The terminology of psychology and addiction is ever changing and typically constitutes little more than a series of labels. Professionals like labels. They’re powerful things that allow us to bill insurance companies. Moreover, they imply we have great expertise and know exactly what we’re doing.
Anyone in the know, however, can tell you we’re making it up as we go along and we’re not doing it especially well. A cursory look at the number of Americans in active addiction, overdose rates, folks living with eating disorders, completing suicide, engaging in self-injury and struggling with depression and anxiety shows just how far we have to go.
So, we change things up. We change the terminology and little else.
George Carlin often noted that Americans tend to manipulate language by watering it down. He did a routine years ago about the terminology of trauma. He noted that in World War I, combat veterans were said to have, “shell shock.” In World War II, the term shifted to “Battle Fatigue” and by the Korean War, we were calling it, “Operational Exhaustion.”
“Post-Traumatic Stress Disorder” was not conceptualized as a formal mental health diagnosis until 1980. We’ve barely scratched the surface of understanding the impact or trauma and how to treat it. Case in point, we really only have one diagnosis that points unequivocally toward being a survivor of trauma.
More recently, we’re inventing terms like “Adverse Childhood Experiences.” Take a moment and let that term roll around in your brain. ”Adverse.” Getting a bee sting is an adverse experience. But in this new terminology, being raped frequently as a child is deemed an “adverse experience.”
We have moved away from discussing “addiction” and toward discussing “Substance Use Disorders.” I appreciate attempts to reduce stigma, yet it makes me a little crazy because we rate these disorders as mild, moderate, or severe. Nearly all active addicts or alcoholics are continuously minimizing the impact and significance of their use, and now we might say they have a “mild” substance use disorder, which feels a lot like having a “touch of the flu.”
Finally, we have moved away from terms like “dual diagnosis” because we are starting to see that folks very frequently do not have two conditions that require treatment. They have three, or seven, or ten.
A person who was “dually diagnosed” was thought of as a person with an addiction and a mental health disorder, which is reasonably stupid, because there is no such thing as an addict who does not meet criteria for a mental illness.
I’m old school. I prefer offering diagnoses like, “It appears that you are up to your ass in alligators and likely to die in short order.” I like saying to folks, “I think you’d need to get six months of continuous sobriety before you could be accurately diagnosed for your mental health.”
Most of all, I like Winston Churchill’s words, “When you’re going through hell, keep going!”
I’ve known a lot of folks who are very effective in helping others find their way out of hell. None of them hinted around, alluded to, or softened a person’s struggles with watered down language. They say things like, “Let’s start getting you unfucked.”
Over the past week I have found myself urging folks to pay close attention to how they speak to themselves and to notice how we use language to manipulate ourselves and each other. I don’t ever want to be less than clear and transparent so here it is:
It’s not terribly important to me what diagnoses you may happen to have on record. What I want to know is – what’s the core? What’s the bottom line? What do you need to do to get better (not all better), what are you willing to do to attain it, and how can I help you do it?