Talking Mental Health.ps, page 1-23 @ Normalize ( Talking Meental )

Talking aboutmental health

A resource that explores how mental healthconditions are described, and helps you defineyour experiences in your own terms

Contents

Introduction

1 Anxiety

2 Bipolar disorder

3 Dementia

4 Depression

5 Hyperactivity

6 Phobia

7 Schizophrenia

8 Self-harm

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Introduction

Using this book

This book from Together’s Directorate of Service-user Involvement looks atthe different ways in which different types of mental distress can be described.It shows that many mental health conditions are described in very differentways by different groups of people – such as doctors, people in other parts ofthe world, and, most importantly, those who experience them.

This in turn helps us remember that the medical way of describing mentalhealth problems is just one among many different ways of looking at mentaldistress. It shows too that clinical diagnoses often seem more negative,pessimistic and judgemental than other ways of perceiving these experiences.

We have written this book because at Together we want to demystify mentalhealth jargon, and focus on people’s emotional experiences, personaljourneys and potential, rather than pessimistic clinical diagnoses.

Each page contains several different definitions of one common mental healthcondition:

a dictionary definition from the New Oxford Dictionary of Englisha condensed medical definition from the Diagnostic and StatisticalManual of Mental Disorders IV-TR, which is the tool psychiatrists use tohelp them make diagnosesdefinitions from around the world – examples of similar ‘illnesses’ andsymptoms found in other culturesTogether definitions – some examples of ways in which people atTogether have told us they might prefer to describe the condition, usingplain English.

At the end of each section there is space for you to write down in your ownwords how you feel. You may find it helpful to use your definition of what youexperience to help you explain to other people (including professionals) whatyour experience of mental distress is like.

We have also included a couple of pages in the middle of the book for you touse to talk about your mental health, and the language you do – and don’t –like to use to describe it. You can photocopy the pages as many times as youlike, so you don’t need to worry about running out of space. If, like manypeople, your feelings change from day to day you could create a diary of yourexperiences. Feel free to use the pages inventively to create a scrapbook ofdrawings, cuttings and images.

Medical definitions

Medical labels and diagnoses can be confusing. They also pigeonhole peoplein a frightening way. So when you read the medical definitions in this book dobear in mind that they should be treated with caution.

You may find some of the wording used in them offensive, and thedescriptions given may not reflect the way you see yourself and your condition.These definitions are not meant to scare or limit you – they are simply here toinform you about official medical thinking.

Definitions from around the world

Other cultures have very different – and frequently much more poetic orevocative – ways of talking about mental distress, and symptoms can take ondifferent connotations according to where in the world you are. For example, inone country hearing ancestral voices may be celebrated instead of being seenas a symptom of an upsetting experience that is called schizophrenia bymedics. There are some illnesses that seem only to exist in one country orculture (which again calls into doubt the validity of the ‘objective’ medical wayof categorising illnesses). We have included some of these descriptions eventhough they do not reflect exactly Western medical diagnoses. Most of thedefinitions from around the world that we have listed are found on the followingwebsite: http://weber.ucsd.edu/~thall/cbs_intro.html

We cannot guarantee the accuracy of these definitions or their translations.If you are interested in reading more about global views of mental distresshowever, the site provides a starting point for further research into ‘culturebound syndromes’.

Together definitions

We have also included some plain English expressions such as ‘I have darkthoughts’ and ‘I get in a sweat about things’, which people we know have usedto describe how they feel.

Your feelings are unique, and at Together we believe that you are the experton your own experience. And we hope this book will help give you confidencewhen talking about how you feel with the mental health and medicalprofessionals with whom you come into contact. We would like to hear howyou describe yourself if you want to share your feelings. You can send yourown definitions to us by using the contact details on the back cover.

The Western psychiatric tradition offers only one way of categorising individualexperience. We hope that this resource helps you to look beyond the labels weget given, to celebrate diversity and take pride in your own individuality.

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Anxietynoun [mass noun] ORIGIN early 16th cent.: from French anxiété orLatin anxietas, from anxius (from angere ‘to choke’)

Dictionary definition

A feeling of worry, nervousness, orunease, typically about an imminentevent or something with an uncertainoutcome.

[with infinitive] desire to dosomething, accompanied byapprehension.Psychiatry a nervous disordermarked by excessive uneasinessand apprehension, typically withcompulsive behaviour or panicattacks.

New Oxford Dictionary of English

DSM definition

Diagnostic Criteria for GeneralisedAnxiety Disorder:

Excessive anxiety and worry(apprehensive expectation), occurringmore days than not for at least sixmonths, about a number of events oractivities (such as work or schoolperformance). The person finds it difficultto control the worry.

The anxiety and worry are associatedwith three (or more) of the following sixsymptoms (with at least some symptomspresent for more days than not for thepast six months). Note: only one item isrequired in children.

restlessness or feeling keyed upor on edgebeing easily fatigueddifficulty concentrating or mindgoing blankirritabilitymuscle tensionsleep disturbance.

Diagnostic and Statistical Manual ofMental Disorders

We have included the DSM definitionsto inform you about official medicalthinking.

They can be confusing and soundjudgemental, and you may find themoffensive.

We suggest that you use them as astarting point to challenge acceptedviews and write your own definitions.

anxiety

anxiété

Ang

stansia

ansietà

ansiedad

anxiété

ansietà

Ang

stansia

anxiety

n

Around the world people say

‘Narahatiye qalb’ – Pounding heart andfeelings of panic.

Iran and Middle East

‘Shenkui’ – Dizziness, frequent dreamsand worry.

China

‘Shin-byung’ – Fear, loss of appetite,insomnia.

Korea

‘Ataque de nervios’ – Attacks of crying,shouting and feelings of heat rising inthe head or chest.

Latin America

At Together we might say

I can’t let go of thoughts which areusually negative.I go on and on about details whichseem to be negative.I get in a sweat about issues andtasks that most people don’t give asecond thought to.I feel ‘wired’ and tense and have anurge to escape from situations thatfill me with dread.In a panic attack I become short ofbreath, my heart races and I feeldizzy and disorientated.

My definition

anxietyanxiété

Angst

ansiaansietà

ansiedadanxiété

ansietàAngst

ansiaanxiety

Bipolar disorderBipolar adjective: Having or relating to two poles or extremities.Disorder noun [mass noun] ORIGIN late 15th cent. (as a verb in thesense ‘upset the order of’): alteration, influenced by ORDER, of theearlier disordain, from Old French desordener, ultimately based on Latinordinare ‘to ordain’


(of psychiatric illness) characterised byboth manic and depressive episodes, ormanic ones only.


DSM definition

Diagnostic Features:

The essential feature of Bipolar Idisorder is a clinical course that ischaracterised by the occurrence of oneor more Manic Episodes or MixedEpisodes. Often individuals have alsohad one or more Major DepressiveEpisodes…The essential feature ofBipolar II disorder is a clinical coursethat is characterised by the occurrenceof one or more Major DepressiveEpisodes accompanied by at least oneHypomanic Episode…The symptomsmust cause clinically significant distressor impairment in social, occupational, orother important areas of functioning.

The following specifiers may be used:Mild, Moderate, Severe withoutPsychotic Features; Severe withPsychotic Features; Chronic; WithCatatonic, Melancholic, AtypicalFeatures; With Postpartum Onset;Longitudinal Course Specifiers (With andWithout Interepisode Recovery);With Seasonal Pattern; With RapidCycling.


We have included the DSMdefinitions to inform you aboutofficial medical thinking.



bipo

lard

isorder

disordinebipo

lare

bipo

lare

Psycho

setra

storno

bipolar

bipo

lard

isorder


‘Boufée deliriante’ – Agitation, confusionand excitement.

West Africa and Haiti

‘Arctic hysteria’ – Episode of excitementoften later forgotten. Those affectedmay shed their clothes, break things,shout, run outside or put their safety atrisk.

Greenland Eskimos

‘Zar’ – Laughing, shouting, singing,weeping and withdrawal: thought to belinked with spirit possession.

North Africa and Middle East


I feel elated and then experiencevery low moods, where the swingbetween both moods is rapid.I can be bouncy and gloomyalmost simultaneously.When I am ‘high’ I have boundlessenergy, experience a flood ofcreative ideas and have no socialinhibitions.

My definition

bipolardisorderdisordine

bipolarebipolare

Psychosetrastorno

bipolarbipolardisorder

Dementianoun [mass noun] ORIGIN late 18th cent.: from Latin demens, dement


Medicine A chronic or persistent disorderof the mental processes caused by braindisease or injury and marked by memorydisorders, personality changes, andimpaired reasoning.


DSM definition

Diagnostic Features:

The essential feature of a dementia is thedevelopment of multiple cognitive deficitsthat include memory impairment and atleast one of the following cognitivedisturbances: aphasia, apraxia, agnosia,or a disturbance in executive functioning.The cognitive deficits must be sufficientlysevere to cause impairment inoccupational or social functioning andmust represent a decline from apreviously higher level of functioning.

A diagnosis of a dementia should not bemade if the cognitive deficits occurexclusively during the course of adelirium. However, a dementia and adelirium may both be diagnosed if thedementia is present at times when thedelirium is not present. Dementia may beetiologically related to a general medicalcondition, to the persisting effects ofsubstance use (including toxin exposure),or to a combination of these factors.

Memory impairment is required to makethe diagnosis of a dementia and is aprominent early symptom. Individualswith dementia become impaired in theirability to learn new material, or theyforget previously learned material. Mostindividuals with dementia have bothforms of memory impairment, although itis sometimes difficult to demonstrate theloss of previously learned material earlyin the course of the disorder. They maylose valuables like wallets and keys,forget food cooking on the stove, andbecome lost in unfamiliarneighbourhoods. In advanced stages ofdementia, memory impairment is sosevere that the person forgets his or heroccupation, schooling, birthday, familymembers, and sometimes even name.





dementia

démence

Dem

enz

demenza

demencia

démence

Dem

enz

demencia

dementia


‘Becoming a child again’ – Helplessbehaviour in an elderly person who isbelieved to have overstayed their timeon earth and been reincarnated.

Senegal

‘Hsieh-ping’ – Disorientation anddelirium: being in a trance state.

Taiwan


I have a memory loss, particularlyabout recent events.I recall and dwell on people andevents from the distant past.I am confused, irritable, anxiousand depressed.My moods fluctuate and mypersonality changes significantly.

My definition

dementia

démence

Dem

enzdem

enzadem

enciadém

enceDem

enzdem

enciadem

entia

In my own wordsHere are some ideas to help you to explore what your experience of mentaldistress feels like. Get in touch with your stories and descriptions – your wordscan help us set new standards for describing mental health issues.

How I feel about the medical language professionals use about me

What my family and friends say about my experience

anxiety

bipo

lard

isorder

dementia

depression

hyperactivity

phob

iaschizoph

renia

self-harm

anxietybipolardisorder

dementia

depressionhyperactivity

phobiaschizophrenia

self-harm

Ways of describing mental distress that I find acceptable

Ways of describing mental distress that I don’t find acceptable

Depressionnoun [mass noun] ORIGIN late Middle English from Latindepressio(n-) from deprimere ‘press down’


Severe despondency and dejection,typically felt over a period of time andaccompanied by feelings of hopelessnessand inadequacy.

Medicine a condition of mentaldisturbance characterised by suchfeelings to a greater degree than seemswarranted by the external circumstances,typically with lack of energy and difficultyin maintaining concentration or interest inlife: clinical depression.


DSM definition

Criteria for Major Depressive Episode:

Five (or more) of the following symptomshave been present during the same two-week period and represent a changefrom previous functioning; at least one ofthe symptoms is either depressed moodor loss of interest or pleasure.

depressed mood most of the day,nearly every daymarkedly diminished interest orpleasure in all, or almost allactivities most of the day, nearlyevery daysignificant weight loss when notdieting or weight gain, or changedappetiteinsomnia or hypersomniapsychomotor agitation orretardationfatigue or energy lossfeelings of worthlessness orexcessive or inappropriate guiltdiminished ability to think orconcentrate, or indecisivenessrecurrent thoughts of death,suicidal ideation or a suicideattempt.


We have included the DSM definitions toinform you about official medical thinking.



depression

dépression

depression

eDepression

dépression

depresión

depression


‘Brain fog’ – Fatigue from too muchthinking, difficulty concentrating,pressure and burning around the head.

West Africa

’Shenjian shuairuo’ – Physical andmental fatigue, sleep disturbance,difficulty concentrating, headaches andother pains.

China

‘Dhat’ – Feelings of weakness orexhaustion.

India


I feel a constant low mood thatdisables me.I can’t see even a glimmer of lightat the end of the tunnel.I have dark, frightening anduncomfortable thoughts thatplague me.I am so depressed it physicallyhurts.

My definition

depressiondépression

depressioneDepression

dépressiondepresión

depression

HyperactivityHyper- [prefix] from Greek huper over; beyond. Activity noun[mass noun] ORIGIN late Middle English: from French activité or Latinactivitas, from Latin act- ‘done’, from the verb agere ‘to do’


Hyperactive [adjective]: abnormally orextremely active.


DSM definition

Diagnostic Criteria:

The essential feature of Attention-Deficit/Hyperactivity Disorder is apersistent pattern of inattention and/orhyperactivity-impulsivity that is morefrequently displayed and more severethan is typically observed in individuals ata comparable level of development…

Some impairment from the symptomsmust be present in at least two settings(e.g. at home and at school or work).There must be clear evidence ofinterference with developmentallyappropriate social, academic, oroccupational functioning…

Inattention may be manifest in academic,occupational or social situations.Individuals with this disorder may fail togive close attention to details or maymake careless mistakes in schoolwork orother tasks…

Individuals often have difficultysustaining attention in tasks or playactivities and often find it hard to persistwith tasks until completion. They oftenappear as if their mind is elsewhere or asif they are not listening…

There may be frequent shifts from oneuncompleted activity to another...

Hyperactivity may be manifested byfidgetiness…by appearing to be often ‘onthe go’ or as if ‘driven by a motor’, or bytalking excessively…In adolescents andadults, symptoms take the form offeelings of restlessness and difficultyengaging in quiet sedentary activities.


hyperactivity

hyperactivité

iperattiv

itàhiperactividad

Hyperaktiv

ität

hyperactivity

nAround the world people say

‘Perdida del Alma’ – Restlessness andexcitability.

Latin America


I have boundless energy, feel alertand need little sleep.I switch my attention from onesubject to another all the time.

My definition




hyperactivityhyperactivité

iperattivitàhiperactividad

Hyperaktivität

hyperactivity

Phobianoun ORIGIN late 18th cent.: independent usage of -phobia via Latinfrom Greek


An extreme or irrational fear of oraversion to something.


DSM definition

Diagnostic Criteria forSpecific Phobia:

Marked and persistent fear that isexcessive or unreasonable, cued by thepresence of or anticipation of a specificobject or situation (e.g. flying, heights,animals, receiving an injection, seeingblood).

Exposure to the phobic stimulus almostinvariably provokes an immediate anxietyresponse, which may take the form of asituationally bound or situationallypredisposed Panic Attack.

The person recognises that the fear isexcessive or unreasonable.

The phobic situation(s) is avoided or elseendured with intense anxiety or distress.

The avoidance, anxious anticipation, ordistress in the feared situation(s)interferes significantly with the person’snormal routine, occupational (oracademic) functioning, or social activitiesor relationships, or there is markeddistress about having the phobia.

In individuals under 18 years, the durationis at least six months.





phob

iafobie

Phob

iefobia

fobie

Phob

iefobia

fobie

Phob

iefobie

fobia

phob

ia


‘Shinkeishitsu’ – Perfectionism, worryabout social situations and fear of illness.

Japan

‘Taijin kyofusho’ – Fear that other peopledislike one’s body or appearance.

Japan

‘Pa-feng and pa-leng’ – Fear of exposureto too much yin energy through being inwind or cold respectively.

China


I can’t survive without repeatingactions: for example hand cleaning,turning off electrical appliances.I am convinced for much of thetime that others will abandon me,get ill etc.I feel terror and panic that I realiseare unrealistic in proportion to thething I worry about, but can’tovercome my fears.I feel sick, clammy and breathlessand my heart pounds whenconfronted with my phobia (havinga panic attack).

My definition

phobiafobie

Phobiefobia

fobiePhobie

fobiafobie

Phobiefobie

fobiaphobia

Schizophrenianoun [mass noun] ORIGIN early 20th cent.: modern Latin, from Greekskhizein ‘to split’ + ‘mind’


A long-term mental disorder of a typeinvolving a breakdown in the relation betweenthought, emotion, and behaviour, leading tofaulty perception, inappropriate actions andfeelings, withdrawal from reality and personalrelationships into fantasy and delusion, and asense of mental fragmentation.


DSM definition

Diagnostic Criteria

Characteristic symptoms:Two (or more) of the following, each presentfor a significant portion of time during a one-month period (or less if successfully treated):

delusionshallucinationsdisorganised speech (e.g. frequentderailment or incoherence)grossly disorganised or catatonicbehaviournegative symptoms, i.e. affectiveflattening, alogia, or avolition.

Note: only one symptom is required ifdelusions are bizarre or hallucinations consistof a voice keeping up a running commentaryon the person’s behaviour or thoughts, or twoor more voices conversing with each other.

For a significant portion of the time sincethe onset of the disturbance, one or moremajor areas of functioning such as work,interpersonal relations, or self-care aremarkedly below the level achieved prior tothe onset (or when the onset is in childhoodor adolescence, failure to achieve expectedlevels of interpersonal, academic, oroccupational achievement).

Classifications of longitudinal course thatmay be applied:Episodic with Interepisode ResidualSymptoms; With Prominent NegativeSymptoms; Episodic With No InterepisodeResidual Symptoms; Continuous; WithProminent Negative Symptoms; SingleEpisode in Partial or Full Remission; Otheror Unspecified Pattern.

Diagnostic and Statistical Manual of MentalDisorders




schizoph

renia

schizoph

rénie

Schizoph

renie

schizofrenia

esqu

izofrenia

schizoph

renia

Around the world people say At Together we might say

I hear voices and/or have visions.I hold strong beliefs that others donot understand. I have thoughtsthat are persistent, and thisinterrupts my life.

My definition

schizophreniaschizophrénie

Schizophrenieschizofrenia

esquizofreniaschizophrenia

‘Spell’ – Folk term for a trance in whichpeople ‘talk to’ dead relatives or spirits.

Southern US states

‘Locura’ – Behaviour that does not followsocial rules, agitation, hallucinations.

Latin America

‘Ghost sickness’ – Obsession with death,hallucinations, disturbed dreams andfeelings of suffocation and futility.

American Indian groups

Self-harmSelf noun ORIGIN Old English, of Germanic origin: related to Dutchzelf and German selbe. Harm noun [mass noun] ORIGIN Old Englishhearm (noun), hearmian (verb), of Germanic origin: related to GermanHarm and Old Norse harmr ‘grief, sorrow’


Harm: Physical injury, especially that whichis deliberately inflicted.New Oxford Dictionary of English

DSM definition

There is no DSM category for self-harm.Self-mutilation is mentioned in theDiagnostic Criteria for BorderlinePersonality Disorder, where one of theindicators for the condition is given as:‘recurrent suicidal behaviour, gestures, orthreats, or self-mutilating behaviour’ (if partof a pervasive pattern of instability andpresent in a variety of contexts). Five ormore indicators need to be present for adiagnosis of Borderline Personality Disorderto be made.

Diagnostic and Statistical Manual of MentalDisorders

The website of the National Self-HarmNetwork at www.nshn.co.uk dispels somecommon myths and gives the followingfacts about self-harm.

Self-injury and suicide have an intimaterelationship, but are different.

Self-injury often represents theprevention of a suicidal period.Self-injury is one way of avertingsuicide.Self-injury may be a survivalstrategy.Self-injury is frequently the leastpossible amount of damage andrepresents extreme self-restraint.

A diminishing sense of worth may culminatein suicide as its ultimate expression.

People who self-injure are statistically at agreater risk of going on to commit suicide.

Accident and emergency staff may assumethat the severity of the injury represents theseverity of the condition. This leads tosome common misconceptions:

‘If it’s not an artery they don’t mean it. It’sacting out.’

‘Minor injuries are attention-seeking andaren’t serious.’

‘Serious injuries mean psychosis.’

‘It’s masochism.’

People who self-injure have responded thatself-harm is not an easy way of attractingattention, a behaviour or development‘disorder’ or a diagnosis – it is a privateactivity and accident and emergencydepartments will see only a few of theinjuries before healing. Commonly it is adialogue with yourself: an expression ofinexpressible emotion or an absence ofself-value. The seriousness of an injurymay not indicate the extreme distress thatthe injury represents.




self-harm

auto-m

utiler

automutilare

automutilar

Selbstmutilieren

auto-m

utiler

self-harm


‘Koro’ – Fear that the genitals will retractinto the body and cause death: peoplemay self-injure to prevent this.

South-east Asia


I injure myself by cutting or hittingmy body as a way of dealing withdeep feelings of distress.I misuse alcohol or drugs.My relationship with food isuncomfortable, even destructive.I get involved in abusiverelationships.I punish or distract myself to copewith numb feelings or painfulmemories.Expressing myself through a‘silent scream’ is the only way Ihave of communicating or takingcontrol.I hide the evidence from friendsand family.

My definition

self-harmauto-m

utilerautom

utilareautom

utilarSelbstm

utilierenauto-m

utilerself-harm

This booklet from Together’s Directorate of Service-userInvolvement looks at how common mental health issuesare described by different groups including doctors,dictionary writers, and the people who live with themaround the world. For each experience the book gives:

a dictionary definitiona medical definitionexamples of what people around the world sayexamples of what people at Together have said.

Most important of all there is also space for you to writedown your own thoughts and feelings about yourexperiences because at Together we believe that you arethe expert, and your own experience is just as meaningfulas an official diagnosis.

This book is designed to support you to talk to people likeprofessionals using language you feel comfortable withrather than medical jargon. We hope you will use it tochallenge stereotypes, record your goals and celebrateyour individuality.

For more information contact:Together’s Directorate of Service-user Involvement82a Wick StreetLittlehamptonWest Sussex BN17 7JS01903 733443Email [email protected]

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Documents

Talking Mental Health.ps, page 1-23 @ Normalize ( Talking Meental )