The language of consumerism
We use the term 'consumer' throughout this website and in the work we do as part of the Our Consumer Place team.
The language of consumerism in the Australian mental health context and why it is both contested and important
Many people, including some people who identify as users of mental health services or people who have, at some stage of their lives, been defined as 'mad', dislike the use of the word 'consumer' in a mental health context. Many find it strange and incongruent. Others dislike its market place connotations. Many clinicians say 'their' patients hate it.
In order to understand our use of the language of consumerism it is helpful to know a little about its historical and political roots. The use of the term, 'consumer', in a health context was borrowed from a burgeoning consumer movement in other areas of health in the 1970s. 'Patients' started to insist that they wanted some say in important decisions being made about their own bodies. This quickly developed into a push to influence the health agenda, the allocation of funds and then on to 'consumer perspective' input into health policy development. It was a declaration that in medical transactions the person being 'done to' and 'done on' medically should have a right to demand good quality work, value for money and information to guide their decision making.
The word, 'consumer' in mental health policy and practice
Many people diagnosed with 'mental illness' or 'mental disorders' are seeking a way of positioning themselves within national debates about the efficacy of their own treatment, recovery and policy. In order to do this they feel disadvantaged by both the language of 'patient' and the language of 'client'.
There is a perception that the language of 'patient' has been colonised by doctors and that psychologists and social workers have laid claim to the term, 'client'.
Criticism of the word 'consumer'
Criticism from the 'left'
The term 'left' is used in this context to describe those people who see themselves as survivors of the mental health system, which they view as intrinsically damaging. One of the important points of difference is that where those who ascribe to being 'consumers' are often driven by a need to reform the system, those who ascribe to a platform of 'psychiatric survivor' often see themselves as revolutionaries, particularly in relation to forced treatment.
In politics, "left-wing", "the political left", or "the Left" often refers to politics that seek to radically overhaul social hierarchies and promote an equal distribution of societal wealth and privilege. In relation to mental health politics people who see themselves as survivors of psychiatric systems fight for the abolition of an imposed order of disadvantage justified by medicine - an order that renders the idea of self-determination obsolete for many.
More radical commentators from the 'left' also argue that in reality mental health consumers have very limited purchasing power and very little choice - especially, but not only, when they are being treated under mental health legislation. Their argument is straight forward --consumerism is based on the concepts of capitalism and fundamental to a capitalist economy is choice. Without choice there can be no consumer. The term, for them, is a deceptive misnomer.
In public systems most people have almost no say about which clinicians they see, appointment times, frequency of visits, or drugs they are prescribed. Many clinicians still find it difficult to practice in a truly collaborative way, rendering the idea of reciprocity of responsibility and joint decision making somewhat utopian despite the rhetoric about partnerships. The idea of 'the mental health patient' as a genuine consumer is, they argue, a misnomer as the power differential between consumers and clinicians remains a fundamental deterrent.
Criticism from the 'right'
On the other hand there is criticism from the 'right'. In this context the term 'right' is being used somewhat simplistically and perhaps the word 'conservative' might be more appropriate. Reasons some consumers give for being wary of the word 'consumer' include:
- "My doctor might hate me for using that word and I want her to like me."
- "I feel safer with the word 'patient'. It makes me feel looked after."
- "The word consumer doesn't mean anything."
- " I don't want to be political"
- "I'm not a consumer! I'm a patient -just like any other patient."
- "I might antagonise them if I call myself a consumer rather than a patient."
- "My doctor doesn't like me calling myself a consumer."
- "My psychiatrist wants me to get on with my life rather than being a consumer forever. She says consumers are 'stuck in the sick role'."
- "I like my psychiatrist and she doesn't like that word"
- "We can still achieve change and call ourselves 'patients'".
Criticism from clinicians
Some clinicians criticise the term because they think it is crude and misrepresents their mission. The archaic definition of the word 'patient' is about 'suffering' or 'someone who suffers'. Most clinicians are strongly committed to their patients and believe they are there to relieve suffering and genuinely care for people in pain. It feels insulting to some that this mission is being undermined by a crude language of consumerism.
Language is contextual
Sometimes individual consumers use different words for different purposes. Words change meaning depending on how they are used and what we are trying to do with them. As consumers we sometimes name ourselves differently in different contexts depending on many things; sometimes fear, sometimes because we want to influence someone or a debate, sometimes because we want to feel safe, sometimes because we want to appear knowledgeable and have our knowledge respected. Even as we construct meaning through language we ourselves are constructed as social beings by language. Too often we fail to acknowledge or even recognise that meanings are relative and do not dwell in the words themselves but in the social, cultural and historical contexts in which words they are used.
For example: As much as we might name ourselves as 'consumers' some of us might prefer a different language when we are, for example, a patient in an acute unit. At this point of time we might see ourselves as direct recipients of services and our role (very temporarily hopefully) will be that of a 'sick person'. When we are 'sick' we might use the language of 'patient'. However, many of us don't want to be permanently defined in this sick role. To hold this persona of 'patient' outside direct service delivery contexts can be very disempowering for many and detrimental to recovery for some.
Different language according to location and purpose
Internationally people and groups of people use many different terms to describe themselves. Different terminology includes 'patient'; 'client'; 'resident'; 'service recipient'; 'sufferer'; 'psychiatric survivor'; 'psych. Survivor'; 'user'; 'service user'; 'consumer'; someone who is 'mad', 'batty', 'crazy', 'nuts' etc.; 'ex-patient'; 'C/X/S' (Consumer/Ex-patient/Survivor) and more. Language not only changes according to the political leaning of the group or individual but it is also determined by geography. In Australia the most commonly used term is 'consumer'. The term 'survivor' has currency in much of the USA and Europe. In New Zealand the dominant language is 'service user', as it is in the U.K.
The Language Challenge
The fundamental reality is that, "being defined by others is exactly what this movement is NOT [author's emphasis] about."
We do have a language challenge. However, the fundamental reality is that this language debate belongs to us. There are rumblings coming from different parts of the consumer movement which are driving us to our own crisis of confidence in the language of consumerism but we do not yet have an agreed alternative and we are understandably angry when other groups, especially more powerful groups within the mental health debates of the 21st Century, pontificate on our behalf. Melbourne consumer, Alan Pinches, argues that:
The word consumer is far from perfect but it's the best we have available at the present time.
- Meagher Janet, What are You? Terminology - a paper prepared for the Australian Mental Health Consumer Network
- Pinches, Allan, What's in a name? Well, When it comes to that widely detested tag "consumer'… quite a lot, actually (follow the link from the home page).