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The Language Barrier

The Language Barrier 
An Obstacle to "Consumer-Forward" Initiatives

Language, as it has evolved on this planet, allows us to express our thoughts and feelings, and, therefore, to communicate with one another. When we think, we manipulate words in our minds and derive meaning from this manipulation. On this planet, people think in hundreds of languages; making meaning from words that mean nothing unless you speak the language. People who speak the same language can speak to each other, and it is human nature that people who speak to each other form social groups.

A social scientist looking at a group of people who speak the same language will tend to see a culture. While the dictionary definition of culture is "the sum total of the attainments and activities of any specific period, race or people", it is not difficult to see that supporting those attainments and activities is the experience of being able to derive common meaning from the words used by any specific race or people in any specific period.

It is both pleasing and frightening to look at the sum total of the attainments and activities of this forty year period of care of the seriously mentally ill in the United States. Since the introduction of thorazine in 1952, an event that revolutionized care available to persons with serious mental illness, there have been major changes in the mental health care delivery system in this country. Diagnostic criteria have become more clearly defined, a plethora of medications have been made available, a national system of community-based treatment centers has evolved, treatment planning includes consideration for the many facets of a seriously mentally ill person's life, research has led to a more profound understanding of the complexities involved in both having and treating mental illness, and there have been some partially successful efforts at actually reducing the stigma associated with being seriously mentally ill.

These attainments and activities have, for the most part, been brought about by mental health professionals.

Mental health professionals could be described as a small but earnest culture comprised of persons who have made it their business to care for persons with serious mental illness. If cultures are at least partly defined by language, the culture of mental health providers has its own language, and it is a dialect: a mix of the languages of psychiatry and social work theory. This is born of the fact that mental health professionals, as part of their training, are generally taught to think and to speak in two different languages - that of psychiatry and social work. Because of the breadth of the problem of serious mental illness, the languages combine to form a synthesis of the relevant terms from each.

Thus, mental health providers have invented a new language in which to think about the problems they are trying to solve, to speak to each other about the problems they are trying to solve, and to describe the solutions found for the very problems with which they are occupied. It takes years to learn the language, and the language training involved in becoming a mental health professional is actually most like spending an extended period of time in a foreign country.

The newest trend in mental health calls for consumer participation in all aspects of program planning and service delivery. In theory, this a wonderful, sane, timely idea that has the capacity to transform the American mental health service delivery system, not to mention the lives of millions of people diagnosed with serious mental illness. Consumer input and practice has the potential to enrich beyond measure the existing service delivery system. Implementation of meaningful consumer involvement in the policy, program, and service components of the system is fraught with difficulties, not the least of which have their origins in language.

Consumers have the distinct advantage of intimate knowledge of and experience with serious mental illness, and the distinct disadvantage of not having spent years learning to describe it in the dialect spoken by the system that cares for them.

For consumers, implementation of that "consumer-forward" trend is as complicated as trying to get a hot dog in a restaurant in Tanzania. You can import thousands of tourists to Tanzania, and they may all crave a hot dog, but due to the language barrier and the absence of hot dogs, success at obtaining a hot dog in a restaurant in Tanzania is not highly probable. In fact, once they are hungry enough, your average tourist-suffering-from-a-language-barrier in Tanzania or anywhere will point at something that looks somewhat appetizing on a plate on another table and, with some difficulty, communicate to the waiter that that is what they want.

Consumers all over the country, driven in van loads to planning meetings and strategy sessions and conferences, are busily pointing to the plates of existing services and programs and saying "I want to consume THAT!", because we are hungry for change, and really invested in being helpful, and we just don't see any hot dogs around.

A waiter in a good foreign restaurant who has no frame of reference for a hot dog may procure for you a sausage. It is up to consumers to insist that although sausages are nice, they are NOT hot dogs; and up to good mental health systems to invent hot dogs if that is what is being requested.