Words matter

A letter in response to an article I wrote for The Drum on mental health stopped me in my tracks. Language is critical in tackling prejudice.

Yesterday Harold A. Maio called out my use of language in an article that I’d written for The Drum about mental health in public relations. He’s a retired editor and lifelong stigma fighter.

Mr Maio makes the point that a writer should examine their own bias, avoid lazy descriptions, and call out prejudice and discrimination. I’m publishing his letter below in full with his permission.

Dear Stephen

“Removing the stigma around the issue of mental health.”
— Stephen Waddington, The Drum, 9 March 2017

Once we used the term stigma it is a difficult prejudice to shake. But not impossible.

Assigned to rape for generations, an empowered Women’s Movement told us to stop, we had done enough harm. We stopped.

It was, of course a prejudice (the accurate term).

In its present guise it is precisely that, a prejudice we exercise rather than acknowledge the prejudice. It does considerable harm, but allows us not to acknowledge the reality, prejudice.

As a public relations tool it is very effective, it hides motive.

If you teach a stigma, you place your voice beside everyone who does. If you teach people who say there is a stigma, you raise your voice above theirs.

Some words for you to consider

‘Advocacy for’ is the positive use of language to achieve positive goals. It is measured by the frequency of positive affirmations, the infrequency of negatives.

As simple as that seems, recognizing the positives and the negatives in a society which confuses the two is often difficult.

The use of positives must be deliberate, constant, and consistent, for it takes many positives to overcome one single negative.

Although it is a rule of ‘advocacy for’ to present the positive, sometimes negatives are so well established, focusing on them can bring them clearly to peoples’ consciousness.

In the simplest, most common metaphors, lie the most powerful negatives.

Language does and don’ts

Avoid the intransitive verbs ‘are’ or ‘is’ and thereby avoid the offensive labelling of people as ‘schizophrenics’ or ‘a schizophrenic.’

Instead, use person-centered language and name the illness, such as “He/she has schizophrenia.”

Avoid the articles ‘the’, ‘a’, and thereby avoid ‘the’ mentally ill, ‘a’ depressive.

Use ‘person-centered’ language, such as ‘people with bipolar disorder’ or an ‘individual with depression.’

Avoid using adjectives that label people. Instead, use substantives, naming their conditions.

Avoid ‘mental illness.’ Whenever you can use the fully informative, specific diagnosis.

Avoid ‘mental illness’ in the singular. Use the plural, ‘mental illnesses’ as there are many.

Avoid ‘mental’ illness. Whenever possible, use illness instead. They are illnesses.

Avoid the innuendo “’stigma’, it victimizes. Use instead ‘prejudice’ or ‘discrimination,’ specifics which can be concretely addressed or redressed.

Avoid recounting ‘myths,’ as they are repeated in folk cultures well known, instead inform and educate to truths.

Avoid what is ‘not’ true, educate to truths.

Harold A. Maio
Mental health editor
Fort Myers, Florida

Choosing language carefully is important for writers and anyone in the public sphere. It’s absolutely critical when dealing with difficult issues.

Lesson learnt.

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Stephen Waddington

Partner and Chief Engagement Officer, Ketchum and Visiting Professor in Practice, Newcastle University.


  1. Stephen,

    One has to respect the point, but equally one has to acknowledge that creating or advocating the sense that there is always and only ‘a’/one right way to express what is a very unclear and fluid daily reality is actually counter productive?


  2. Hi Stephen,

    You should be congratulated for raising awareness of the issue in PR and communications. To have someone sending you a prescriptive list of terms you should or should not use is counterproductive in encouraging conversation around something that is surprisingly widespread, even if it is not always apparent. It will simply make people wary of talking about it and we don’t want that.

    My own background has contributed towards my personal depression. Mercifully it’s not at the severe end of the scale. But I don’t see it as an illness per se – some days it is a minor inconvenience, while at other times it feels like I’m in a catastrophic tailspin. But I’ve worked (in a previous life) for people who knew or cared nothing about it and saw it as a performance issue to be managed out, just like your original article said. Finely crafted terminology offers little comfort in that situation.

    We should rejoice that you raised the issue – hopefully you made those (often senior) people who treat anxiety, depression and a range of other mental illnesses as an inconvenience to be removed at the earliest opportunity feel just a little uncomfortable. It is they who need to learn lessons, not you.


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