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The power of language
As an academic health professional,
I am dismayed when my fellow health
professionals refer to their patients as
diseases rather than as people dealing
with a condition. Similarly, professional
journals more often than not employ
such characterisations in their case
As children, you might have recited the
familiar rhyme: 'Sticks and stones may
break my bones but words will never hurt
m e .' (late 19th Century proverb). The reality
is that words can and do wound.
Stigma begins with labelling someone.
Hurtful words like 'psycho' and 'schizo'
are common, as are jokes on television
about loony bins and characters in
straitjackets. But if you or a loved one
has a mental health disorder, you know
that these words aren't just harmless
fun. They perpetuate the stigma
attached to mental health conditions.
Stigma may make the victim angry and
upset, and it can cause the public to
misunderstand mental illnesses.
The common consequences for victims
of stigmatisation are real, and include
social exclusion, financial hardship,
and many forms of discrimination.
Such attitudes may prevent individuals
from seeking diagnosis and impair
their willingness to access health care,
thus contributing to the morbidity and
mortality of disease.
Stigma, by definition, is a mark
of disgrace or shame. It has four
• labelling someone with a condition as
• stereotyping people who have that
• creating a division -- a superior us
group and a devalued them group,
resulting in loss of status in the
• discriminating against someone on
the basis of their stigmatising label.
There is a big and meaningful difference
between stigma and label. Labels can be
useful, and they are not always negative.
In health, for instance, a diagnosis is,
in essence, a label. A label can offer
reassurance that a condition has a medical
cause, and it can help steer the individual
toward appropriate treatment.
Labels don't always result in stigma,
either. Labels should describe the illness
and not the person. Many illnesses are
gaining acceptance and empathy today.
Breast cancer is a prominent example.
Survivors used to feel shamed and kept
their condition secret for fear of being
stigmatised. Today though, survivors
and advocates talk openly about
As with the placebo, psychological
processes are involved in both labelling
and stigmatisation. A fascinating study of
patients examined the impact of labelling
on Quality of Life Scales, identified as
physical function, general health, vitality
and mental health. Those patients who
knew they had hypertension presented
scores on the four measures that revealed
more distress, including more bodily pain,
than those who were unaware of their
hypertension. There were no differences
between patients who were unaware of
their hypertension and other patients who
did not suffer from it.2
All health professionals should give
serious consideration to the effect of
labelling people and avoid stigmatisation
at all costs. For example, calling a person
a diabetic, a schizophrenic, an asthmatic,
a hypotensive, a manic-depressive, a
depressive, an epileptic, etc, is calling a
human being a disease.
A recent position paper by Diabetes
Australia has highlighted the importance
of words in connection with diabetes.
This paper is essential reading for any
health professional working with people
with chronic disease.3
1. Link BC, Phelan JC. Stigma and its public health implication.
The Lancet, 2006;37(3509):528--9.
2. Mena-Martin FJ, Martin-Escudero JC, Simal-Blanco F. et al.
Health-related quality of life of subjects with known and
unknown hypertension: results from the population-based
Hortega Study. J Hypertension 2003;21:1283--9.
Associate Professor Louis Roller
Faculty of Pharmacy and Pharmaceutical Sciences
Monash University, Victoria.
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