Mental health services for ‘experts by experience’?

To the Editor

Many mental health clinicians in Australia may have come across recommendations about the desired terminology (Australian Health Ministers’ Advisory Council, 2013). Thus, we have learned that ‘patients’ and ‘clients’ are not appropriate and that we should adopt terms such as ‘experts by experience’ and ‘people with lived expertise’ (p.5). Likewise, we are told that these people do not suffer from ‘mental illness’, but, rather, that they have ‘mental health issues’, ‘challenges’ and/or ‘emotional distress’ (p.5).

One way of reacting to this would be to ignore it as another bureaucratic nuisance. However, by doing so we would turn a blind eye to a number of important issues.

First, this terminology only reinforces the already rampant stigma about psychiatry by implying that terms like ‘patients’ and ‘clients’ are inherently stigmatizing. It is naïve to think that psychiatric patients will be less stigmatized if they are called ‘experts’. There is also a problem with logic. Experts usually seek no help for what they are experts on, and why would ‘experts by [psychiatric] experience’ seek help from the mental health staff who may not have the relevant ‘expertise’? Such logic ultimately makes mental health services redundant, although this is probably not the conclusion that was intended.

Moreover, what are we to make of ‘experts’ who are hospitalized against their own will? It is hard to find another example where people with expertise may actually be punished for it. Is it a curse to be an expert – the more one knows, the more one is likely to get into trouble?

Implicit in the reconceptualization of psychiatric patients as ‘experts’ is romanticizing of mental illness. There is nothing glamorous about psychiatric disorders and suggesting otherwise is hypocritical.

Regardless of the debates about the definition of mental disorder, the practical reality is that mental disorders do exist. If they did not exist, there would be no mental health services. Reducing mental disorders to ‘issues’, ‘challenges’ or ‘distress’ will not reduce the stigma, too; it trivializes patients’ suffering and further blurs the already hazy boundary between a disorder and non-disorder.

Finally, these verbal, neo-Orwellian acrobatics show the absurdity of trying to be ‘politically correct’ beyond any reproach. That is impossible when it comes to the unpleasant facts of life, for example, a psychiatric admission due to illness. Such facts should not be hidden behind a preposterous and perilous terminology.