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Mental health awareness is a crucial topic in contemporary society that seeks to educate individuals on mental health disorders, reduce stigma, and advocate for accessible treatment. When constructing a thesis on this topic, a decisive, clear, and specific thesis statement is imperative. This text will provide and analyze good and bad thesis statement examples on mental health awareness to guide students in developing robust research arguments.

Good Thesis Statement Examples

Specific and Clear: “The research quantitatively analyzes the impact of school-based mental health awareness programs on adolescents’ levels of depression and anxiety.” Bad: “School programs about mental health awareness are important.”

The good example is specific and clear, offering a quantitative approach, focus group (adolescents), and measurable outcomes (levels of depression and anxiety). Conversely, the bad example is vague, lacking clear metrics or specific focus areas.

Well-defined Scope: “This thesis explores the role of social media in propagating mental health stigma among adults in the United States.” Bad: “Social media plays a role in mental health.”

The good statement precisely defines the scope, focusing on stigma propagation, the adult demographic, and limiting the study to the United States. The bad example is too broad and lacks specificity on the aspect of mental health and target demographic.

Arguable and Debatable: “The availability of teletherapy services significantly improves access to mental health care for rural populations facing transportation barriers.” Bad: “Teletherapy services are beneficial.”

The good thesis is arguable and presents a specific claim about teletherapy’s impact on rural populations and access barriers, whereas the bad example is non-debatable and too general without a particular focus or claim.

Bad Thesis Statement Examples

Overly Broad: “Mental health is important for everyone.”

This statement, while true, is too broad and general. It doesn’t guide the reader towards a specific aspect of mental health, making it ineffective for a thesis.

Lack of Clear Argument: “Mental health issues affect people in different ways.”

While this statement is factual, it lacks a clear argument or focus, leaving the reader without direction or understanding of the paper’s purpose. Seeking paraphrasing help can enhance the clarity and focus of your statement, ensuring your paper effectively communicates its purpose.

Unmeasurable and Unresearchable: “Positive thinking can cure mental disorders.”

This statement is not only scientifically incorrect but also unmeasurable and unresearchable, making it inappropriate for scholarly research.

A strong thesis statement is pivotal for the success of a thesis on Mental Health Awareness. As illustrated, good thesis statements are clear, specific, and arguable with a well-defined scope, guiding the reader effortlessly through the research’s purpose and objectives. In contrast, bad thesis statements are often overly broad, lack clear arguments, and are not measurable or researchable, leading to confusion and a lack of direction. By carefully considering these examples, students can craft thesis statements that offer clarity, precision, and a roadmap for their research on the vital and complex issue of mental health awareness.

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Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review

Ahmed a ahad.

1 Psychiatry and Behavioral Sciences, Florida International University, Herbert Wertheim College of Medicine, Miami, USA

Marcos Sanchez-Gonzalez

2 Health Services Administration, Lake Erie College of Osteopathic Medicine, Bradenton, USA

Patricia Junquera

Stigma, characterized by negative stereotypes, prejudice, and discrimination, is a significant impediment in psychiatric care, deterring the timely provision of this care and hindering optimal health outcomes. Pervasive in all aspects of psychiatric care, stigma leads to delayed treatment, increased morbidity, and diminished quality of life for those with poor mental health. Hence, better understanding the impact of stigma across different cultural contexts is critically essential, aiming to inform culturally nuanced strategies to minimize its consequences and contribute to a more equitable and effective psychiatric care system. The purpose of the present literature review is twofold (i) to examine the existing research on the stigma surrounding psychiatry across different cultural contexts and (ii) to identify the commonalities and differences in the nature, magnitude, and consequences of this stigma in different cultures in the psychiatry field. In addition, potential strategies for addressing stigma will be proposed. The review covers a range of countries and cultural settings, emphasizing the importance of understanding cultural nuances to combat stigma and promote mental health awareness globally.

Introduction and background

Stigma, characterized by societal prejudice and discrimination, profoundly influences psychiatric care, creating barriers to the timely recognition and treatment of mental health disorders [ 1 ]. Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of psychiatric care, leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.

The importance of addressing stigma in psychiatry cannot be overstated as stigma impacts individuals seeking care, their families, healthcare professionals, and broader society. At the individual level, stigma can lead to fear and avoidance of mental health services, causing delays in seeking help even when a patient is in dire need. Delays in seeking care can exacerbate mental health conditions leading to worse outcomes and reduced quality of life [ 2 ]. For families, the stigma can lead to shame and isolation, making seeking necessary support and resources more difficult. Interestingly, in healthcare professionals, stigma can lead to burnout and demoralization, reducing the quality and provision of care. Stigmatization can also create barriers between healthcare providers and patients, complicating matters to establishing trustful and therapeutic relationships, which are essential for effective care [ 1 ]. For society at large, stigma can result in the misallocation of resources, with mental health services often being underfunded and overlooked [ 3 ]. Hence stigma has profound effects at personal and societal levels, negatively impacting multiple levels of the psychotic care continuum. 

Addressing the stigma surrounding mental health can significantly enhance the effectiveness of psychiatric care. To this end, developing programs and strategies that foster a culture of understanding and acceptance may encourage more individuals to seek help when they need it, improving early detection and intervention, which are crucial for better health outcomes. Furthermore, challenging and changing stigmatizing attitudes can improve the therapeutic relationship between healthcare providers and patients, leading to more personalized and effective treatment strategies.

Stigma, however, is not a monolithic entity but varies across cultures, influenced by distinct societal norms, values, and beliefs. Understanding these cultural variations is essential for developing effective, culturally sensitive interventions. Therefore, this literature review aims to examine the manifestation and impacts of stigma across different cultural contexts, laying the foundation for tailored strategies to combat this healthcare barrier.

Stigma as a psychological construct

In the literature, there have been several attempts at creating instruments to measure and understand stigma as a psychological construct in the context of mental health. In this vein, the Internalized Stigma of Mental Illness (ISMI) scale and the Perceived Devaluation-Discrimination Scale, among others, seek to quantify stigma more objectively [ 4 , 5 ] . The ISMI scale, as defined by Ritsher et al. (2003), measures the subjective experience of stigma, including the internalization of negative stereotypes and beliefs about mental illness [ 4 ]. It includes five subscales: Alienation, Stereotype Endorsement, Discrimination Experience, Social Withdrawal, and Stigma Resistance. These subscales were further defined as follows: (i) Alienation: The feeling of being less than a full member of society due to one's mental illness, (ii) Stereotype Endorsement: The extent to which the individual agrees with common negative stereotypes about people with mental illness, (iii) Discrimination Experience: Personal experiences of rejection or exclusion due to mental illness, (iv) Social Withdrawal: The extent to which the individual avoids social situations for fear of being stigmatized, and (v) Stigma Resistance: The individual's ability to resist or counteract stigma. The Perceived Devaluation-Discrimination Scale, as described by Link (1987), measures the extent to which individuals believe that most people will devalue or discriminate against someone with a mental illness [ 5 ]. It focuses on the individual's perceptions of societal attitudes, rather than their personal experiences with stigma. Overall, while the ISMI scale can give insights into the internalization and personal experience of stigma, the Perceived Devaluation-Discrimination Scale can provide a view of societal attitudes and perceived discrimination. The above are crucial to understanding the full landscape of stigma in psychiatry across different cultures by helping identify where interventions might be most needed and most effective, whether at the level of societal attitudes, personal beliefs, or both. The pervasive nature of stigma presents a daunting challenge to psychiatry, necessitating a rigorous and nuanced approach to its understanding and mitigation. However, despite recent awareness campaigns, the field still struggles with the barriers that stigma imposes on patient care, necessitating additional analysis of the effects.

Individual and societal impact of stigma

Stigmatization of mental illness across cultures is a significant barrier to psychiatric care. The stigma can lead to delayed diagnosis and treatment-seeking behaviors, reduced quality of life, and an increased risk of social exclusion and discrimination [ 2 ]. Furthermore, mental illness stigma often intersects with other forms of stigma, such as gender, race, and socio-economic status, leading to further marginalization of already vulnerable populations making it challenging to provide equitable, culturally sensitive, and effective psychiatric care to individuals with mental illness. Accumulating research suggests that stigma toward mental illness is common in various cultures, which can affect mental illness diagnosis, treatment, and management [ 6 ]. Furthermore, some studies reveal that mental health stigma manifests differently across cultures and can be influenced by cultural beliefs, attitudes, and values [ 7 ]. The stigma surrounding psychiatry and mental health disorders has numerous detrimental effects on individuals and communities, including:

1. Delayed Treatment-Seeking Behavior

Stigma plays a significant role in delaying treatment-seeking behavior for individuals struggling with mental health issues. The fear of being labeled, ostracized, or misunderstood due to their condition often deters individuals from seeking help promptly. According to a study by Clement et al. (2015), stigma was associated with an increased likelihood of delaying or avoiding seeking help for mental health concerns [ 8 ]. Consequently, symptoms may worsen over time, escalating the condition's severity and making treatment and prospective recovery more challenging. Healthcare delays can also lead to decreased self-esteem and increased depressive symptoms, creating a vicious cycle of self-blame, isolation, and hopelessness. Prolonged untreated mental health issues can further impair an individual's functionality in various life domains, including work, relationships, and self-care, thus reducing their overall quality of life [ 9 ].

2. Social Isolation and Discrimination

Stigma can lead to social isolation and discrimination for those affected by mental health issues. Brohan and Thornicroft (2010) found that individuals with mental health disorders often face discrimination in multiple life domains, including employment and interpersonal relationships [ 2 ]. The negative stereotypes and misconceptions surrounding mental illness often result in a lack of understanding and empathy from others, leading to social exclusion [ 10 ]. Individuals with mental health issues might face discrimination in various aspects of life, including the workplace, where they might encounter bias in hiring, job retention, and career advancement. Furthermore, to complicate matters, discrimination can further strain personal relationships, as friends and family may distance themselves due to discomfort, fear, or misunderstanding, exacerbating feelings of isolation and loneliness [ 9 ].

3. Reduced Treatment Adherence

Stigma can significantly impact adherence to mental health treatments. Sirey et al. (2001) found that perceived stigma predicted treatment discontinuation in older adults with depression [ 11 ]. People living with mental health conditions may avoid or discontinue treatment due to fear of being identified as a mental health patient. This fear could stem from concerns about the stigma associated with visiting mental health facilities, taking psychiatric medications, or being seen engaging in therapeutic activities [ 12 ]. Non-adherence to treatment regimens can lead to suboptimal treatment outcomes, hinder recovery, and increase the risk of relapse or worsening symptoms. Furthermore, stigma can diminish self-efficacy, making individuals less likely to actively engage in their treatment process, which is crucial for successful recovery.

4. Perpetuation of Misconceptions

Stigmatizing attitudes towards mental illness contribute to the perpetuation of harmful stereotypes and misinformation. AsCorrigan and Watson (2007) discussed, stereotypes such as appearing dangerous, unpredictable, or culpable for their illness can make people with mental illness perceived inaccurately as dangerous or to blame for their condition, both internally and externally [ 12 ]. Stereotyping, deeply embedded in societal attitudes, can foster a culture of fear, rejection, and discrimination against individuals with mental health conditions. Misconceptions often result in people with mental health issues being perceived inaccurately as dangerous, unpredictable, or responsible for their condition. In addition, misinformation can hinder public understanding and acceptance of mental illness, exacerbating stigma while negatively influencing policy and legislation, leading to inadequate funding and support for mental health services.

5. Influence of Gender on Stigma

The impact of stigma on individuals with mental illness is known to vary across different social and demographic categories, including gender. Research evidence indicates that the experience of stigma related to mental illness can be significantly different for men and women, and these differences can be further influenced by cultural context.

In some societies, women seem to face higher levels of stigma related to mental health issues compared with men. A study by Al Krenawi et al. (2006) conducted in the Bedouin-Arab community found that women experienced a significantly higher degree of stigma associated with mental illness than their male counterparts [ 13 ]. This may be due to traditional gender roles and societal expectations, which often place women in a more subordinate position and associate mental illness with weakness or vulnerability. Women with mental illnesses may therefore face dual discrimination - first for their gender and then for their mental health condition. This can make women less likely to seek help for mental health issues, further exacerbating their condition and creating a vicious cycle of stigma and untreated mental illness.

However, the influence of gender on stigma is not uniform across all cultures. Ayalon and Areán's (2004) study on older adults in an Arab cultural context found that men reported higher levels of perceived stigma related to mental illness than women [ 14 ]. This discrepancy might be rooted in traditional masculine norms prevalent in many Arab societies, which value strength, stoicism, and emotional control. Mental illness, which is often erroneously perceived as a sign of emotional weakness or lack of control, can be particularly stigmatizing for men in these contexts. Furthermore, the expectation for men to be the primary earners and providers in the family can make the potential economic impacts of mental illness, such as unemployment or reduced productivity, particularly stigmatizing.

These findings underscore the importance of considering gender and cultural context in understanding and addressing stigma related to mental illness. It is crucial to develop and implement culturally sensitive strategies that consider these differences in the experience of stigma. This might involve, for example, promoting mental health literacy, challenging harmful gender norms, and providing gender-specific mental health services. We can move toward a more equitable and effective mental health care system by acknowledging and addressing the unique stigma-related challenges different groups face.

Ethnic and cultural variations in stigma

The stigma surrounding psychiatry, as research suggests, manifests differently across cultures due to various factors [ 7 ]. This stigma operates at various levels, including individuals, families, healthcare providers, and society, and cultural norms, religious beliefs, and social attitudes influence its manifestations and implications.

At the individual level, mental health issues may be internalized differently depending on cultural background. For instance, some Asian cultures may view mental health issues as a sign of personal weakness or a failure of self-control [ 15 ]. The internalization of stigma can significantly influence an individual's self-perception and willingness to seek help. In the family context, cultural beliefs also play a significant role in shaping attitudes toward mental health. A study by Yang and Kleinman (2008) found that in Chinese culture, mental illness is often attributed to social and interpersonal factors, such as family conflict [ 16 ]. Such attributions can contribute to a sense of shame or blame within the family, exacerbating the stigma experienced by the individual with mental illness.

Healthcare providers are not immune to these cultural beliefs and they can influence their practice. In some cultures, mental illnesses are viewed through a supernatural lens rather than a medical one. Girma et al. (2013) found that in Ethiopian culture, mental illness is commonly associated with supernatural causes, such as evil spirits or curses [ 17 ]. This widely held belief can influence healthcare providers' approach and potentially limit the provision of evidence-based psychiatric care.

Lastly, at the societal level, these cultural perceptions and beliefs can contribute to the broader social stigma surrounding mental health, leading to discrimination and social exclusion. Differences in societal perceptions across cultures can lead to distinct forms of discrimination, further compounding the challenges faced by individuals with mental health issues. Hence, understanding and addressing cultural stigma in psychiatry involves a multifaceted approach that considers individual, family, healthcare providers, and societal levels. Each level offers potential avenues for stigma reduction and improved mental health outcomes.

Asian Cultures

In many Asian societies, mental health issues are often perceived as a sign of personal weakness or a failure of self-control. The concept of 'face' is significantly influential, and the stigma associated with mental illness can be seen as bringing shame to the family [ 15 ]. For instance, a strong cultural emphasis on academic and professional achievement in South Korea contributes to stigmatizing attitudes toward mental illness, which may discourage individuals from seeking help [ 18 ].

African Cultures

Mental illnesses in some African cultures are often attributed to spiritual or supernatural causes such as curses or possession by evil spirits. This understanding can contribute to high levels of stigma and deter individuals from seeking psychiatric help [ 19 ]. In Ethiopia, the belief in supernatural causes of mental illness has been reported, leading to the stigmatization of affected individuals [ 17 ].

Arab Cultures

Mental illness in Arab societies is frequently viewed as a form of divine punishment. Religious belief perpetuating mental health stigma can lead to delayed or avoided treatment as individuals may resort to religious or spiritual interventions [ 20 ].

Latin American Cultures

In some Latin American cultures, mental illness is often attributed to personal weakness or lack of willpower. This perspective could stigmatize individuals with mental health disorders and discourage them from seeking psychiatric care [ 21 ].

Western Cultures

In Western societies, stigma often stems from misconceptions about mental illness, including the belief that individuals with mental health disorders are dangerous or unpredictable. While mental illness is recognized more as a health issue, stigma still exists, often resulting in social exclusion and discrimination [ 12 ].

Additionally, culture-bound syndromes, defined here as a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease within specific cultures or societies, are a critical component of a discussion on cultural stigma in psychiatry. That is to say, culture-bound syndromes refer to unique mental health conditions closely tied to specific cultures or ethnic groups. For instance, among the Latino community, 'Ataque de Nervios,' characterized by uncontrollable shouting, crying, trembling, and sometimes aggressive behavior, is a recognized condition often associated with a stressful event such as a panic attack [ 21 ].

Hence, a clinician's awareness and understanding of such culture-bound syndromes can enhance their diagnostic and therapeutic effectiveness. In fact, a study conducted by Hughes and Wintrob (1995) in New York discovered a significant improvement in therapeutic relationships when clinicians were knowledgeable about culture-bound syndromes prevalent in their patients' cultures, such as 'Qigong Psychotic Reaction' in Chinese immigrants, a condition associated with overdoing Qigong, a type of spiritual martial art [ 22 ].

Furthermore, cultural competence, which includes knowledge about culture-bound syndromes, has a substantial impact on treatment outcomes. Culturally competent care, defined by an understanding and respect for cultural differences, can improve patient satisfaction and adherence to treatment. A systematic review by Truong et al. (2014) demonstrated the positive effect of cultural competence on healthcare outcomes, including in a Native American population suffering from 'Ghost Sickness,' a culture-bound syndrome characterized by feelings of terror, weakness, and a sense of impending doom, often linked to the perceived presence of the supernatural [ 23 ].

Simultaneously, addressing culture-bound syndromes can influence and reduce mental health stigma across cultures. Misinterpretation of these syndromes can contribute to stigma, as individuals might be wrongly diagnosed or misunderstood. For instance, Kirmayer's (2012) study on cultural variations in depression and anxiety found that misunderstanding culture-bound syndromes, such as 'Taijin Kyofusho,' a Japanese syndrome characterized by an intense fear that one's body or bodily functions are displeasing to others, could lead to misdiagnosis and increase stigma [ 24 ]. Practices that raise awareness of culture-bound syndromes offer a deeper, richer perspective on cultural influences on mental health. Awareness and understanding of these syndromes can enhance diagnostic and treatment approaches, optimize patient outcomes, and potentially contribute to reducing mental health stigma across various cultures.

Taken together, these studies highlight the importance of understanding cultural contexts when addressing the stigma surrounding mental health disorders and psychiatric care. The cultural beliefs and attitudes towards mental health disorders, summarized below in Table ​ Table1, 1 , influence how stigma is manifested and the approaches needed to reduce it effectively. By acknowledging cultural variations, more culturally appropriate and effective strategies can be developed to combat stigma and improve mental health care across different societies worldwide.

Strategies for addressing mental health stigma

Several strategies have been proposed in the literature to address the stigma surrounding psychiatry across cultures:

1. Public Awareness Campaigns

Awareness campaigns can be instrumental in dismantling misconceptions and fostering understanding of mental health disorders. Public awareness campaigns can dispel myths, reduce stigma, and encourage empathy towards affected individuals by promoting accurate information about mental illnesses, their prevalence, and the possibilities for recovery. For instance, a study by Pinfold et al., (2003) showed that public campaigns using direct social contact with people with mental illness could significantly improve public attitudes towards mental health [ 25 ]. The study by Pinfold et al., (2003) implemented educational interventions in UK secondary schools, consisting of video presentations and direct social contact with individuals who had personal experiences with mental illness [ 25 ]. The UK campaign's goal was to challenge common myths about mental illness and replace them with accurate information. The results showed that students exposed to this intervention demonstrated less fear and avoidance of people with mental health problems and were more likely to see them as individuals rather than defining them by their illness.

2. Cultural Competency Training for Healthcare Professionals

Medical education can equip healthcare providers with the necessary knowledge and skills to understand and respect their patients' cultural backgrounds and experiences, which is critical for reducing stigma in healthcare settings. Research indicates that healthcare providers who lack cultural competence may inadvertently contribute to stigma, further deterring patients from seeking help [ 26 ]. A study by Kirmayer (2012) found that cultural competence training improved healthcare providers' understanding of cultural influences on health behaviors and led to more effective patient-provider communication, thereby reducing perceived stigma [ 24 ]. For instance, a study in Australia provided cultural competency training to healthcare providers and found that their understanding of Indigenous Australians' health needs significantly improved [ 24 ]. They were able to better respect and incorporate Indigenous perspectives in treatment, which led to increased trust and better patient-provider relationships.

3. Peer Support Programs

People with lived experiences of mental health disorders who share their stories, can normalize mental health issues and challenge stigma. By providing real-life examples of individuals living with and managing their mental health disorders, peer-to-peer advocacy programs may debunk myths and reduce the perceived 'otherness' of mental illness. A study by Pitt et al. (2013) showed that peer support reduced self-stigma and improved self-esteem and empowerment among individuals with mental health disorders [ 27 ]. The study focused on "consumer-providers," individuals who had personally experienced mental health issues and were now providing support services to others. The findings demonstrated that consumer-providers significantly reduced self-stigma among service users, while also improving self-esteem and feelings of empowerment.

4. Community-Based Mental Health Services

Integrating mental health care into primary care and community settings can reduce the stigma associated with seeking psychiatric help. This emphasis on integrating measures for mental well-being along with other routine and standard primary care protocols allows mental health care to be more accessible and less intimidating, encouraging individuals to seek help when needed. A study by Thornicroft et al. (2015) found that community-based mental health services can reduce stigma and discrimination and improve mental health outcomes [ 28 ]. For instance, a program in India called the MANAS project integrated mental health services into primary care and community settings [ 28 ]. This approach not only made mental health services more accessible but also more 'normal' and less stigmatizing. The project reported a significant increase in the utilization of mental health services and a decrease in the experience of stigma among service users.

5. Evidence-Based Approach

Another approach to overcoming the barriers created by stigma is to use evidence-based methods to reduce mental illness stigma. A meta-analysis by Corrigan et al. (2016) found that various evidence-based interventions, including education and contact-based interventions, can effectively reduce mental illness stigma across cultures [ 9 ]. Contact-based interventions involve interaction between people with mental illness and members of the public to challenge negative attitudes and beliefs. Education-based interventions aim to increase knowledge and awareness of mental illness and reduce negative stereotypes. Educational interventions can be delivered in a variety of formats, such as in-person workshops, online courses, and mass media campaigns.

The role of the healthcare provider in ameliorating stigma cannot be overlooked. Moreover, a review by Ayalon and Areán (2004) suggests that mental health providers can play a critical role in reducing mental illness stigma by engaging in culturally sensitive practices [ 14 ]. For instance, mental health providers can develop cultural competence, which refers to the ability to provide effective services to individuals from diverse cultural backgrounds. Cultural competence involves understanding and respecting cultural differences, tailoring treatment to meet diverse populations' unique needs, and integrating cultural factors into treatment planning.

Research also highlights that stigma towards mental illness has significant implications for treating and managing mental health conditions. For example, several studies suggest that stigma can lead to delayed diagnosis and treatment-seeking behaviors [ 13 , 16 ]. This is concerning because early intervention is critical for managing mental illness and improving outcomes for individuals living with these conditions. Considering the documented impact of stigma on timely diagnosis and treatment-seeking behaviors, strategies such as public awareness campaigns, cultural competency training for healthcare professionals, peer support programs, community-based mental health services, and an evidence-based approach can play a crucial role in combating cultural stigma in psychiatry. These measures collectively contribute to improved awareness, understanding, and acceptance of mental health conditions, thus facilitating early intervention and better management of mental illnesses across diverse cultural contexts.

Conclusions

Stigma surrounding mental health and psychiatric care is a complex and multifaceted issue that varies across ethnic and cultural contexts. To effectively address and reduce stigma in mental healthcare settings, developing culturally sensitive interventions and promoting understanding and acceptance of mental health issues is crucial. By doing so, we can work towards improving access to mental health care and promoting the well-being of individuals and communities across the globe.

Overall, the literature suggests that stigma is a complex and pervasive issue that affects individuals with mental illness across cultures. The studies reviewed reveal that mental illness stigma is influenced by cultural beliefs, attitudes, and values, and can manifest in different ways across cultures. It is important to understand these cultural differences to develop more effective interventions to reduce mental illness stigma and improve outcomes for individuals living with mental illness. Furthermore, stigma across cultures impacts psychiatric care in various ways and can create significant barriers to effective treatment. Evidence-based interventions, including education, contact-based interventions, and culturally sensitive practices can help overcome these barriers. Mental health providers should strive to develop cultural competence and deliver culturally sensitive interventions to meet the needs of diverse populations. Research to understand the impact of stigmatization of mental health patients and its impact in providing services is warranted. Reducing mental illness stigma is critical to providing equitable, effective, and compassionate psychiatric care to individuals with mental illness.

The authors have declared that no competing interests exist.

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• 10 February 2020

Scrutinizing the effects of digital technology on mental health

• Jonathan Haidt &

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The topic in brief

• There is an ongoing debate about whether social media and the use of digital devices are detrimental to mental health.

• Adolescents tend to be heavy users of these devices, and especially of social media.

• Rates of teenage depression began to rise around 2012, when adolescent use of social media became common (Fig. 1).

• Some evidence indicates that frequent users of social media have higher rates of depression and anxiety than do light users.

• But perhaps digital devices could provide a way of gathering data about mental health in a systematic way, and make interventions more timely.

Figure 1 | Depression on the rise. Rates of depression among teenagers in the United States have increased steadily since 2012. Rates are higher and are increasing more rapidly for girls than for boys. Some researchers think that social media is the cause of this increase, whereas others see social media as a way of tackling it. (Data taken from the US National Survey on Drug Use and Health, Table 11.2b; go.nature.com/3ayjaww )

JONATHAN HAIDT: A guilty verdict

A sudden increase in the rates of depression, anxiety and self-harm was seen in adolescents — particularly girls — in the United States and the United Kingdom around 2012 or 2013 (see go.nature.com/2up38hw ). Only one suspect was in the right place at the right time to account for this sudden change: social media. Its use by teenagers increased most quickly between 2009 and 2011, by which point two-thirds of 15–17-year-olds were using it on a daily basis 1 . Some researchers defend social media, arguing that there is only circumstantial evidence for its role in mental-health problems 2 , 3 . And, indeed, several studies 2 , 3 show that there is only a small correlation between time spent on screens and bad mental-health outcomes. However, I present three arguments against this defence.

First, the papers that report small or null effects usually focus on ‘screen time’, but it is not films or video chats with friends that damage mental health. When research papers allow us to zoom in on social media, rather than looking at screen time as a whole, the correlations with depression are larger, and they are larger still when we look specifically at girls ( go.nature.com/2u74der ). The sex difference is robust, and there are several likely causes for it. Girls use social media much more than do boys (who, in turn, spend more of their time gaming). And, for girls more than boys, social life and status tend to revolve around intimacy and inclusion versus exclusion 4 , making them more vulnerable to both the ‘fear of missing out’ and the relational aggression that social media facilitates.

Second, although correlational studies can provide only circumstantial evidence, most of the experiments published in recent years have found evidence of causation ( go.nature.com/2u74der ). In these studies, people are randomly assigned to groups that are asked to continue using social media or to reduce their use substantially. After a few weeks, people who reduce their use generally report an improvement in mood or a reduction in loneliness or symptoms of depression.

The best way forward

Third, many researchers seem to be thinking about social media as if it were sugar: safe in small to moderate quantities, and harmful only if teenagers consume large quantities. But, unlike sugar, social media does not act just on those who consume it. It has radically transformed the nature of peer relationships, family relationships and daily activities 5 . When most of the 11-year-olds in a class are on Instagram (as was the case in my son’s school), there can be pervasive effects on everyone. Children who opt out can find themselves isolated. A simple dose–response model cannot capture the full effects of social media, yet nearly all of the debate among researchers so far has been over the size of the dose–response effect. To cite just one suggestive finding of what lies beyond that model: network effects for depression and anxiety are large, and bad mental health spreads more contagiously between women than between men 6 .

In conclusion, digital media in general undoubtedly has many beneficial uses, including the treatment of mental illness. But if you focus on social media, you’ll find stronger evidence of harm, and less exculpatory evidence, especially for its millions of under-age users.

What should we do while researchers hash out the meaning of these conflicting findings? I would urge a focus on middle schools (roughly 11–13-year-olds in the United States), both for researchers and policymakers. Any US state could quickly conduct an informative experiment beginning this September: randomly assign a portion of school districts to ban smartphone access for students in middle school, while strongly encouraging parents to prevent their children from opening social-media accounts until they begin high school (at around 14). Within 2 years, we would know whether the policy reversed the otherwise steady rise of mental-health problems among middle-school students, and whether it also improved classroom dynamics (as rated by teachers) and test scores. Such system-wide and cross-school interventions would be an excellent way to study the emergent effects of social media on the social lives and mental health of today’s adolescents.

NICK ALLEN: Use digital technology to our advantage

It is appealing to condemn social media out of hand on the basis of the — generally rather poor-quality and inconsistent — evidence suggesting that its use is associated with mental-health problems 7 . But focusing only on its potential harmful effects is comparable to proposing that the only question to ask about cars is whether people can die driving them. The harmful effects might be real, but they don’t tell the full story. The task of research should be to understand what patterns of digital-device and social-media use can lead to beneficial versus harmful effects 7 , and to inform evidence-based approaches to policy, education and regulation.

Long-standing problems have hampered our efforts to improve access to, and the quality of, mental-health services and support. Digital technology has the potential to address some of these challenges. For instance, consider the challenges associated with collecting data on human behaviour. Assessment in mental-health care and research relies almost exclusively on self-reporting, but the resulting data are subjective and burdensome to collect. As a result, assessments are conducted so infrequently that they do not provide insights into the temporal dynamics of symptoms, which can be crucial for both diagnosis and treatment planning.

By contrast, mobile phones and other Internet-connected devices provide an opportunity to continuously collect objective information on behaviour in the context of people’s real lives, generating a rich data set that can provide insight into the extent and timing of mental-health needs in individuals 8 , 9 . By building apps that can track our digital exhaust (the data generated by our everyday digital lives, including our social-media use), we can gain insights into aspects of behaviour that are well-established building blocks of mental health and illness, such as mood, social communication, sleep and physical activity.

Stress and the city

These data can, in turn, be used to empower individuals, by giving them actionable insights into patterns of behaviour that might otherwise have remained unseen. For example, subtle shifts in patterns of sleep or social communication can provide early warning signs of deteriorating mental health. Data on these patterns can be used to alert people to the need for self-management before the patterns — and the associated symptoms — become more severe. Individuals can also choose to share these data with health professionals or researchers. For instance, in the Our Data Helps initiative, individuals who have experienced a suicidal crisis, or the relatives of those who have died by suicide, can donate their digital data to research into suicide risk.

Because mobile devices are ever-present in people’s lives, they offer an opportunity to provide interventions that are timely, personalized and scalable. Currently, mental-health services are mainly provided through a century-old model in which they are made available at times chosen by the mental-health practitioner, rather than at the person’s time of greatest need. But Internet-connected devices are facilitating the development of a wave of ‘just-in-time’ interventions 10 for mental-health care and support.

A compelling example of these interventions involves short-term risk for suicide 9 , 11 — for which early detection could save many lives. Most of the effective approaches to suicide prevention work by interrupting suicidal actions and supporting alternative methods of coping at the moment of greatest risk. If these moments can be detected in an individual’s digital exhaust, a wide range of intervention options become available, from providing information about coping skills and social support, to the initiation of crisis responses. So far, just-in-time approaches have been applied mainly to behaviours such as eating or substance abuse 8 . But with the development of an appropriate research base, these approaches have the potential to provide a major advance in our ability to respond to, and prevent, mental-health crises.

These advantages are particularly relevant to teenagers. Because of their extensive use of digital devices, adolescents are especially vulnerable to the devices’ risks and burdens. And, given the increases in mental-health problems in this age group, teens would also benefit most from improvements in mental-health prevention and treatment. If we use the social and data-gathering functions of Internet-connected devices in the right ways, we might achieve breakthroughs in our ability to improve mental health and well-being.

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Competing Interests

N.A. has an equity interest in Ksana Health, a company he co-founded and which has the sole commercial licence for certain versions of the Effortless Assessment of Risk States (EARS) mobile-phone application and some related EARS tools. This intellectual property was developed as part of his research at the University of Oregon’s Center for Digital Mental Health (CDMH).

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Research Article

What should we call mental ill health? Historical shifts in the popularity of generic terms

Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft

* E-mail: [email protected]

Affiliation Melbourne School of Psychological Sciences University of Melbourne Parkville, Melbourne, Victoria, Australia

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Writing – review & editing

• Nick Haslam, 

• Published: June 4, 2024
• https://doi.org/10.1371/journal.pmen.0000032
• Reader Comments

Substantial attention has been paid to the language of mental ill health, but the generic terms used to refer to it–“mental illness”, “psychiatric condition”, “mental health problem” and so forth–have largely escaped empirical scrutiny. We examined changes in the prevalence of alternative terms in two large English language text corpora from 1940 to 2019. Twenty-four terms were studied, compounds of four adjectival expressions (“mental”, “mental health”, “psychiatric”, “psychological”) and six nouns (“condition”, “disease”, “disorder”, “disturbance”, “illness”, “problem”). Terms incorporating “condition”, “disease” and “disturbance” became less popular over time, whereas those involving “psychiatric”, “mental health” and “illness” became more popular. Although there were some trends away from terms with medical connotations and towards more normalizing expressions, “mental illness” consolidated its position as the dominant term over the study period.

Citation: Haslam N, Baes N (2024) What should we call mental ill health? Historical shifts in the popularity of generic terms. PLOS Ment Health 1(1): e0000032. https://doi.org/10.1371/journal.pmen.0000032

Editor: Vitalii Klymchuk, University of Luxembourg: Universite du Luxembourg, LUXEMBOURG

Received: January 17, 2024; Accepted: March 7, 2024; Published: June 4, 2024

Copyright: © 2024 Haslam, Baes. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data and all scripts are available at OSF: https://osf.io/6egsz/ .

Funding: This work was supported by Australian Research Council Discovery Project DP210103984 to NH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Terminology has long been a vexed issue in the domain of mental ill health. Blatantly stigmatizing colloquial expressions such as “crazy” and “lunatic” have been controversial for many years [ 1 ], and official diagnostic terms such as “schizophrenia” have also been denounced [ 2 ]. Some critics challenge the use of diagnostic terms in general, sometimes out of concern for the ill effects of labelling [ 3 , 4 ] and sometimes driven by a broader critique of medicalization [ 5 ]. Some writers who are comfortable with diagnostic terms criticize disease-first language (e.g., “schizophrenic person”) for reducing people to their illnesses, whereas others criticize person-first language (e.g., “person with schizophrenia”) because some people strongly identify with their diagnosis [ 6 , 7 ]. There is also lively disagreement about appropriate terminology for referring to users of mental health services, such as “patient”, “client”, or “consumer” [ 8 ].

Generic terms for mental ill health are one kind of terminology that has largely escaped systematic attention. These expressions serve as umbrella terms that refer to the class of specific conditions. Official psychiatric classifications such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) employ the term “mental disorder,” but laypeople and professionals alike use a wide array of other expressions. These are typically compound, involving an adjectival expression followed by a noun, the former stipulating how the latter applies to the specific domain of mental ill health. Among the most common adjective expressions are “mental”, “psychological”, and “psychiatric”, with some writers now preferring “mental health” despite the occasional clumsiness of three-word terms such as “mental health disorder”. Some of the most common nouns include “condition”, “disease”, “disorder”, “disturbance”, “illness”, and “problem”. All combinations of these adjectives and nouns can be encountered in everyday use.

These adjectival and noun expressions have distinctive connotations. As a generic term, “mental” implies that the common element of the phenomena of interest relates to the mind. Thesauri list “physical” and “somatic” as antonyms of “mental”, arguably suggesting a dualistic contrast between “mental” and “physical” conditions. “Psychological” has a similar connotation (“of, relating to, or occurring in the mind” in the Merriam-Webster dictionary) but with a clearer connection to a specific profession and field of study (“of or relating to psychology” in the same dictionary). “Psychiatric” relates the phenomena of interest to a particular medical specialty. Like “psychiatric”, and unlike “mental” and “psychological,” “mental health”, used adjectivally (e.g., “mental health problem"), invokes a health context but without referring to a specific profession or discipline.

The noun components of generic terms also carry differing meanings, varying in the extent to which they implicate a medical framing of mental ill health. “Disease” and “illness” are arguably the most clearly medical. According to the ‘Small World of Words’ word association norms [ 9 ], the terms are strongly associated with one another and with “sickness”. Conceptually, “disease” refers to an objective organic malfunction, an entity prototypically caused by an external pathological agent such as a bacterium. “Illness,” by contrast, refers to the subjective experience of a state of ill health. “Disorder” and “disturbance” are sometimes used as near synonyms of “disease” and “illness” but imply a functional impairment or aberration rather than a structural pathology. According to the Compact Oxford dictionary [ 10 ], “disorder” is “usually a weaker term than disease, and not implying structural change” (p.449). “Disturbance” is less tied to the health domain than “disorder”, primarily linked to “problem” and “disruption” in Small World of Words. “Condition” is more neutral than most of the other terms, capable of referring to positive and negative states of health. “Problem,” finally, implies a negative state–associated in the word association norms with words such as “solve” and “issue”–without any direct reference to health. In short, the components of generic terms vary widely in their linkage to health and medicine and in their implied normalcy.

Terminology of this sort is one aspect of what Berrios [ 11 ] calls “psychopathological language”, the systematic language that at any point in history is deemed appropriate for referring to the psychopathological domain. Many generic terms have been widely used in recent history. Berrios notes that “insanity” and “madness” were popular terms in the 19 th century. “Mental disease” became a popular expression early in the late 19 th and early 20 th century, featuring in the title of the Journal of Nervous and Mental Disease , the world’s oldest scientific monthly devoted to human behavior. “Mental disorder” became the preferred generic term in organized psychiatry when formal psychiatric classifications were developed, such as DSM’s first edition, published in 1952. The emerging preference for this term may have arisen because it did not presume a biomedical causation and side-stepped debates over the legitimacy of “mental illness” or “mental disease” [ 12 , 13 ]. More recently, terms whose connotations are even less medical have become popular, such as those including “mental health” and “problems.” The emergence of these expressions reflects a desire to destigmatize and normalize mental ill health, akin to the “euphemism treadmill” [ 14 ], whereby new terms replace those that have come to be seen as offensive or pejorative to ameliorate them. As a result of these terminological shifts, many generic terms are now in widespread circulation.

The implications of alternative generic terms are unclear and have attracted little research. Despite having different connotations, several alternative terms (“mental disorder”, “mental illness”, “mental health problem”) do not differ substantially in the range of phenomena to which they refer [ 15 ]. There is also little clear evidence of differential impacts on judgments of people with mental ill health. Szeto, Luong, and Dobson [ 16 ] found that undergraduate participants did not differ in their attitudes towards and desire for social distance from a person labelled as having a “mental disease”, a “mental disorder”, a “mental health problem”, or a “mental illness”. Similarly, Fox et al. [ 17 ] found no effects on a range of stigma measures when the terms “mental illness”, “mental health problem” or “psychological disorder” were used in a large sample of people with a history of mental illness. However, Lawson [ 18 ] found a greater desire for distance from a hypothetical person when they were labelled as having a “mental disorder” rather than a “mental illness” or “mental health condition.” As yet, no studies have examined other dimensions along which alternative terms might have differential implications, such as effects on professionals’ clinical judgments or on laypeople’s beliefs about causes and appropriate treatments. Although there may have been a trend away from directly medical terms towards more normalizing alternatives, there is as yet no evidence to suggest such a trend has had beneficial effects.

The previous empirical work on generic terminology reviewed above has compared four terms at most, and theoretical work has typically addressed the strengths and weakness of single terms (e.g., “mental illness” [ 19 ]). Studies have also restricted their focus to current usage of terms rather than how that usage has evolved over time. The present study therefore investigated historical trends in the popularity of a comprehensive set of generic terms. We examined the frequency of 24 terms relative to all terms and to one another over a 80-year period using two large English language text corpora. The study was primarily descriptive, aiming to characterize shifts in preferred terminology within society at large. However, we expected to find evidence of diminished popularity of more medical terms (e.g., those including “disease”) and rising preference for more normalizing terms (e.g., those including “mental health” and/or “problem”).

Two corpora were used to track the rise and fall of generic terms from 1940 to 2019. These corpora were chosen for their wide historical span, their very large magnitude, and their differing text sources. The first was derived specifically from books published across the Anglophone world, whereas the second includes text from diverse sources in the USA. If historical trends in terminology are robust, they should replicate across these two distinct corpora. The open-access repository contains all preprocessing scripts: https://osf.io/6egsz/

The Google Books corpus contained “books predominantly in the English language published in any country”, incorporating 361 billion words that appear over 40 times across the corpus from the 1500s onwards [ 20 ]. Frequency counts for specific terms were extracted using the `ngramr`package in R Studio [ 21 ], which facilitates direct access to the corpus, and annual total frequencies were downloaded from Google Books Ngram Viewer Exports. This study used the most recently compiled general English version of the corpus (eng_2019), which excludes low optical character recognition quality and serials. The Google Books corpus contains numerals, did not require preprocessing, and contained 1,423,515,352,830 tokens in the 1940–2019 period.

The second corpus is a combination of two closely related corpora: the Corpus of Historical American English (CoHA [ 22 ]) and the Corpus of Contemporary American English (CoCA [ 23 ]). CoHA contains ~400 million words from 1810–2009, drawn from 115,000 texts distributed across everyday publications (fiction, magazines, newspapers, and non-fiction books). CoCA contains 560 million words from 1990–2019 drawn from ~500,000 texts (extracted from spoken language, TV shows, academic journals, fiction, magazines, newspapers, and blogs). A similar merged CoCA/CoHA corpus has been used in previous research [ 24 ].

After merging, the combined corpus spanning 1810–2019 was processed following recommendations from Alatrash et al. [ 25 ] to clean it without compromising the qualitative and distributional properties of the data. This process included first excluding the special token “@”, which appears in 5% of the COHA corpus (introduced for legal reasons), malformed tokens that are possible artifacts of the digitization process or the data processing, and clean-up performed using the web interface (“&c?;”, “q!”, “|p130”, “NUL”), and removing escaped HTML characters (“(STAR)”, “<p>”, “<>”). Other symbols were excluded after manual inspection of the corpus (e.g., “//”, “PHOTO”, “(COLOR)”, “ILLUSTRATION”). Blogs were also excluded (“web” = 89,054 articles; “blog” = 98,788 articles) for not containing associated year data. Forty-one lines were removed for missing text data (3 fiction, 11 news, 25 magazines, 2 spoken text). The cleaned corpus was then lower-cased and punctuation (commas, periods, question marks) was removed. Numerals and function words were retained to mirror the Google Books corpus. The final combined corpus contained 931,569,490 tokens from 370,091 texts from academic articles ( n = 25,418), fiction books ( n = 30,497), magazines ( n = 136,493), newspapers ( n = 113,440), non-fiction books ( n = 2,635), spoken language ( n = 43,210) and TV shows ( n = 18,398). The current study restricted the corpus period from 1940 to 2019 using 716,070,640 tokens from 330,970 articles. Although very large, the combined CoCA/CoHA corpus was therefore 0.05% the size of the Google Books corpus.

Generic terms

We examined 24 generic terms (bigrams and trigrams) by combining four adjectival terms (“mental”, “mental health”, “psychiatric”, “psychological”) with six nouns (“condition”, “disease”, “disorder”, “disturbance”, “illness”, “problem”). The popularity of each term in each time period was examined as its prevalence as a share of all terms in that period.

The relative frequency of generic terms for mental ill health as a proportion of all terms was extracted annually for the Google Books corpus but by decade (i.e., 1940–1949, 1950–1959 etc.) for the combined CoHA/CoCA corpus in view of its smaller size and the relative sparsity of the generic terms. Three sets of historical trends in the popularity of the generic terms were examined in parallel for the two corpora. First, we examined the frequency of the generic terms collectively to assess whether these terms have changed in their overall popularity. Second, we examined the frequency of the alternative adjectival and then noun terms relative to one another, to evaluate which terms have risen and fallen in relative popularity. In these analyses, the frequency of an adjectival expression is summed across all nouns it combines with (e.g., “mental” = “mental condition” + “mental disease” + “mental disorder” + “mental disturbance” + “mental illness” + “mental problem”) and vice versa. Finally, we examined trends in the relative popularity of the 24 compound generic terms to determine which have risen and fallen in dominance.

Figs 1 and 2 presents the combined relative frequency of the 24 generic terms in the Google Books and CoCA/CoHA corpora. Both corpora show strong upward trends, with the generic terms more than twice as prevalent in the most recent time period as at the beginning of the study period. This rise is consistent with the growing cultural salience of mental health and illness, and the rise of psychiatry, clinical psychology, and other mental health professions through the 20 th century and since.

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https://doi.org/10.1371/journal.pmen.0000032.g001

https://doi.org/10.1371/journal.pmen.0000032.g002

Figs 3 and 4 displays the relative popularity of the adjectival components of the generic terms, each expressed as a percentage of all such expressions in each time period. The two corpora yield very consistent patterns. “Mental” is clearly the most prominent expression throughout the 80-year study period, reducing its share of all expressions only slightly. “Psychiatric” and “psychological” both emerge as increasingly popular adjectival expressions in the 1960s but then remain relatively stable. “Mental health” emerges in the 2000s but is always less popular than its alternatives.

https://doi.org/10.1371/journal.pmen.0000032.g003

https://doi.org/10.1371/journal.pmen.0000032.g004

Figs 5 and 6 show the corresponding trends for the noun expressions, which are again broadly consistent across corpora. Terms incorporating “disease” fell in popularity over time (especially in Google Books), those incorporating “problem” and “disturbance” were relatively unpopular but stable, and “illness” rapidly becomes the dominant noun term in the 1950s and steadily increased its popularity since then. The trajectories of the moderately popular “disorder” and “condition” terms are less clear, the former rising gradually in Google Books but falling across the first two decades in CoHA/CoCA, and the latter showing a general decline in recent decades.

https://doi.org/10.1371/journal.pmen.0000032.g005

https://doi.org/10.1371/journal.pmen.0000032.g006

Figs 7 and 8 , finally, present the 10 most popular complete terms in each corpus, calculated based on their average relative frequency over the eight decades. The terms are ordered from bottom to top in average relative frequency, with the summed relative frequency of the 14 least popular terms represented by the white “Remainder” band. The two corpora yield highly convergent rankings, sharing nine of the top 10 terms and with their top four (“mental illness”, “mental disorder”, “mental condition”, “mental disease”) in identical order. “Mental illness” steadily rises to be the dominant generic term, “mental disease” steadily falls, “mental disorder” becomes a stable distant second, and two terms with “psychiatric” gain some ground in recent decades. However, most of the terms are of very low prevalence and demonstrate few meaningful historical shifts in popularity. Normalizing or de-medicalizing terms incorporating “problem” appear low in the top 10 once (Google Books) or twice (CoHA/CoCA), but those incorporating “mental health” do not.

https://doi.org/10.1371/journal.pmen.0000032.g007

https://doi.org/10.1371/journal.pmen.0000032.g008

In two large English language text corpora, we found consistent patterns in the popularity of a comprehensive set of generic terms for mental ill health. These patterns can be divided into those that are relatively stable over time and those that represent historical shifts. With regard to stable patterns, “mental” was overwhelmingly the most prevalent adjectival expression within generic terms throughout the 1940–2019 study period, with “psychiatric” and “psychological” far behind and “mental health” a very infrequent alternative. “Illness” was almost equally dominant as a noun expression within generic terms, with “disorder”, “disease”, and “condition” in a second tier and “disturbance” and “problem” rare. The relative unpopularity of “mental disorder” is surprising given the term’s ratification by influential psychiatric classifications. With regard to generic terms rather than their components, “mental illness” is easily the most prevalent in the study period, representing half or more of all uses of the 24 generic terms since the 1960s. Along with “mental disorder”, “mental condition” and “mental disease” it consistently accounts for more than 80% of all uses of generic terms throughout the study period in both corpora.

Patterns of change are also evident. Terms beginning with “psychiatric” and “psychological” made modest gains in popularity over time, as did those ending with “disorder”, whereas “disease” and “condition” tended to decline. Terms commencing with “mental health” grew steeply but from a very low base, and therefore did not feature among the most common generic terms. “Illness” consolidated its high popularity over time and “mental illness” rapidly rose to prominence, increasing its share of usage at least three-fold from 1940 to 2019. “Mental illness” rose most steeply from the 1940s to the 1960s at the apparent expense of “mental disease”, which fell steeply out of fashion during this period.

These patterns present a complex picture of the role of medical framing within generic terminology. Critics of medicalization have opposed terms they see as embodying a medical or disease model and proposed new terms to replace them. Their critique is often motivated by philosophical objections as well as the belief that the replacement terms will reduce stigma. Our findings offer some encouragement to these critics. Terms referring to “disease” have fallen from favor and those that include “psychiatric”, identifying mental ill health with a medical specialty, have not established a strong foothold. Normalizing terms such as “mental health problem”, which has no medical connotation and implies that mental ill health is an everyday dilemma to be solved, have become more prevalent in recent years.

Several findings point in the opposite direction, however. “Illness” may be less wedded to organic pathology than “disease”, but it is medical nonetheless and remains the dominant noun when referring to mental ill health. Its dominance, especially in the expression “mental illness”, has only increased in recent years, despite decades of criticism surrounding its legitimacy [ 13 ]. Less medically saturated terms that incorporate “mental health” or “problem” remain unpopular, at least as indexed by appearance in diverse forms of text, calling into question claims that “mental health” is increasingly used as a euphemism for “mental illness” [ 26 ]. Efforts to overhaul generic terminology have thus far not been effective in bringing about substantial change, and the rising prevalence and historical durability of “mental illness” suggests that altering public preferences for generic terms may be difficult. It could be argued that “mental illness” foregrounds subjective experience in its adjectival and noun components and should therefore be embraced rather than dismissed as medicalizing [ 19 ].

There has been very little systematic research on generic terms for mental ill health, so many possible avenues for future work are open. The corpora examined in the present study primarily represent written language generated by people outside the mental health professions, and it would be informative to assess preferences within and between these professions (e.g., clinical psychology, psychiatry, mental health nursing, social work). It would be equally informative to evaluate how professionals, laypeople and service users construe the differences in connotation between generic terms as well as their preferences among them, just as studies have examined preferences for alternative ways of referring to service users [ 8 ]. One informal exploration found that “some people prefer the phrase ‘mental illness’ as it emphasizes the seriousness of the conditions experienced by people; others prefer ‘mental health problem’ because they see it as less stigmatizing; others prefer mental ‘disorder’ as potentially encompassing both ‘problems’ and ‘illnesses’ while also acknowledging the non-medical dimension” [ 27 ] (p.46)]. A more systematic empirical investigation of understandings and preferences for generic terms is overdue.

Equally important is to establish whether generic terms have differential effects on perceptions of and by people experiencing mental ill health. Although vignette studies find few effects on stigmatizing attitudes [ 16 , 18 ], they are limited in quantity, in realism, and in the range of terms examined. No studies have explored whether generic terms have implications for how people with mental ill health perceive themselves (aside from Fox et al.’s [ 17 ] examination of self-stigma) or for how clinicians view them, including possible effects on the perceived durability, causation, or appropriate treatment implied by different terms. Is a condition described as a “psychiatric disease” likely to be perceived as more serious, organic, and suitable for pharmacological treatment than one described as a “mental health problem”? Examining the possible implications of different terms for how the general public and affected persons perceive and evaluate mental ill health should be a research priority.

Our study has several limitations. First, it only examines terms in English and its findings are unlikely to generalize to other languages. It would be worthwhile exploring shifts in preferred terminology in other linguistic and cultural contexts. Second, the study’s datasets ended in 2019 and there may have been significant changes since that time, during a period of intense attention to mental ill health. Future studies should examine ongoing terminological shifts. Third, the two corpora are drawn entirely (Google Books) or primarily (CoHA/CoCA) from written texts drawn from specific regions and therefore cannot be presumed to correspond to spoken language use or equally to all relevant geographical communities. More colloquial spoken language might employ different terms from written texts, or the same terms with significantly differing frequencies. The corpora are entirely (CoCA/CoHA) or predominantly (Google Books) based on U.S.A. sources, for example, and the extent to which our findings generalize across the Anglosphere is uncertain. Regrettably, addressing these possibilities may be challenging because corpora of comparable size and historical depth that collect spoken language or text from other regions may not exist. Fourth and more generally, while corpus studies enable powerful, large-scale quantitative analyses of language use, they do not allow for more nuanced analyses of connotational meaning or detailed studies of how words are understood or used differently in specific communities or contexts and possibly even replaced. Qualitative studies that illuminate these complexities would be valuable to complement our findings.

Debates over diagnostic labels, person- versus identity-first language, and appropriate ways of referring to people using mental health services reflect a conviction that language use in the field of mental health is profoundly important. The present study points to intriguing shifts in the use of generic terms for mental ill health, but it remains to be seen whether the implications of these terms are equally consequential.

Acknowledgments

The research reported in this manuscript was supported by Australian Research Council Discovery Project DP210103984.

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A FRAMEWORK FOR ACHIEVING THE FOUR STUDENT WELLNESS OUTCOMES USING COLLECTIVE SYSTEM DESIGN

In response to the evolving demands of todays competition, there is a growing expectation for enhanced services to industry and academic enterprises. This thesis explores the application of System Engineering methodologies as a strategic approach to securing success with both industrial and academic enterprises. Industry faces issues with the absence of a positive tone, inefficiencies and delays in delivery, and customer satisfaction. Meanwhile, academia faces several challenges including lack of communication between departments, how to allocate institutional resources to simplify student experience, reduce complexity in students college experience, and lack of students motivation. These issues for students lead to poor academic performance, financial struggles, and possibly mental health problems. There is a recognized need for a systematic approach to ensure student success at universities. A fundamental approach emerges in the form of Collective System Design (CSD) to find ways to address the above- mentioned challenges. Collective System Design is explored for ad- dressing the challenges faced by academic organizations and industrial processes. Collective System Design aims to improve the long-term viability of an enterprise by fostering sustainability and success. This thesis further investigates the Collective System Design Language, offering a communication tool for design and an approach to assess effectiveness before implementation. This thesis highlights two case studies: Shuttleworth (manufacturing industry) and the Purdue University Fort Wayne Student Success Standard Process Lifecycle. The impact of solving these problems can be measured through several key indicators: Shuttleworth (Manufacturing Industry). • Reduction in Lead Time • In on-time Delivery • Enhanced Customer Satisfaction and improvement in product quality. Purdue University Fort Wayne. • Improvement in Student Experience and Quality of Life. • Achievement of Student Wellness Functional Requirements and improvements in student retention and four and five year graduation rates. Achievement of Student Success Functional Requirements and improvements in student retention and four and five year graduation rates. There are three main objectives of this thesis: (1) Apply and contrast the application of Collective System Design principles across a manufacturing industrial client and a service enterprise, namely higher education (2) Offer a systematic approach for manufacturing to improve on-time delivery, enhance customer satisfaction, create positive tone by using the principles of Collective System Design, and (3) For academia, develop a System Design Decomposition to define the functions of the university to foster student wellness according to four viewpoints: academic, financial, career, and living wellness. The objective is to incorporate the development of a System Design Decomposition that provides methodology to ensure that student wellness outcomes consider the four viewpoints of wellness (Academic, Financial, Career, and Living). The Student Success Standard Process Lifecycle defines standard processes in all process steps that will facilitate the desired student experience and four wellness outcomes. The lifecycle consists of Student Success States where the lifecycle begins from S0 (learning about university) to S7 (Supportive alumni) and defines standard process steps in each state. Each standard process step seeks to achieve the Functional Requirements from the four wellness viewpoints (academic, financial, career, and living) in Student Success Standard Process Lifecycle. The Collective System Design Decomposition methodology will serve as a structured approach to defining desired student wellness outcomes within a Rapid Design Process, which takes place in the first session focusing on defining outcomes. By leveraging this framework of four wellness viewpoints, the thesis aims to address issues with defining the outcomes for academic, financial, career, and living wellness viewpoints. Each wellness viewpoint has specific Functional Requirements (outcomes) that need to be defined and achieved by Student Success Standard Process Lifecycle and Rapid Design Process, to ultimately enhance student success and well-being at Purdue Fort Wayne University.

Degree Type

• Master of Science
• Electrical and Computer Engineering

Campus location

Advisor/supervisor/committee chair, additional committee member 2, additional committee member 3, usage metrics.

• Systems engineering