Mental health counselors have more benevolent, less authoritative reactions to statements that use the phrase "person with schizophrenia" instead of "schizophrenic," according to a new study published last week in the Journal of Counseling & Development, Maddie Bender reports for STAT News.

Cheat sheet: Incorporating inclusive language

Study details

For the study, Darcy Granello, study co-author and a professor of counselor education at Ohio State University, sent a survey to 251 mental health counselors and students in counseling designed to measure their tolerance toward patients with schizophrenia. Half of the counselors and students were provided a survey that used person-first phrases such as "person with schizophrenia," while the other half received identity-first phrases, such as "schizophrenic." The researchers observed the different responses to each terminology.

Respondents rated their agreement on a scale of 1 to 5 with statements such as, "Schizophrenics need the same kind of control and discipline as a young child," and the survey measured authoritarianism, benevolence, community mental health ideology, and social restrictiveness.

Students and clinicians scored higher on authoritarianism when they were given the survey that used the noun "schizophrenic" rather than person-first language, Bender reports. These respondents also scored lower on benevolence—especially those who were current counselors. 

However, Granello said the study can't determine if the counselors' different attitudes affect how they treat patients, since the study surveyed only beliefs and opinions. She noted that future research would need to measure how these language differences affect patient care.

Commentary

According to study authors, the results suggest that a linguistic phenomenon, known as the Sapir-Whorf hypothesis, could be responsible for the disparity between responses. Under that theory, using modifiers before a noun emphasizes the descriptions more than when the modifiers follow the noun. In other words, according to Bender, a phrase such as "schizophrenic" emphasizes the condition, while "person with schizophrenia" emphasizes the person first.

According to Bender, the study adds to limited research on—and supports the use of—such person-centered language in clinical care, which aims to destigmatize disabilities, mental health conditions, and other conditions. Currently, theAmerican Psychological Associationrecommends using both person-first and identity-first language, unless a community's preference is known.

That said, Granello said even without a clear understanding of how language affects patient care, counselors should assume the terms they use, even between care providers, does impact their ability to treat patients—and they should stop using terms like "schizophrenic."

"When clinicians and counselors receive the instrument that says 'schizophrenic,' they score lower on benevolence, on recognizing the basic humanity of the other person," Granello said. "I think when we lose basic humanity of the person sitting across from us, that does have clinical implications."

Separately, Joshua Kantrowitz, director of the Columbia Schizophrenia Research Center, who was not involved in the study, said, "It seems like a no-brainer to put the term 'schizophrenic' into the dustbin of history." (Bender, STAT News, 9/22)