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The language of psychiatric discourse: power and imbalance

Freya Sewell Mental health nursing student, Edinburgh Napier University



This paper examines the use and importance of language in mental health nursing. It argues that the language of psychiatric discourse establishes unhelpful power imbalance, difference and distance between persons and mental health nurses, between ‘them’ and ‘us’.

Key words

Language, psychiatric discourse, power, imbalance, relationships, practice


Language is an essential way of constructing meaning and communicating in human society. It functions as a social signalling system, and a means of exchanging messages and establishing expectations in relationships (Fine, 2001; El-Mallakh and Doenninghaus, 2016). Choice of language expresses something of speakers’ inner thoughts, attitudes and beliefs – it makes the private public (Douglas et al, 2008; Kemp and Howard, 2017).

This paper considers the importance of language in mental health and what it produces in the nurse-person relationship. Relating through language is foundational in mental health nursing (Kemp and Howard, 2017).

Effective communication is an imperative of nursing practice generally (NMC), 2015). In mental health services, psychiatric discourse dominates with its unique language of symptoms, behaviours and diagnosis (Byrne et al, 2016; Turner, 2017). Through language this discourse is transacted, making it a powerful area for enquiry (Brown et al, 1996). If language shapes meaning, it is important to consider how language is used and its intended and unintended consequences (Holtgraves and Kashima, 2008).

Despite the rise of recovery and service user movements and policy ‘empowerment’, psychiatric discourse – which is inherently hierarchical and categorical – continues to direct care (Scottish Government, 2015).

There is a gap between policy aspirations and practice realities (Hui and Stickley, 2007; Bee et al, 2015). For many reasons the language of psychiatric discourse may be considered useful, and some perspectives are considered in the background section of this paper.

However, in the nurse-person relationship this language is unhelpful and, at worst, damaging. From the literature, three lines of reasoning emerge to support this critical perspective, further explored in the main body of this paper. First, the connection between language, knowledge and power. There is a potential for language to perpetuate power imbalances and hinder nurses and people meeting as equals.

Second, there is a capacity for language to create disabling environments, which are inclusive only of those who speak it and excluding those who do not.

Finally, there is an unhelpful and erroneous social distance between nurse and person created through psychiatric labelling. Both are persons capable of experiencing distress, yet one person’s experience becomes abnormal or ‘other’ through professional re-authoring.

This thematic multiplicity speaks of the myriad ways that language influences mental health nursing practice. Contemporary research in this area is partial and fragmented, appearing in articles secondary to other subjects. More focused research is needed to unfold the significance of language. This paper aims to pull together existing health and social care literature.

Throughout, use of the term ‘person’ is a reminder of individuals’ multi-faceted nature. Persons are unique in a way that broadly grouped ‘service users’, ‘patients’ and ‘clients’ cannot be (Heffernan, 2006).

A survey the by National Survivor User Network (NSUN) (2015) found that people with lived experience prefer ‘person’ identity markers, reminding professionals ‘I am a person first’.


Discourse refers to sets of knowledge that inform understanding and interaction with the world (Foucault, 1994, cited in Hamilton and Manias, 2006).

The dominance of discourse is maintained via strengthening cyclical exchange between knowledge, power and use (Hamilton and Manias, 2006). Knowledge wields power and power lends authority, leading to further investment of research and technology.

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About Mental Health Nursing

The June/July 2018 #MHNjournal highlights include: - A report on concerns over money lending for people with mental health problems - The language of psychiatric discourse: power and imbalance - Guidance on writing for publication - Speak Up! features on experiences of working with mental health nurses, and recovery from anorexia - MHN Student Focus: Matty Laycock on the important of focusing on recovery - Inside the mind of... Natasha Devon - Resource reviews - Our regular updates from LPO Dave Munday and news from the mental health nursing world