Tag Archives: mental health categories

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Naming our Mental States

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Building on the premise that a name must come prior to the perception, our rapid growth of awareness in mental crises is abetted by an expanding lexicon of depression terms.

[With theories of communication, the most interesting ideas are also the most difficult to pin down.  So it is with the idea of linguistic determinism:  the observation that the power to name is the power to see.”  Note the reversal of conventional wisdom in the wording. Give this some thought and it turns into a kind of IMAX of communication models. It is a monumental observation and a good reason to take a second look, with a few more caveats now in place. This short piece suggests that we may be victims of our own proliferating mental health language: a justifiable lede that is buried in the very last sentence.] 

It’s an old truism in the language arts that we see what we can name. It’s the idea behind the phrase “linguistic determinism.” If so, our national concern about the spreading darkness of suicide and depression in the young is fed by increased usage of these terms, which have become top of mind. Two generations ago, these mental health labels were scarce in our discourse, even though these problems clearly existed. As a child I remember a family we knew well with a son who died while on an academic exchange. There was really no evidence of foul play, but that was the narrative that was accepted. At a certain point most of us will be made aware of concerns about the distress and safety of a young relative or family friend.

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Having a term for a condition primes us to notice it. Mental health researchers tell us that rates of clinical depression in the United States have been steadily increasing. One estimate from the Centers for Disease Control is that about one in five Americans carry that condition, with 2.5 percent suffering from persistent depression. Similarly, the still relatively new diagnosis of Attention-deficit/hyperactivity Disorder (ADHD) rate grew from five and a half percent in 1997 to nearly ten percent by early 2021.

What’s going on?

Anyone asking the question must be humble when proposing causes. Among other factors, our reporting is probably better than it has ever been. Suicide used to be concealed behind other less stigmatizing causes, such as auto accidents. But the problems of depression and suicide are now a cause for significant national soul-searching. To be sure, taking one’s own life is a rare consequence of depression. But it is the third most common cause of death in people aged 15 to 25, assuming we can sort out true accidents from intentional acts.

Every case is different. But it is probably fair to assume that teens lack the ballast of experience to ride out rough patches, which may include broken relationships, family tensions, and low self-esteem brought on by corrosive comparisons of oneself with others built into a lot of social media.

It also seems as if there has been a sea change in the amount of public mental health talk that is now part of the lives of younger Americans and their families. Institutional mental health services have come out from under a cloud of concealment that was common in mid-twentieth century America. Counseling services have proliferated in schools and universities. And discussions of depression and anxiety are now baked into the formal orientations new college students are likely to hear when they show up on campus. Meanwhile, our media culture is bolder in dwelling on depression episodes, abetted by direct-to-consumer ads for psychoactive drugs that go not just to patients, but sometimes to their friends. Consider as well that just a few years ago no mainstream provider of television content would have touched a series like 13 Reasons Why (2017), Netflix’s fictional account a of a teen’s descent into suicide, or Hulu’s The Girl From Plainville (2022). In myriad ways, our culture has normalized the sources of teen angst that can occasionally turn self-destructive.

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It also seems evident that students living on a campus are rarely ‘on their own’ and out of contact in the ways their parents once were. For some, frequent text or phone contact with home keeps family problems in play at a time when, for prior generations, being away at school offered a kind of refuge.  But I digress.

Add in linguistic determinism, and you have a perfect storm. Building on this view that a name must come prior to the perception, our rapid growth of awareness in mental crises is abetted by an expanding lexicon of depression terms. And here is the key point: with its emergence out from under its former stigma, perhaps we have inadvertently over-represented mental health issues. This kind of ‘clinicalization’ of our mental lives has now gone on for years, with frequent talk about others in terms of what were once more formal diagnostic categories. We now talk casually about someone’s “anxiety,” “attention deficits” or “paranoia,” mixing subjective judgments with classification categories once limited to the bible of mental illness diagnoses, the Diagnostic and Statistical Manual of Mental Disorders known as the “DSM.”

Merging these labels into our everyday rhetoric has done its part in putting what were formally considered passing states of mind front and center. Sometimes that can be good. But it also follows that such language gets formalized through diagnosis and treatment. Once a person self-identifies as a victim of a labeled condition, that awareness can hopefully lay the groundwork for recovery. But these terms can also become self-protective justifications that delay it.

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A Theory of the Depression Monsoon

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It’s an old truism in rhetoric that we see what we can name.  If so, our national monsoon of concerns about the spreading darkness of depression is partly a function of its lexicon. We notice it because we can name it.

Mental health researchers tell us that rates of clinical depression in the United States have been steadily increasing.  One estimate from the Centers for Disease Control is that about 9 in 100 Americans carry that diagnosis, with 3 percent suffering from chronic depression.

What’s going on?

Anyone asking the question must be humble when proposing causes. Among other factors, our reporting is probably better than it has ever been. But it is obvious that the effects are especially stark among the young: a cause for some national soul-searching. To be sure, suicide is a rare consequence of depression. But it is the third most common cause of death in people aged 15 to 25. At some point in our lives most of us have been touched by concerns about the distress and safety of a young relative or family friend.

Every case is different. But it is probably fair to assume that teens lack the ballast of experience to ride out rough patches, which may include broken relationships, family tensions, and low self-esteem brought on by—among other things—the sometimes corrosive comparisons of self with others encouraged by social media.

It also seems as if there has been a sea change in the amount of mental health talk that is now part of the lives of younger Americans still in the pursuit of an education. For most Americans, the use of  institutional mental health services has come out from under a cloud of secrecy that was common in mid-twentieth century America. Over the last two decades counseling services have proliferated in schools and universities. And there can be no doubt they are helpful.  But with increased emphasis on coping with stress, there is also more discussion of anxiety and clinical depression. First year students in college are now asked to be aware of these issues in the midst of a whirlwind “Welcome Week.” And staff are asked to be more proactive if a student speaks about stress or anxiety. Meanwhile, our media culture is more bold in dwelling on depression episodes, abetted by direct-to-consumer ads for psychoactive drugs that go not just to patients, but sometimes to their friends. Consider as well that just a few years ago no mainstream provider of television content would have touched a series like 13 Reasons Why (2017), Netflix’s fictional account a of a teen’s descent into suicide. The effect is a culture that has normalized teen angst into something more ubiquitous.

It also seems evident that students living on a campus are rarely ‘on their own’ and out of contact in the ways their parents once were. For some, frequent text or phone contact with home keeps family problems in play at a time when, for prior generations, being away at school offered a kind of refuge.

Add in some linguistic determinism, and you have a perfect storm. It’s an old truism in linguistic and rhetorical theory that we see what we can name. This idea means that the name comes prior to perception. Building on this view, the monsoon described here may be abetted by the widespread use of a lexicon of depression terms. With its emergence out from under its former stigma, perhaps we have inadvertently over-represented its existence.* This kind of ‘clinicalization’ of our mental lives has now gone on for years, with frequent talk about others in terms of what were once understood as formal diagnostic categories.  We now talk casually about someone’s “anxiety,” “attention deficits” or “paranoia,” mixing subjective judgments with classification categories found in the bible of mental illness diagnoses, the DSM.

Merging of these labels into our everyday rhetoric has done its part to put what were once considered passing states of mind front and center.  Sometimes that can be good. But it also follows that such language gets formalized through diagnosis and treatment. Once a person self-identifies as a “victim” of a labeled condition, that awareness can lay the groundwork for recovery, or become a self-protective justification that delays it.

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*I take a less extreme view than psychiatrist Thomas Szasz, who has written extensively about what he sees as the “Myth of Mental Illness.” (Harper Perennial, 2010). But I give Szasz credit for understanding the power of clinical labels to shape expectations.