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Edit: Since this article was published, a few folks from the autism community have come forward to let me know that people with autism prefer to lead by their diagnosis. I felt this edit was important to make, as this article does not appear to include this community. PCL does not work for all people, and that’s okay!
“Language is the foundation of civilization. It is the glue that holds people together. It is the first weapon drawn in a conflict.”
-Louise Banks, Arrival
After a couple of years of telling my partner that I had no interest in sci-fi movies, watching one actually proved useful. This quote is taken from Arrival, a film that follows a linguist as she tries to help the military figure out what aliens who recently landed on Earth want; she is tasked with not just deciphering their language, but teaching them English. She stresses the importance of understanding how others who do not speak our language understand words, and how those words dictate the way we think and perceive others. And, suddenly, we have the power to make peace or to wage war.
I’m reminded of Louise when I think of Person-Centered Language (PCL,) or the language we use in order to describe people with compassion rather than labels, and how it leads us to harbor conscious and subconscious biases towards people. These biases, in turn, become the weapon, and the path to recovery is the war.
Professionals are sinking their own ships when they don’t use PCL.
Why Person-Centered Language Matters
We know that certain labels in the recovery world have negatively affected people who are working towards sobriety. I could have described the people I’m talking about as alcoholics. But as we covered in our previous article on co-occurring disorders and AA, labels — especially for folks recovering from substance use — force folks into an identity riddled with shame; they imply helplessness; they imply that there is no separation between who someone is and the addiction they struggle with. Without PCL, they become one and the same. They become diseased, rather than a person struggling with a disease.
Non-PCL doesn’t just affect the way we categorize others (and the way it makes people in recovery feel,) it affects the way all human service and medical staff communicate about people in treatment and, in the long run, that influences the way staff treats the people in their care. Using language that implies deficiency means that 1. Staff stop believing in the possibility of recovery, instead of believing that a lifelong stint in services is the only reality for people in treatment, and 2. Perpetuates learned helplessness and hopelessness for one’s own recovery.
A recent study from the Journal of Drug and Alcohol Dependence, researched by Oklahoma State University Center for Health Sciences showed that an analysis of current Alcohol Use Disorder (AUD) language does not conform to Person-Centered-Language (PCL) standards.
AUD-related articles from May 2018 to April 2020 were selected and screened for human subjects and available in English, resulting in 3,445 articles and 49 journals. 500 of these were randomly screened for non-PCL standards
After excluding editorials and commentaries, 292 were retained. They found 59 (20.1 %) publications adhered to PCL. Among articles with non-PCL, labeling occurred in 198 (67.8 %) articles, and emotional language implying helplessness was identified in 123 (42.1 %) (Hartwell et al., 2020).
This is research completed in August of this year (2020). That means that the people who are treating folks in recovery — and this includes me, perhaps it includes you — are embedding their permanent medical records with deeply oppressive language. A 2016 study asked a sample of adults, including professional counselors, about their perceptions of mental illness. Study participants who were asked about “people with mental illness” demonstrated more acceptance than participants asked about “mentally ill people.”
Without realizing it, the words we use say a lot about our thoughts, feelings, and perceptions of the world and the people around us, rather than others’. For this reason, the way all helping professionals regard the people they serve will make or break a relationship.
Here are a few examples of how to turn non-PCL statements into statements full of human experience!
Examples of Non-PCL
“Charlie is an addict.” (“Diseased” identity label)
“Emma is non-compliant in taking her medication” (Implies a person “should” comply with a treatment they may not want; coercion)
“Peter is a victim of abuse.” (Weakness, victimhood)
Examples of PCL
“Charlie is a person with an alcohol use disorder; Charlie is in recovery.” (Human experience)
“Emma would prefer not to take medication.” (Choice)
“Peter is a survivor of abuse.” (Strength/resiliency)
Language is not static; it changes constantly, and not all individuals unanimously agree on language all the time. For example, there is some disagreement in peer support around the use of the word “client” when referring to someone receiving services. Some peers believe using the word to refer to people in treatment follows clinical-based language. For those peers, all clinical-based language is inherently oppressive and shouldn’t be used by peers. Other peers, myself included, feel the word “client” insinuates that we are in service of the person in treatment. This, in my mind, is always the goal. The nuances can be frustrating and confusing; the point is not perfection. The goal is to reduce harm in our language and move towards language that centers on the human experience rather than the disorder or diagnosis.
This skill is not just for professionals. It has the power to change societal attitudes towards misunderstood people. This begins in our everyday conversations about the hot-button issues we want to share our opinion on. Mental health has been one of those topics on the rise, especially now with COVID. We still have a long way to go with substance use, primarily because it’s viewed as a choice rather than a product of generational trauma and mental health disorders or socio-economic status.
We read and speak often about stigma, but it has to be more than an ideology. Destigmatizing mental health is a decision, a daily practice. Part of the change can and will come from the ways that we choose to classify, categorize, and describe people in need of treatment services.