Language: A Carrier of Stigma in Mental Health

Language: A Carrier of Stigma in Mental Health

Language Shapes Perceptions and Cognitions

According to the principle of linguistic relativity, language is said to have the power to shape our worldview and it has great influence on our thinking processes. One way in which language can influence our view of the world is through attentional biases, the tendency to pay attention to certain things while ignoring others.

Take for instance subtle variations like “person with mental illness” and “mentally ill person”, which are often used interchangeably. The former promotes the view that the mental illness is only one portion of an individual’s identity while the latter promotes the view that the mental illness envelops the identity of an individual.

Language: Person-first Language vs Premodified Nouns

In person-first language, the disability-related term comes after the individual. The use of person-first language attempts to reduce spotlight effect on the disability by addressing such individuals respectfully while protecting their dignity. An example of person-first language would be, “the boy with depression”.

On the other hand, the use of premodified nouns indicates that the identity of the individual is inseparable from his diagnosis, disability or condition. An example of a premodified noun would be, “the depressed boy”. Concerns regarding the use of premodified nouns include its potential to devalue others, express negative attitudes, and promote stigma.

The Current Study

Granello and Gibbs (2016) conducted a survey to investigate the effect of language and labels on tolerance towards people with mental illnesses. There were 3 groups of participants: undergraduate students, adults in a community sample and professional counsellors or counsellors-in-training. Each group was randomly divided into half and given a premodified version (“Person with Mental Illness”) or postmodified version (“The Mentally Ill”) of the “Community Attitudes Towards the Mentally Ill” survey. The survey assessed participants’ impressions of individuals with mental health issues, such as depression and anxiety disorders.

The survey measured 4 indicators of tolerance which are defined below:

Authoritarianism: The belief that people with mental illnesses are inferior in society and it is necessary to treat them with force.

Benevolence: The view that people with mental illnesses should be treated in a paternalistic manner but with compassion.

Social Restrictiveness: The view that people with mental illnesses are dangerous and pose as a threat to society.

Community Health Ideology: The belief and acceptance that community integration and deinstitutionalized care is beneficial for people with mental illnesses.

Results from the Current Study

Across the 3 groups of participants, language and labels were found to have significant influence on their tolerance towards people with mental illnesses. Within each group, significant differences were found between participants who received premodified and postmodified versions of the survey. The differences are highlighted in the table below.

  Authoritarianism  Benevolance 

Social Restictive 

 Health Ideology 

 Undergraduates             X            X  
 Adults           X               X
Counsellors             X            X  

Note: X indicates that there is a significant difference in measurements between the two versions, for each group

Notably, there are significant differences in how language and labels influence tolerance across groups. Although counsellors had higher levels of tolerance than other groups, language still led to differences within the group. It is clear that individuals in varied walks of life, with different tolerance levels, and different experience with mental illness are all affected by labels. No one is resistant to the effects of labeling, despite the fact that both labels were given the exact same definition.


While the mentioned study used a largely European sample, its findings are likely to be applicable in Singapore as well. In the first few months of 2019 alone, The Straits Times published 3 newspaper articles that were titled with the premodified noun “the mentally ill”. This raises great concern because The Straits Times is an established news outlet with a wide audience. The use of such labels in mainstream media could normalize its usage.

While most individuals use premodified nouns without intentions of promoting stigma, it is often used carelessly, without much thought. You can refer to a another article here to find out further how person-first language could be used instead in different situations.

Stigma has always been ingrained in language, which plays the role of a carrier that transmits stigma. Labels and stigma has always had profound effects on individuals with mental illnesses. The effects of public stigma have even been found to be more profound and isolating than the mental illness itself. While it may appear to be a subtle shift in one’s choice of words, it could drive a powerful change.


Granello, D. H., & Gibbs, T. A. (2016). The Power of Language and Labels: “The Mentally Ill” Versus “People With Mental Illnesses”. Journal of Counseling & Development, 94(1), 31-40. doi:10.1002/jcad.12059

Article written by Tay Shi Ying. Shi Ying is a psychology undergraduate at the Nanyang Technological University (NTU) undergoing internship with ImPossible Psychological Services.

Muhammad Haikal Bin Jamil

About the Author

Haikal received his Master degree at the National University of Singapore (NUS), under a full scholarship awarded by the National Council of Social Service (NCSS). Before entering private practice, he has gained much experience in both hospital and social services settings.

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