"Patient", "Client", "Service User"; Why Language Matters

I refuse to use the word "patient" to refer to folks that seek out a professional/counseling relationship with me. First of all, I'm not a medical doctor. Second, and more importantly, "patient", implies "sick, in need of cure, being enacted upon, one who is helpless or dependent, one who is acted upon". I could see the argument for "patient" as "sufferer" or "one seeking healing" but that's just not the cultural context we're living in in America right now. "Patient", given the history of the language and practices around the physician-/psychiatrist-/doctor-patient relationship, is nearly always associated with not only an archetype of the sick person in need of treatment/a cure, but also the reality of who gets labeled with/as what in America. One not need look far to find the history associated with the word "patient" and the paths that word has traveled. Originating in the 14th Century, the word has been weaponized against women, trans and intersex people, people of color, disabled* folks, spiritual leaders, etc. "Patient" perpetuates therapy and healing as transactional and individual, rather than relational and collective. I don't believe that healing can really happen in holistic ways when mediated by individual transaction and capitalism. I'm not fixing anyone. I'm not curing anyone. The fix and the cure is societal, not individual. I'm in relationship with people who are suffering and trying to make sense of their experiences. Part of what I love about language is that we all have the power, collectively, to socially construct the ideas and concepts that certain words perpetuate. What would it look like if we collectively shifted to new words and new ways of relating as we move through healing journeys? Can we find language that doesn't feel so unidirectional, so transactional? Can we allow those seeking healing to dictate the terms of their own engagement and choose the words that work best for them? If we need common language to understand what we're talking about, where are the roots that need pulled up so we can plant something new that will last? In all of my work, I'm striving towards language and practices that offer options, that empower my clients and myself, and that move us in the direction of liberation. I don't have perfect language for this relationship yet. I most often use "client" as it's simple and it's a word many people can understand with ease. It's a word that at least indicates some sense of agency, that is vague enough to not carry such specific connotations as "patient", and that allows for broader terms of engagement with one another. I've considered "community member" but find that term to be vague when I am trying to indicate to others the more specific nature of my relationships with the people I serve.

I've used "service user", especially when working in non-profit spaces and adaptive

MARK MCCONNELL, 1999

recreation spaces. Particularly with "service user", however, the unidirectional nature of the language is flipped and moves from service user to service provider (vs. clinician to patient). However this creates a dynamic where there's an attitude of "well if they want

services they need to come get them" and removes responsibility and action on behalf of the service providers. I've seen this play out time and again, and "service users" are often some of the most marginalized groups with the biggest barriers to care, in this context. As licensed/pre-licensed clinicians we're stuck in a unique position. We hold a particular gatekeeping role that requires us to uphold certain institutional and cultural norms in order to keep our jobs/maintain our licensure, and maintain our respectability within clinical and professional spaces. On the one had this gives someone who looks (and is perceived) like me the ability to gain power and access. On the other hand, it's incredibly painful at times to engage in this work from this role as someone who has been harmed by people like me. It's hard to sit in rooms with clinicians who are talking disparagingly about clients and their diagnoses from a completely different reality than me, often not realizing that they are describing someone just like me.

I could choose to go the route of peer support, and forego my licensure in favor of more flexibility and ease in my own life and practice. But to disengage from the field and credentialing process would also mean that I'm giving up opportunities to generate change from this specific professional location; I would need to come at the industry as an outsider/community member/service user. In keeping my role as a licensed professional, I gain leverage and "credibility" and can also bring my experience as a service user/psych survivor into my work and I can amplify the voices of those without credentials.

I choose the imperfect practice of liberated gatekeeper, centered and grounded in community. Because we hold these roles (culturally, institutionally, interpersonally) we have collective power! It's been a real gift to connect with other clinicians/counselors/healers (that language is a whole other conversation!) who are also invested in shifting the frameworks we use and invested in upholding new and different language choices to support this shifting. If you're one of those folks, I'd love to hear from you and how you think about this language piece. Let's continue to find each other and build coalitions and momentum towards new possibilities.

In care,

Max

------------------------------------------------------------------------------------------------- If you're interested in what's informed my thinking about this, look into the Mad Pride movement, the anti-psychiatry movement, what it means to be a psychiatric survivor,

and read more at the following resources: Do We Need a New Word for Patients? by Julie Neuberger, 1999 The Protest Psychosis by Jonathan Metzl, PhD, 2010 Project LETS The ICARUS Project / The ICARUS Project NYC Fireweed Collective The Mad In America Blog