Selecting language in mental health communities

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I’ve been in a widely ranged swath of mental health units, wards, houses, groups and communities. They all have their own rules when it comes to what can and cannot be said: literally, what is allowed to be uttered. The folks in these communities go along with the rules most of the time, for there’s a necessary general sense of commitment to the rules of the treatment that persists in everyone’s heads. I’ve seen both ends of a spectrum, that being excessive censoring on one side and excessive relaxation on the other. Let’s examine.

When I first entered into serious treatment in 2014, I was jarred by how little we could say about our experiences. There was a rule against “war stories,” the definition of which is still hazy to me but which I think can be summarized as an excessively pornographic retelling of “problem behaviors,” a term that is also murkier than it should be but which can be aptly summarized as any behavior that is prompted by pathological thoughts and actions. Pathological, too, means something less nefarious in this world than in public, but I’m going to stop slicing the onion.

Discussion of cutting wasn’t allowed. We were a bunch of suicidal kids, we had all cut at some point, even if just to see what all of the hype was about. Is there something to this cutting thing? For me, cutting words into my legs had some merit but there generally was not much to the practice. Regardless, my cuts were obvious, as were the cuts of everyone else. But mentioning the cuts was seen as potentially too triggering (a word that, again, is much more meaningful and diagnostic/technical in the mental health world than in public).

Suicide was not a topic we could broach, either. I’ve seen this theme repeated several times in my life. My family has now learned to directly ask “are you suicidal,” “are you spiraling,” “do you want to die,” because they know that talking about it doesn’t increase the event’s likelihood. However, the hospital didn’t seem to concur in practice.

I understand where they were coming from. It’s very possible that a bunch of kids could have conspired to come up with better ways to engage in serious problem behaviors, such as “improved” methodology for cutting and suicide attempts, and especially between the patients who were not as healthy, who were destined for another year or more of inpatient treatment.

In fact, I don’t really have an opinion on the matter. I’m simply here to share with you. So here’s the other end of the spectrum.

I’ve absolutely nailed my old, therapeutic school, before. In a way, the lack of helpfulness of the school enhanced my appreciation for the seemingly tedious methods used in genuine therapeutic environments. I suppose the school tried its best, which is actually even more damning.

Racial slurs and ferocious bullying were both allowed in the school environment. Kids frequently shared not only methodological discussions about drugs and alcohol, but shared the substances themselves on campus. Cutting, alcohol, sex, drugs, suicidal thoughts and actions, missing school and therapy, mocking of therapy, were all common topics of discussion among the students, while the teachers struggled to even get half of their class to show up. They had no time to police wording, or actions outside of the classroom. The problem was a lack of healthy and thought out structure by the administration, who should all be replaced (they had asked, I think indicatively, my old psychiatrist, who used to run an adolescent unit in a hospital, to consult and help, but he/she turned it down).

If you found this interesting, I also hope that you retain from this piece an alternative message. The term “triggering” has a whole different meaning outside of the so-called SJW community that many men mock, with limited to no validity. Triggering can mean something that sets off PTSD symptoms, one that fails to evade everyone from rape victims to war veterans. Triggering can mean intense discussion of hanging in front of someone who tried to hang themselves yesterday. It can also mean excessive censoring and walking on eggshells.

As always, I’ve provided you with the spectrum, and a balance is preferable.

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