Jim Holsomback, MA


Language is important. For those that were raised to believe the adage “It’s not what you say, but how you say it”, it was a lesson learned early in life. From childhood, we are taught that using manners, speaking kindly to others and avoiding words that we may later regret are integral lessons in communication that are important to adopt. In the clinical and addiction field, we often find kinder, gentler tones to describe disorders, behaviors and interactions because semantics are important and we strive to have relationships with patients that keep them engaged in treatment and feeling heard, respected and understood.

In the treatment community, we have also worked to ensure that words are behaviorally defined and absent of stigma which can contribute to experiences of feeling marginalized as a patient, or unequal in the patient/practitioner relationship. The lay community has certainly noticed as well, and words like ‘crazy’ and ‘druggie’ are viewed as the ignorant and inconsiderate words that they are. As we continue as a treatment community and society to better define our language, and thus, diagnoses, symptoms and behaviors; we have also reached a time to strike a few other antiquated terms from our clinical language that would continue to destigmatize the important clinical work we provide. Here are some proposed words and phrases that have hit their expiration date…

“Client” – The word ‘patient’ is used to describe someone receiving treatment for a pathology that needs clinical care. Formally, patient is defined as ‘a person receiving or registered to receive medical treatment’. A client is defined as ‘a person or organization using the services of a lawyer or other professional person or company’. So, how did the psychiatric and addiction community begin using the word ‘client’ to describe a person seeking medical treatment? The short answer? Stigma. The medical community describes their patients as just that. A person seeking treatment for leukemia is
not a ‘cancer client’ nor is a transplant patient a ‘client receiving a new heart’. They are patients because of their pathology and their willingness and strength to engage in treatment which is celebrated by their status as a patient receiving care for their pathology. We should not denigrate our patients by hiding behind euphuisms such as ‘client’ or ‘individual’ and communicate shame in their mental health or addictive disorder.

“Enabling/Enabler” – Again, if we were to rely on the actual definition, we would be casting blame on the ‘enabler’ as giving the patient the authority to engage in an unwanted behavior. It simultaneously takes the control for changing an unwanted behavior away from the patient and gives an inflated sense of power (and implied control) over the behavior to another person. If that were true, once an ‘enabling’ person stopped contributing to another person’s behavior, then the behavior would stop. It is full of pretense, a perceived control, and judgment. Let’s work toward behaviorally defining what is happening and avoid harsh judgment around the intention. Most behavior that is defined as ‘enabling’ should be defined as the desire for someone to reinforce behavior with negative consequences with really good intentions and a lack of awareness. Practitioners often see people in families and relationships working in a diligent manner to help a family member or friend and often, they have been reinforced to do so without bad consequences. As a behavior becomes more acute and pathological, family members continue to find themselves reinforcing the same behavior in spite of it becoming problematic. Rather than casting blame and hoping that someone can bring awareness to their unintended reinforcement, let’s work toward defining the behavior and helping them understand how to find a more effective role as a support in a patient’s recovery.

“Rock Bottom” – If ‘rock bottom’ would announce itself as a certainty that things would never, ever get any worse, we could endorse this phrase as a useful treatment term. Unfortunately, as we all know, what is ‘rock bottom’ one day can often be ‘topped’ (or bottomed?) the following week with behavior or symptomatology that is more concerning and acute. When we are treating patients that are implicitly at risk for relapse, the utility of labeling a behavior or situation as ‘incapable of getting any worse’ seems counterintuitive. A lot of people have another relapse left- but unfortunately, everyone doesn’t have another recovery. That may be the only accurate usage of the ‘rock bottom’ verbiage.

Using a disorder to describe a person – Again, when we think of traditional medicine, patients are not labeled as an ‘insuliner’ or ‘melanoma-ey’. Yet, when we are working in psychiatric and addiction circles, we hear patients described as “so borderline”, “addict” or a “cutter” and more. Let’s put some space between the person and their disorder or behavior in the same way we would with any other diagnoses because everyone is, first and foremost, a person who is receiving treatment for or suffering with the diagnosis for which treaters can provide compassionate treatment…..and language.

Jim Holsomback is the Director of Clinical Outreach for McLean Hospital and Program Director for Triad Adolescent Services. www.mcleanhospital.org