That which we call a patient….

…. by any other name would smell as rank

There’s a bit of a discussion going on in the blogosphere – or, at least, the bits of it that I tend to hang around in – about the right word(s) to use to describe mental patients.  Now, I’ve pretty much let the cat out of the bag by using the word patients there, and that is, quite definitely, what I would prefer to be called.

In much the same way, when I ride on a train I like to be called a passenger, not a customer.  That’s because passenger is a specialised word describing a particular kind of customer – one who’s bought passage on a train.  In other words, it’s a more precise term.

I think the same applies to patient versus service user, as a patient is a particular kind of service user – one who uses medical services.  It also applies to the word client.  A client makes use of someone’s professional services – architects and lawyers have clients (as do prostitutes, as a number of people have pointed out).  Patient is a more precise term, because it describes someone who is a client of doctors, nurses etc.

My main objection to customer on a train, and service user or client in MH (Mental Health) services, isn’t that those words are inaccurate, but that they’re unnecessarily vague, given that much more precise ones already exist.

When I was starting to think about writing this post, I looked up the word patient in the Oxford English Dictionary – I know, I know, my pathetic lack of a life is reaching truly desperate levels.  As well as the two definitions I already knew about (being tolerant of the faults of others, and someone who receives medical treatment) there were a whole range of other ones that I’d never heard of.  A couple of them are interesting to think about in the context of this discussion.  Or, at any rate, they’re interesting to someone like me, with the aforementioned desperate lack of a life etc….

First of all, there’s a definition which states that a patient is, ‘A person subject to supervision, correction or pastoral care by another.’  This is an old definition – the most recent example of it in use that the OED gives is from 351 years ago – but it seems like it’s certainly relevant to the description of someone who receives attention from MH services.  I might object to the word ‘correction’ in this context, but it seems to me that everyone involved in MH services is involved in supervising, or overseeing, their patients.  I find ‘pastoral care’ a bit more tricky, as it has religious overtones (care given by a pastor), but the term is used in education to mean looking after the general well-being of a student or pupil, and again I think those who work in MH are (or should be) interested in the general well-being of their patients.

Secondly, a patient is, apparently, a person ‘to which something is done; a (passive) recipient.’  If the word does carry this kind of connotation (and it’s really a debatable point, if not very many people know about the definition), then I can see a reason why some people might want to avoid it in MH circles.   As mental patients, we’re always encouraged to think of ourselves as active participants in our own recovery – although, privately, I think of myself as in charge of my recovery, and the various doctors and nurses as assistants.

The problem, of course, is that changing words in this way is a certain kind of political correctness.  I’m not necessarily opposed to this kind of political correctness, as it comes from a good place – it’s a nice idea not to use words that will upset, or undermine, or offend the person you’re talking to, or about.  The problem is that many people who talk about avoiding offensive words get stuck at the level of the words themselves, and forget that what really need to be changed are the attitudes that underlie the words.

A good example is the word gay, which was deliberately chosen by poofs in the mid-twentieth century as a positive way of describing ourselves.  It’s still the word that lots of people would use to describe themselves, but since the early 90s, gay has started to be used as an insult, especially by kids.  What this shows is that people can be using the most right-on, politically-correct words imaginable, but if the attitudes that underlie them are the same, then nothing’s really changed.

Things aren’t this clear-cut in MH, of course.  I think it would be quite hard to make the case that a mindset that thinks of patients as ‘passive recipients’ is as offensive as a mindset that’s actively racist, sexist etc.  But, if there are problems with the attitudes some people who work in MH have towards the people in their care (and I think that, in some cases, there are) then that can only be addressed by encouraging and persuading those people to change their attitudes, not by ordering them to use different words.

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3 Responses to That which we call a patient….

  1. Greybeard says:

    I think they’re calling us “mental healthcare consumers” or some such bullshit in the states. Etta posted on this sometime in last week or so.


  2. survivorworker says:

    i think you’ve hit the nail on the head as to why some people have a problem with the word “patient”. for me it’s the implied passivity that’s the issue – there’s a point where you get sick of being “done to” and want to try and take some of the power back, even if it’s just with words. i don’t find it particularly offensive though.

    i’m all for self-identification & choosing our own labels however, and it annoys me when people deride other people’s choices (in the past couple of weeks for example, i’ve seen others describe people who identify with the term “survivor” as both “smug” and “silly” – hmm). the problem comes when you’re trying to use the appropriate collective noun. i’ve come to the conclusion that you can never please all the people all the time – either stick to one term rigidly or alternate between different ones so you’re only annoying some people some of the time ;o) as you say, it’s the mindset behind the words that’s the important thing.

  3. Lola says:

    Personally, i would like to be referred to as a Headcase, or a Looper. Either is fine by me. I think behind my back my doctors refer to me as ‘oh-god-not-that-difficult-little-cow-again’. I may be a little paranoid.
    i’m fine with it!

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