general public and non-clinical counterparts.

I hope those of you seeking more guidance find it useful as well.

http://www.frameworksinstitute...CMH_Toolkit_FAQs.pdf

Thanks for the link, Shawn. I'm a little confused, because Frameworks uses "mental health" throughout both of the links mentioned here, even when they discuss solutions. I think they offer a good start in reframing the conversation in taking a solution-oriented approach to children's mental illness and health (it's toxic stress, it can be solved), but could be enhanced by adding specifics of what causes toxic stress (the 10 original ACEs, plus racism, bullying, witnessing violence outside the home, involvement with the foster care system, involvement with the medical care system, attending a zero-tolerance school, involvement with the juvenile justice system, homelessness, moving often, etc.), so that people can have some ideas on what to start working on to change.

Thank you, Jane! This reframe of moving away from the idea that people are organically mentally ill to the understanding that exposure to Toxic Stress requires adaption in behavior and health allows for hope and solutions rather than diagnosis and risk of re-traumatization due to stigmatization. 

I really appreciate this discussion and learning more. I admit, that before I was an ACEs member I would totally tune out when I see the phrase "mental health" and assume it was written by someone in the helping profession or that it would be advice or traditional social worker approaches and signaled, to me, a "talking at" tone. Or a super broad overview, so general as not to be all that meaningful or helpful.

I am becoming a better listener now and I am not proud of my own tune out response but I am sharing it because I want to say that I responded with a gut "amen" to Corinna's headline.

AND while I responded with a gut, "Yes. Yes. Yes" I too have sometimes used the phase for simplicity to refer, quickly, to a bunch of stuff related to mental health that I don't have time or word count to get into.

For me, personally, as a reader, it's not that I have a problem with the words "mental health" it's just that to me, it is a phrase often used to wrap all kinds of issues up together.

For example, imagine using "physical health" as a buzzword for every cold, flu, surgery, medical issue or complaint? To me, it's not that the words are offensive, it's just that they aren't specific or personal or about a particular thing.

If I'm in crisis or struggling with symptoms, I don't think, "My mental health is acting up." I think, "I've got anxiety" or "I'm feeling overwhelmed" or "This is hard."  

I think, for me, sometimes people talk about mental health in a way that is distancing, clinical and remote and that itself is alienating and makes me feel other. Like me and my people with all the "mental health" stuff are some other group that fall under this category or catch phrase.

I think, it's similar to how we talk or don't talk about race. We are so afraid of saying the wrong thing, so afraid of offending and/or so unaware of race issues as experienced by others, that we avoid discussion and if we mention stuff at all, we just say "race relations" or "race issues" but we don't get specific.

It's that certain words signal awkwardness or discomfort or distance and aren't invitational or real. And I'm sure, as it relates to the words mental health, it doesn't help that some of us get irked, offended and frustrated. But we've often been hurt by people using the words without sensitivity and in ways that aren't trauma informed.

I appreciate this discussion as someone with post-traumatic stress and as a writer and as a reader.

I admit that I don't always read all the links given in the comments, so if there is good stuff it might be worth repeating, IN the comments, for those who are reading the stream here and maybe don't have time to read the entire article.

For me, I like to just get specific, when possible, and talk about feelings, sensations or experiences or the specific issue. I try not to use mental health broadly unless I'm also using physical health broadly. I also think one of the things I LOVE most about ACEs is that they show us that wellness, physical health and well-being INCLUDE our responses to stress, our early experiences as well as our coping and so often, there's no need to make a differentiation between physical or mental health. It's all just health stuff.

That said, I struggle with finding the words as well at times.

Cis

It's a long document linked, but a good one. This is an excerpt I found helpful.

Thanks for your comments, Cissy. Very helpful. And I like your comparison of how we describe our physical health (I've got the flu, etc.) with mental health. I also agree, the more specific, the better, combined with what solution you're pursuing. I have the flu, so I'm getting bed rest and lots of fluids. I'm anxious because I have a big project due, so I'm adding five more minutes of mindfulness (or exercise or whatever works) to comfort myself.

Frameworks' don'ts are useful, but what are the do's?

Thanks - what a great conversation. I'm also interested in the "DOs" that Frameworks suggests so if anyone finds the time to read the whole article and excerpt that would be great!  Cissy and Corinna's comments about simple language remind me of the importance of trauma informed practices such as Community Meeting where people are asked  the simple question "How are you feeling right now." It provides an opportunities to say things like "I'm feeling anxious, stressed, sad, vulnerable, scared, freaked out etc.. (some places pass out a list of feeling words to facilitate the process).

I read the entire article, and couldn't find DOs. If I missed them, or if someone knows where they are, please post a link!

Jane Stevens posted:

What words do you suggest we use instead, Corinna?

I would suggest we use neurological in place of "mental" Developmental Trauma Disorder is really all neurological - it already IS all physical. It's about brain science and the "hard wiring" of the brain. I really hate the term "mental health or "emotional" outbursts etc. It's all about the trigger of physiological chain reactions.  Could use some feedback on this

http://www.inciid.org/developmental-trauma-education

What they say to DO #1

1. Prime communications with values that orient audiences toward the collective importance of ensuring children’s mental health. I.e. talk about Prosperity "Child well-being is important for community development and economic development. Young children with strong mental health are prepared and equipped to develop important skills and capacities that begin in early childhood."

Or talk about Ingenuity, ie, "As a society, we need to invent and replicate more effective policies and programs for young children.:

What is important to include in the values frame: • An explanation that connects children to a shared, positive outcome. • A can-do assertion that solutions are available, and they need to be implemented. • An explanation that using resources today can produce long-term improvements in children’s outcomes.

What is important to leave out of the values frame:  • Any articulation of disparities or vulnerable children who deserve more. • “Prevention” or “Crisis” as orienting themes.

What they say to DO #2

2. Use the simplifying models or metaphors to make complex science undestandable.

A good one is the metaphor of Levelness. This is the idea that children and their environments need to be brought into a functional state — the metaphor includes ideas of stability, the influence of a variety of causal factors, and the ability to make adjustments and modifications to achieve levelness. Below is an example of how the simplifying model of Levelness was executed in our research:

"Scientists say that children's mental health affects how they socialize, how they learn, and how well they meet their potential. One way to think about child mental health is that it’s like the levelness of a piece of furniture, say, a table. The levelness of a table is what makes it usable and able to function, just like the mental health of a child is what enables him or her to function and do many things. Some children’s brains develop on floors that are level. This is like saying that the children have healthy, supportive relationships, and access to things like good nutrition and health care. For other children, their brains develop on more sloped or slanted floors. This means they’re exposed to abuse or violence, have unreliable or unsupportive relationships, and don’t have access to key programs and resources. Remember that tables can’t make themselves level — they need attention from experts who understand levelness and stability and who can work on the table, the floor, or even both. We know that it’s important to work on the floors and the tables early, because little wobbles early on tend to become big wobbles later. So, in general, a child’s mental health is like the stability and levelness of a table."

What is important to include in the Levelness Model: • That Levelness is a quality, with analogy to a piece of furniture such as a table. • Levelness is important because it determines the functioning and usability of the table and, likewise, with children’s mental health. • In reality, there are many degrees of the levelness of a table, as there are also degrees of levelness of the floors they’re placed on. • There are many reasons that a table might be level or unlevel; it could depend on the condition of the table, the floor, or both. • Positive mental health can be achieved by adjusting the floor, the table, or both. • Tables don’t level themselves. They must either be made that way or they require intervention by people who know about furniture and levelness.

After being presented the model of Levelness, FrameWorks’ research informants could explain what child mental health is. As Erard et al. explain, “It [Levelness] easily generated a brain-based conception of mental health, as opposed to one based on emotional or moral conceptions, but without defaulting to genetics as the only explanation for changes in brain structure or functioning.”

In other words, because they could grasp that a table that isn’t level cannot function, they were able to consider that child mental health was important to children’s overall functioning. Finally, equipped with the metaphor, informants recognized the existence of multiple causal factors of mental health and the need for flexible and multi-modal intervention strategies that would address “levelness.”

Jane, this is where you add in all those issues that challenge "levelness" , the
10 original ACEs, plus racism, bullying, witnessing violence outside the home, involvement with the foster care system, involvement with the medical care system, attending a zero-tolerance school, involvement with the juvenile justice system, homelessness, moving often, etc.)

TO DO, #3,

3. Rely on elements of the core story of development to explain what develops, how development happens and what derails development, but use the model of Levelness to specifically address problems in public thinking related to children’s mental health.

Given the public’s lack of understanding of developmental processes, it was not surprising to discover that existing elements of the core story of development improve some aspects of the public’s thinking about child mental health: • Both of the values noted above, Prosperity and Ingenuity, are those that prior FrameWorks research has found to lift support for a variety of early childhood policies.

These same values also serve to shift attitudes toward greater support for child mental health policy by expanding considerations of what is at stake, and should be adopted as orienting themes in communications about child mental health. • Another critical element of the core story is the simplifying model of Brain Architecture, which explains that the interaction of genes and early experiences shapes the developing architecture of the maturing brain.

Various stages of the research reported here found that the metaphor of brain architecture inoculated against some of the unproductive dominant cultural models the public relies on when reasoning about child mental health. The metaphor of a brain’s architecture signals that something material is constructed in the brain, inoculates against deterministic evaluations and can set the stage for expanded notions of the environments and experiences that serve to form that architecture. •

The simplifying model of Toxic Stress, which explains how development can be derailed, also proved fruitful in discussions with ordinary Americans about child mental health. Toxic Stress distinguishes the experience of damaging stress from growth-promoting stress, by explaining that when the body’s stress management systems are activated for prolonged periods the body can release chemicals that are toxic to the brain’s architecture.

In Peer Discourse sessions, FrameWorks found that this notion of Toxic Stress33 was successful in improving informants’ understanding of how stressful environments might affect child mental health outcomes. As O’Neil34 © FrameWorks Institute, 2010 14 explains, the Toxic Stress simplifying model allowed participants to consider how particular types of environments and experiences — exposure to violence, trauma, etc. — could impact mental health outcomes in children, and possibly affect one’s mental health throughout the life course. This aspect of the core story, then, serves to shift thinking away from both mentalist and fatalist default explanations about mental health and illness. •

At the same time, the default cultural models which people use to reason about child mental health specifically are nuanced enough to require specific bridging via a metaphorical model particular to children’s mental health, namely, Leveling.

In short, 

DON"T SAY, "We gotta help the poor poor kids get better mental health treatment because their epigenetics are gonna get messed up because of trauma and you are immoral if you won't help the kids who need it so so much because they are gonna go out and commit crimes if we don't do this."

DO SAY, "We should build future properity of our country by investing in kids who need supports. This provides a levelling influence, like patching a leg on a 2 leg table, to relieve effects of toxic stress. So that way we can harness american ingenuity to help all kids reach full potential."

SORTA like that.