Seven “Dirty” Words That
 Social Workers Should Not Use
In Their Work

There is a strong movement in the mental health field to advance the understanding and recognition that “recovery” is a real and attainable goal for consumers of mental health services.  Social Work Speaks states that the mental health system of care should have, “an emphasis on empowerment and recovery” (Social Work Speaks, 7th ed., 2006, p. 272).  Recovery has different meanings for each individual, however, and does not, in most cases, mean that a person will no longer have a mental health concern or symptoms.  For some, “recovery” might mean that they are able to maintain a regular full-time job; whereas for others it might mean the ability to live independently outside of a psychiatric institution; and yet to other individuals, recovery might mean that they are able to have a romantic relationship and take a decreased amount of medications.  Our role as social workers is to help each person achieve a recovery that is consistent with their individual wants and needs. 

      There are many ways in which we can help consumers of mental health services to move forward with, and to have, gratifying lives.  One of the most important ways we can contribute is by helping them to understand that they are valuable individuals who can take charge of and make decisions about their own lives.  Our use of language when talking with consumers is a key factor among the efforts we can make to help them understand these facts.  Using words which infer that a person has little worth, is incapable of making decisions, or misbehaves can be discouraging and damaging to any person’s self-confidence.  People with mental health concerns, who experience stigma and discrimination throughout multiple areas of their lives, are particularly likely to be discouraged if their social worker—one of the people who should be helping them the most—uses words that erode their sense of self-confidence. 

Identifying specific words that are likely to be discouraging or damaging to any individual’s self-confidence can sometimes be difficult, since words have various meanings.  An individual with a cultural background that is different from your own, for example, may present particular challenges for you in ensuring that you do not unintentionally use words that are offensive or hurtful.  People with mental health concerns may similarly interpret unintended meanings from seemingly harmless words.

The Depression and Bipolar Support Alliance (DBSA) is an organization dedicated to the support of consumers and their families.  Realizing that individuals may interpret words differently, they have developed a list of what they call “Seven Dirty Words,” which providers should never use when referencing or talking to mental health consumers.  These words (and the reasons) are as follows:

1. Compliance (We use this word with dogs, not people.  The aim of treatment/services is recovery for a person, not the patient/client being a "good dog.")
2. The patient failed the treatment (Sorry, it's the treatment that fails the patient, not the other way around.  If it doesn't work for the individual or can't be tolerated by the individual, it's not the right treatment.)
3. The bipolar in room three (Person-first.  If we as professionals don't see the person as an individual, we are not doing our jobs.)
4. The treatment team (Consider this sports analogy:  If the professionals are the team, what's the patient/client?  The ball?  The opposing team?)
5. Resistant to treatment (See #2.  Again, if the person doesn't want the treatment, it's not the right treatment for them.)
6. Minimal side effect profile (Side effects are not minimal at all to the patient/client who's experiencing them.  Often the remedy seems worse than the "cure."  Weight gain, uncontrollable tremors, dry mouth, sleepiness--we shouldn't expect people to accept these.)   
7. Front line staff in the trenches (Do we really want to use a war analogy?  And, if it's a war, who's the enemy?  The patient/client?  Using this language reduces the patient/client to a sideline participant rather than the focus of treatment efforts.)

(The “Seven Dirty Words” were developed by Sue Bergeson, president of DBSA, and were obtained and reprinted with permission.) 

Helping individuals recover from life’s challenges and live fulfilling lives is a part of the job of all social workers, and mental health consumers are no exception.  Well-intentioned efforts can often go awry, however, if we don’t fully comprehend how what we say is interpreted.  The list above provides some guidance not only on specific words and phrases to avoid, but also to the beginnings of an altered lexicon that might be used in clinical practice.  The ways we communicate must make clear that consumers are important people who have the power and potential to improve their lives.  We as social workers should be at the forefront of professionals who help to incorporate this mindset and understanding into the mental health system. 

REFERENCES:

Bergeson, S. (2005). The Seven Dirty Words. Depression Bipolar Support Alliance (DBSA). (Reprinted with permission.)

De Silva, E. C. & Clark, E. J. (2006).  Social Work Speaks:  National Association of Social Workers Policy Statements 2006-2009 (7th ed.). Washington, DC:  NASW Press.