Let's Speak English - The Language of Recovery

by Mark Sichel, LCSW and Alicia L. Cervini

A psybersquare member wrote in to my Ask the Expert Column and said:

"I'm a Bipolar Disorder II and I also have obsessive compulsive disorder and self-mutilation. I'm on medication but still can't seem to stop self-mutilating. Can you suggest ways to help me stop this habit?"

This was from a young woman who is trying to control her symptom of cutting herself with a razor, a frighteningly common symptom among teenagers.

When a teenager tells me, not that she has Bipolar Disorder II like the girl above, but that she is so lonely, sad, and deadened by pain that she needs to slice herself with a razor or burn herself with cigarettes, I feel profoundly sad for her. But, I feel hope for her as well; I know that this woman stands a good chance for recovery, because she is able to talk about what she is feeling in plain English. It seems, however, that we no longer speak English in America. We talk scientific jargon and labels: Bipolar Disorder II, Social Phobia, Obsessive Compulsive Disorder. Distance from experience and feeling seems to be the symptom as well as the purported cure nowadays.

The young woman in the case above needs to express herself in English. It doesn't help her to know she's a Bipolar Disorder II, but it would help her to verbalize how frightened, alone and out of control she feels. Her medication may or may not be helpful to her, but this girl needs a community of support, a professional who can help her sort things out, and parents who will listen to her anguish, pain, and desperate fear. Mostly this young person needs to know that they are engaging in an activity that can easily be treated with behavioral therapy. It does not help her to know scientific jargon and diagnostic categories. It would help her to talk about how she feels and be part of a clinician client team creating a behavioral plan for eradicating the symptom of self-mutilation.

Using scientific jargon is just a way to label things. Labels may make things easier for the mental health professional, but they tend to make things harder for the patient. For a patient, a label is an "easy" way to make sense out of confusing and conflicting emotions. The problem with labels is that people become comfortable with them. Oftentimes, rather then seek out the cause of their unhappiness by exploring uncomfortable emotional terrain, people will simply accept the label of a diagnostic category as an immutable statement of fact. They think: "I am Bipolar Disorder II. That's just the way it is. I guess I'll have to live with that."

The over-emphasis on medical and scientific jargon has been an American tradition in the mental health community since Freud was originally translated into English. Many years later, the American Psychiatrist Bruno Bettelheim pointed out the inaccuracies of Freud's translators. He noted how humanistic words were changed into scientific ones in order to achieve medical legitimacy in the U.S. The word "ego," which describes the adult functioning part of the personality, was a jargonizing of the word Ich in German that literally means "I." The word "id," which refers to all our sexual and aggressive impulses, was mistranslated from das es that literally means "the It." Rather than use the word "attachment," which says so much, Freud's translators erroneously used the term "cathexis."

Let's change our vocabulary back to English, and let the girl who's cutting herself with razors talk about feeling numb, self-hatred, alone, lonely, desperate and full of hatred and rage. Talk about feeling; forget about labels. Forget about detached terms such as Bipolar Disorder II and Social Phobia. I single these out because they are new diagnoses, coined in recent years, and we therapists have practiced successfully for decades without these diagnostic categories. They say NOTHING for a patient. That is why I advocate a return to English within the mental health community, for talking about the painful feelings, sharing them and expressing them, is what really helps people understand themselves and feel better.


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