Saturday, August 09, 2014

Is "Shrink" offensive? Take a one-question poll!

Over on Clinical Psychiatry News, we had a reader complain about our column title --Shrink Rap News.  He felt it was odd and offensive to use the term Shrink when people have worked so hard to reduce stigma.  I countered with the article there called "The Stigma of Being a Shrink" to discuss how we came to the title Shrink Rap for our work, and that the term "shrink" just didn't strike me as one which would alter care for our patients or leave us being seen in a negative light.  It's been 8 years of Shrink Rap -- the name has worked for us in the form of 3 blogs and a book, and well, shrink is one syllable while psychiatrist is 4 and psychiatrist does not lend itself to any cute puns or double meanings.  We're also not the only Shrink Rap or Shrink Wrap or Shrink Wrapped.  

So I thought I'd ask you: Is the term Shrink offensive?  Does using it alter the care our patients receive?  Should it be abolished from the jargon the way we no longer  use terms such as Lunatic?  Or the way we might like to get rid of words such as Crazy?  

I'm against stigmatizing people because of all sorts of things -- mental illness is only one of them.  I don't think anyone wants to be obese or have a drug or alcohol addiction, but some members of society seems to be okay stigmatizing those folks (--they could eat less and avoid their substances, apparently, if only they so chose...).  Calling a professional a 'shrink' -- I want to say "lighten up,"  but I'm all ears.  Not promising to change our blog name by any means, but what do you think?

And while we're talking about stigma -- there was a terrific article by Allen Frances over on the Huffington Post.  He notes, "Never has there been less stigma for having mild psychiatric problems, but never has there been more stigma for having severe ones." 


Steven Reidbord MD said...

I don't mind the term and don't consider it stigmatizing or offensive. To me, stigma means derisive terms, images, or other references signifying those we hold in contempt. Thus, a nickname delivered as a putdown is stigmatizing, while the same nickname shared between friends or lovers is a term of endearment. The "N word" and "queer" are good examples of how the relation between the speaker and the referent makes all the difference.

"Shrink" is sometimes used derisively. But more often, and most clearly when we use it ourselves, it's a term of endearment. I feel it mildly devalues what we do by making it sound too casual, so I don't use the term myself. But feel free...

And yes, I like that post by Allan Frances, and most of what he's been writing in recent years.

Anonymous said...

Regarding stigma, maybe mental health professionals need to look at their own attitudes first before blaming the public.

"I’ve seen this on twitter and before that in email groups. The most disturbing place that this has happened is among professional groups in which I’ve revealed my ex-patient status. Even in professional groups who at least in theory profess and share my interest in radically changing the system and using alternatives to psychiatry is this bigotry present. Not by all the professionals of course but depending on the group whether it be alternative or mainstream mental health professionals anywhere from 50% to 80% I’d say are dismissive of me when I identify primarily as lets say, the author of this blog. This in spite of the fact I will include my professional history as well. It’s clear what people remember though is that I was a user of psychiatry. A mentally ill person, I guess. (I don’t consider myself such but that doesn’t seem to matter even among those professionals who profess to not believe in mental illness!!)

When I am not the author of this blog and only identify as clinician and/or social worker I am received with a respect I do not receive as author of this blog. I am also engaged more deeply and with more interest."

Anonymous said...

Agreeing with the other anonymous. The most important contributors to stigma are psychiatrists themselves and its institutional bodies like the APA and similar.

This point was raised in a recent commentary published by The Lancet in which the Council For Evidence-based Psychiatry responded to angry comments by defenders of British institutional psychiatry

”And in terms of stigma, the evidence consistently finds that it is the idea that mental illness is like any other illness that is most likely to lead to stigma[5] and so to more potential pain and suffering for patients.”

“Throughout its history, psychiatry has been slow to admit the negative effects of its drugs, as is well documented in the case of antipsychotic drugs and tardive dyskinesia. By branding severe adverse reactions to antidepressants as unexplained medical symptoms distorted by the incentive of litigation, Nutt and colleagues’ perpetuate this tendency and pour scorn on the experience of patients and their families.”

As it always happens with psychiatrists, a discussion on whether the term "shrink" is stigmatizing is a distraction from the real problem that the main source of stigma comes from the notion that "mental illness" is an illness like physical illnesses in the sense that just as an "ill kidney" means an "abnormal kidney", a "mental illness" must necessarily mean an "abnormal mind".

While people also understand that an "abnormal kidney" has no consequences for society at large, only for the guy who has the abnormal kidney, society is less forgiving with those who have an "abnormal mind".

If psychiatry wants to decrease the stigma towards those who are psychiatrized it should stop using the words "mental illness" or "disorder" and rather speak of different ways of experiencing life which are as good as any other ways. Stopping of considering gayness a mental disorder worked wonders for gay people.

This point was made by The Times of London in recent strongly worded editorial that is partially reproduced here by the Council For Evidence-based Psychiatry

“The current fashion to label and try to treat aspects of human behaviour is not only unsustainably expensive, it may also prove injurious to the health of society as a whole…

Individuals should not be subject to… a pseudo-diagnosis that does little more than stigmatise the particular personality trait they happen to possess and which a prevailing majority view happens to deem unacceptable. Many conditions are created in the naming and the diagnosis often does no good at all.

Nor, other than as a last resort, should a child suffering no apparent physical ailment be routinely placed on long-term medication, whatever difficulty that child’s actions may create for those adults charged with his or her care. A chemical response may well be convenient but convenience seldom makes for the correct or the civilised course of action. Anxious parents and overzealous doctors are making a problem worse.”

Anonymous said...

I don't think using the term shrink promotes stigma. I call my psychiatrist my shrink, and I have the utmost respect for him.

What I think promotes stigma are those in the media who continually call people diagnosed with mental illness "the mentally ill." It's usually followed by commentary on what to do with those scary people, "the mentally ill." Ugh. That's the stuff that promotes stigma.


Andrea said...

Before I was diagnosed with a mental illness, I thought shrink was kind of a funny word. Now that I have been diagnosed with Bipolar I and take an antipsychotic that might have literally shrunk my brain, I don't think it's that funny anymore. However, I really like your blog and believe that you chose to use the word shrink because you think it's funny. Your blog is written in a good spirit and helps a lot of people.
But, when confronted with the question of whether or not shrink is a stigmatizing word, I voted yes.

Claire said...

I've been seeing various counselors, therapists, psychologists, and psychiatrists on and off for nine-odd years now, and since I'm only twenty-one, that's quite a chunk of my life. I habitually refer to my mental health professionals 'shrinks' to my other acquaintances - not as a term of derision (I couldn't get by without these people!) but as a simplifying descriptor.
Many of my friends, peers, coworkers, etc, are unsure of the difference between a psychologist and psychiatrist, or that there is one, or that counselors aren't doctors and so on and so forth. I could explain the distinctions, but often they aren't comfortable or that interested and sometimes there isn't time.
But if I say, "Lunch was fun, but I have an appointment with my shrink I need to get to," there is immediate clarity and understanding - not, perhaps, of my mental health needs or professional, but they get the general point. They understand that I go to an office and sit in a squashy chair and talk about my feelings so that I feel better. The person I talk to is the shrink. There is no confusion about titles or degrees or medications or the definition of cognitive behavioral therapy.
I go to this person, and they shrink my bad feelings. It's as simple as that, when I say I'm off to see my shrink.(Which, incidentally, is how I've explained it to my very young cousin, and he grasped my meaning right away and drew a picture of a smiling doctor holding a shrink-ray device.)
I've asked a few of my assorted professionals, here and there, if I may refer to them as my shrink, but all said I was welcome to do so and displayed no hint of distress (the latter quite possibly due to professionalism alone; hard to be sure).
Inversely, when someone hears I'm in therapy and says something like, "Oh, you have a shrink?" I'm almost never offended. On the one or two occasions that I do recall being offended, it was entirely to do with the speaker's tone and mannerisms.
On yet another hand, if one of my MHP asked me not to call him or her a shrink, I would apologize and discontinue use of the word (at least referring to that person, and possibly altogether).
So I vote no, not offensive unless so intended - but as I am not a shr- mental healthcare professional, I also don't feel like I'm the party which should be primarily consulted. Just thought I'd weigh in.