Input to consensus media guidelines work group
July 23, 2002, NIMH, Bethesda
Sylvia Caras, PhD

Guidelines can frame positive images for raising awareness and understanding of humans in emotional distress. Guidelines can expand the writer’s and the reader’s consciousness, invite neutral language, and reject language that is biased and exclusive. Because words matter.

The hardest part of being a person who experiences mood swings, fear, voices or visions is the language used to describe me. When I speak personally about my mental health, I often note in my listener a shiver of awareness, a protective barrier raised between us. I try to shrug off the distancing from me and from the subject.

Some of us here know that language creates social truth, language creates perception, that language is prior to thinking.

Feeding into what will become the media guidelines is a background of labeling theory and the use of people-first phrases.

When health professionals speak to each other about their "spmi caseload," when citizens bemoan problems caused by "the homeless mentally ill," when the media uses psychiatric diagnoses as all-encompassing adjectives so often that people begin to refer to themselves as their diagnosis, we are then using a language of social rejection which perpetuates stereotypes and permits discrimination.

Good language does not mean finding better words for wrong concepts. The word stigma, for example, is associated with the exposure of sin and shame.

But we are really talking about the place of difference in society. Stigma puts my difference on my palms, nailing me to a cross. The social model of disability instead locates problems outside the disabled person and looks at how economic and social processes now discriminate and can be improved to accommodate our differences. Instead of creating a new and isolating stigma language and stigma concept, advocates sensitive to this nuance prefer the more generally understood language of prejudice and discrimination.

The custom of speaking of mental and physical health, as if the brain were not a physical part of the body lays the groundwork for profiling people with psychiatric disabilities in the very same way that ethnic groups and serial killers are profiled. Politicians have found negative campaigning doesn’t succeed with voters. Negative campaigning doesn’t change attitudes either.

Wellness isn’t a battle, it’s an integration. War language like battle, conquer, oppositional words like anti-stigma, solidly embed just what is being opposed.

If I were presenting for an audience of media professionals I’d stress these three ideas:


Watch your language

Remember to show not tell. Even though English words to render emotional distress are few, use that extra word or two to describe the experience.

Do your homework

Biology isn’t everything, despite all the money behind it. There are half a dozen models of misbehavior.

Put us in your rolodex and paint us at our best

Balance every sensational event with a normalizing quote from a professional and a personal quote from someone who experiences mood swings, fear, voices or visions. Join us in adopting the slogan of the disability community: Nothing About Me Without Me

Language is everything. The story is yours to shape. Use the power of your pen to make sure your words matter.


About creating consensus guidelines, I’m not sure how there got to be so many players in my health care. When I hear "we can all agree" my senses sharpen, because consensus often means that the primary voice has been excluded. It is said that when we change one thing we change everything. The inclusion of people who experience mood swings, fear, voices and visions is a necessary step towards reevaluating preconceptions and dispelling myths. I’m pleased that I was invited here today.