Stigma, humanizing terms, and taking on hostility

~ Jason Schwartz

I’ve posted quite a bit on language in advocacy over the years.

Most recently I posted about the choice between words (“chronic brain disease”) that evoke less blame but more pessimism about change, or words (“problem”) that evoke more blame but more optimism about change.

A couple of months ago, I examined a few examples of controversial language and the impact of attitudes vs. word choice. I also called for more discernment about language that has an innate negative valence vs. language that may have been tainted by the attitudes of others. Where language is tainted by attitudes, maybe our locus for change should be the attitudes rather than the language.

Between those two posts, I shared a tweet from Keith Humphreys on a “peculiar ‘conspiracy'” among people who see themselves as compassionate toward people with addiction, but actually contribute to cultural pathologizing and pity toward them.

Keith Humphreys (yes, I’m a fan) recently posted a series of tweets about changes in “acceptable” language on the basis of perceived stigmatizing effects.

30 years ago, professionals were urged to not say patients “returned to substance use” because it was stigmatizing; “Relapsed” was better. Recent papers argue that “relapsed” is stigmatizing and “returned to use” is best. No evidence supports either requested language change.

Keith Humphreys (@KeithNHumphreys) January 19, 2021

He continues with questions about whether some advocacy to improve language is not only ineffective, but might be self-defeating.

What happens is that as “humanizing” terms get more convoluted, they are converted to acronyms like PWUD which aren’t humanizing at all.

Keith Humphreys (@KeithNHumphreys) January 20, 2021

He describes the lateral violence that often accompanies language advocacy. (Also, check out Bill’s recent post asserting that we shouldn’t think ourselves immune to abusive behavior.)

I think it is hard when working on a societally-despised population for all of us to avoid taking on that hostility in our own interactions, to the point that we start tearing each other down instead of lifting each other up.

Keith Humphreys (@KeithNHumphreys) January 19, 2021

He highlights the absurdity of the lateral violence in the context of the instability and circularity of many of these language changes.

That is the current claim. 30 years ago, I was told “Return to use” was a blaming phrase indicating moral failure because it implied the person chose to use again. “Relapse” was allegedly more sympathetic. Again though no data, just people condemning each other’s language.

Keith Humphreys (@KeithNHumphreys) January 19, 2021

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Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I currently serve as the Director of Social Work and Spiritual Care for a healthcare system. I've also served as the Director of Behavioral Health at another hospital. I'm also a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.