The Language of Mental Health, pt. 2

It’s tough not to stumble across mental health talk these days. It seems to be everywhere: TikTok, Instagram, the news, maybe even your dinner table. Normalizing mental health is so important in the process of destigmatizing when we’re struggling. It can also be inspiring when others share the ways they have found to effectively manage their struggles.

The concern? The more ubiquitous mental health language becomes, the more the meaning gets distilled. Misconceptions—and often misuses—of important mental health language have become the norm.

When mental health language is used accurately, it can give people a tool to better understand their experiences. When mental health language is used casually or without understanding the full meaning of the terms, it can act to dismiss the real experiences of others.

So, in this installment, I’m presenting a list of often misunderstood or misused mental health terms and brief clarifications on their uses/meanings. If you missed part one, find it here!

If you don’t want to read through, at least consider this takeaway: Diagnoses are for professionals to use with people to whom they do not have a direct connection. Leave it to the pros. Focusing on symptoms we experience, rather than labels, can increase our understanding of what we think and feel.

Bipolar

How it’s (mis)used: This one has been thrown around for decades. People often say it to mean someone who has expressed a shift in emotions or changing of their minds more frequently than the receiver may be used to experiencing.

Reality check:  Bipolar disorder is a legitimate diagnosis. There are two versions of the diagnosis. Overall, bipolar disorder is marked by periods of depression (to varying severities) and periods of intense mental and emotional stimulation (also to varying severities). Each cycle of bipolar typically lasts for longer than a week and is a consistent emotional state during that time (i.e. not excited about something in the morning and sad at night the same day). One misconception about the periods of intense and emotional stimulation is that it manifests as extreme happiness. It can also manifest as irritability, aggression, feelings of invincibility, or restlessness.  Some folks who meet criteria for bipolar disorder also experience hallucinations and other symptoms associated with pychosis. Psychosis can be very distressing for some people who experience it. For others, the psychosis creates a world for the individual in which they feel really empowered and energetic. When the “up” periods shift back to a depressed period, many people with bipolar disorder experience a period of mourning the “up” period. Bipolar disorder is sometimes difficult to manage with medication, as when folks start to experience the “up” periods, it’s easy to convince themselves to stop medication. The diagnosis also has high incidences of self-harm and deserves not to be delegitimized by using the language carelessly.

Substitutions: Rather than seeking a label to distance yourself from the behaviors causing your discomfort, explore what feels bothersome about the behaviors. Understanding what feels upsetting can help you communicate to others about your experiences. If you are concerned you see symptoms of Bipolar Disorder in yourself or someone else, please seek professional assessment. If you or someone you love is experiencing thoughts of self harm, text 988 for the National Suicide Hotline.

Boundary

How it’s (mis)used: We often misunderstand “boundary” to mean rules for other people. The difficulty with this idea is that it’s nearly impossible to force others to do what we want.

Reality check: In its simplest form, boundaries are rules for ourselves to follow for our own wellbeing. We can ask the people in our lives to support our boundaries by asking for specific behaviors from them, but it is ultimately up to us to hold ourselves accountable to the boundaries we’ve chosen. Boundaries are the foundation of effective, foundational self-care. For example, we cannot make a person stop talking about a certain topic with us, but we can choose how we will react when that person does talk about that topic.

Substitutions: Take the time to explore your wants and needs in a situation. Decide what you can do for yourself in those instances and follow through. Some boundaries function best when they are communicated to others. For other boundaries, it’s not necessary to communicate them; it’s only necessary for you to follow through on them. For example: If you decide you want to limit your alcohol intake to 2 drinks per outing, you can make that active decision without announcing it to your friends; and it would still be a boundary.

Sociopath

How it’s (mis)used: We often use this term when referring to someone who has been hurtful or seemingly does not care how we feel (i.e. lots of new clients have come into an initial session stating that their ex is a “sociopath”).

Reality check: According to the American Psychological Association, “About 1.2% of U.S. adult men and 0.3% to 0.7% of U.S. adult women are considered to have clinically significant levels of psychopathic traits.” So, that makes it pretty unlikely that your ex is in that small percentage of folks in the US. Sociopath is a casual term for folks who meet criteria for Antisocial Personality Disorder (ASPD). “Antisocial” does not mean someone who doesn’t like to be social. It refers to a pervasive belief that one is an exception to general rules. It is usually marked by high levels of narcissism, difficulty establishing intimate connections, and a foundational difficulty with authority. Difficulty with authority is not the same as looking at oppressive structures and working to change them; it is more about establishing control in relationships. As with other personality disorders, it’s very likely ASPD is a result of unresolved trauma.

Substitutions: Try being specific about the behaviors and interactions that are feeling hurtful to you. You can still validate your feelings without labeling others. Consider what has contributed to your feelings and focus on what you need to heal. After you have a better understanding of our needs, you can create a plan to move forward more effectively in the future.

Narcissist

How it’s (mis)used: We use this one a lot. Oftentimes we use it to refer to people in our lives who are focused on themselves or who post selfies. Older generations also use the term to refer to younger generations and their use of social media. We also often refer to our mothers as narcissistic when they are preoccupied with their appearance. Funny how we overlook that we’ve taught cis-women that their worth lies in their appearance and then diagnose them for it.

Reality check: Like ASPD, narcissism is also a personality disorder. The easiest way I’ve found to explain narcissism is: Narcissism is not about having "high self esteem." It is rooted in a profound deficit of self worth, self value, and self esteem. What that deficit creates is a need to look for validation in what the individual perceives as "sameness." The people in their lives become objects of projection, representing and/or validating how they want to see themselves (i.e. highly attractive, intelligent, etc.). When the object starts to show signs that there isn't as much "sameness" as the narcissist believes, it's not just a disappointment, but a deep wound. The narcissist views the differences as direct challenge to who they are (their identity). Because a narcissist has such a flimsy sense of self, that direct challenge is understood as dangerous, resulting in manipulative, controlling, and sometimes abusive behaviors for "survival." The lack of "sameness" feels like a threat to their very being. The behaviors are attempts at recreating the feeling of sameness (or safety) again. It’s an elaborate way to avoid self-reflection, which feels too painful for the individual.

Substitutions: Try being specific about the behaviors and interactions that are feeling hurtful or unlikeable to you. Explore the beliefs that may be informing those feelings. Can you set boundaries to help the relationships with the people you’ve labeled “narcissistic” to flourish?

Gaslight

How it’s (mis)used: Gaslighting has been misused to mean a difference in experience or opinion between people. It’s become common to see gaslight used interchangeably with disagree. It’s normal for different people to experience the same event differently and even feel differently about it. Do we all react dismissively toward our loved ones from time to time? Sure. Is it a nice thing to do? No. It’s also not abuse. It is human error.

Reality check: Gaslighting is a serious abuse tactic. It is a systemic form of abuse that functions to convince the receiver that they cannot trust their own experiences, self assessments, thoughts, or feelings. It is used specifically to exert control over another person, not as an honest difference of experience. It is a recurring interaction, not singular instances. Using it casually functions to minimize the very real harm it can cause. Examples include oppressive structures in the US that convince oppressed populations (Black and Brown folks, LGBTQ+ folks, people with lower socioeconomic status, etc.) that their state of oppression is not so bad or their fault.

Substitutions: Try being specific about the behaviors and interactions that are feeling hurtful to you. Try reflecting on what has been contributing to you feeling as though you cannot trust your own thoughts and feelings. Also reflect on what it’s like for you when someone disagrees with your experience of an event. It can be helpful to process those thoughts and feelings with a professional. When you’re ready, try communicating with the person about it. If you are concerned you are in an abusive relationship, please seek mental health support or reach out to Philadelphia Domestic Violence Hotline. People located outside of Philadelphia can get support at the National Domestic Violence Hotline: 800-799-7233.