21st century neuroscience has done much to bring psychiatry and mental health into the modern age. Our language, however, still lingers behind. Four terms in particular deserve our scrutiny and, in the opinion of many in our field, some alterations.
Why it doesn’t work: This word used to be invoked when behavioral symptoms were found to be the product of a known and observable medical illness. The problem is it implies that, in the absence of such findings, symptoms are therefore NOT organic. At this point, there is overwhelming evidence that all psychiatric disorders are true brain based conditions. How could it be otherwise?
Possible Replacement: Nonpsychiatric. Use it in a sentence. “The lab testing shows evidence of hypothyroidism so it is quite possible than some of your depressive symptoms are nonpsychiatric in origin.”
Why it doesn’t work: When doctors couldn’t find good explanations for symptoms such as pain or neurological symptoms, they could quickly be chalked up as being functional, which implied that they weren’t real or that they were serving some specific purpose. While it’s true that things like anxiety can manifest itself in many ways, the “function” is often difficult to determine and, many times, further medical workup reveals other explanations.
Possible Replacement: Unexplained. Or, if a more precise hypothesis is being proposed, use that more specific term (such as malingering if there is suspicion that a person is consciously making up symptoms to achieve a specific aim). Use it in a sentence. “The patient has unexplained abdominal pain each morning before school. Please evaluate for Separation Anxiety Disorder.”
Why it doesn’t work: The expression “acting out” is actually a psychodynamic term that means a patient is enacting conflicts arising in psychotherapy outside of the therapy session. The term has been usurped to designate any type of disruptive or externalizing behavior.
Possible Replacement: Disruptive or Acting Up. Use it in a sentence. “This child has struggled with a lot of disruptive behavior at school.”
Why it doesn’t work: This one might surprise people as it seems on the surface like a wonderful term to encompass all the potential sources of behavioral problems. Indeed, many psychiatrists continue to love the term. However, it again implies some sort of real division between a biological and psychological factor that can’t really exist. People use the expression as a convenient way to keep track of lots of potential causes involved in the etiology of emotional behavioral problems (genes, adverse events, poverty, etc.). These causes are valid, but the categories themselves collapse under scrutiny. If a series of traumatic experiences results in epigenetic changes in a person’s DNA that in turn evokes increased chaos in the home environment that further exacerbates the patient’s symptoms, what category does this process belong to?
Possible Replacement: Comprehensive or Mutually Interacting Factors. Use it in a sentence. “In my view, this child’s difficulties are the result of a number of mutually interacting factors that require a comprehensive intervention strategy.”
While some will claim that efforts to change these and other terms amounts to little more than political correctness, what we say does have meaning and consequences for our patients. It may take some time, but in the end it is well worth the effort to have our terminology reflect the state of our science.