Glossary
Institutionalisation used to be made possible by the sturdy walls of the asylum which penned in a largely captive audience. Its members were over time deprived of identity, agency, difference, autonomy and potency by a group who acquired all these things for themselves through the way they treated and related to them. Institutionalisation was therefore a kind of theft made possible by hierarchy.
When the walls were flattened by developers or left as facades to house buy-to-let apartments or bolt-holes, institutionalisation was not carried away on the skip-lorry with the debris and detritus of a century and a half of sustained activity. Being a durable instinct or drive, it had to find another expression – and the subtler, the better.
Carespeak, of course, is the new medium through which the professional class gets to work on those who have been deemed mentally ill or disordered. Calling them service users – as we are encouraged to do and ostracized if we don’t – is the velvet glove on the oppressive hand of the new institutionalisation. The message remains clear, in the 21st century as it was in the 19th and 20th centuries. We don’t hear it on the hospital tannoy because it is declared loudly enough in a bright, crisp language in every exchange. It says, as it always said: we are the mainstream and have the knowledge, status and training which cement our position in the higher reaches of the hierarchy we operate by. You are different from us but essentially very similar to each other. You suffer from a kind of deficit which, if you subordinate yourself to us, we will correct. If you fall in step with our constructs and subscribe to our plans and templates, we will begin to approve of you. You might also begin to feel subjectively better. But there is a price to pay for these benefits. Your feelings of authenticity, autonomy and volition will contract; your sense of being ordinary or one of the crowd will begin to desert you; and you will gradually become aware that you carry a kind of mark which no-one can see but everyone is aware of.
The ShrinkTank Glossary translates the absurd excesses of carespeak into everyday English and demonstrates that the Emperor was indeed naked all along.
A
Absconsion Legging it
Action plan Plan
ACT/AOT Assertive Community Treatment or Outreach Team
An expensive import from the US of unproven and doubtful value. Better pay and much lower caseloads in these teams lure disaffected staff from more generic teams. All mental health staff should reach out and be assertive at times.
ADL Activities of Daily Living
1. An interest in these is a symptom of being an OT (see below)
2. Anything that a teenager refuses to do
Anxiety Fear of loss of control where there is an expectation of control
Appropriate Correct, right
ASW Approved Social Worker (pronounced az-wa)
One of three signatories (now replaced by Approved Mental Health Practitioners – amps) needed for a section. Mainly a grizzled bunch of old-stagers who tended to do a difficult job rather well.
AWOL Absent without leave
Did a runner – often, in the case of unpopular patients, with an element of collusion or indifference on the part of staff. The huge number of risky NHS patients AWOL at any one time are accidents waiting to happen.
B
Benzodiazepine
1. The lazy person’s alcohol
2. The poor person’s alcohol
Bereavement reaction Upset because someone has died
Bi-polar disorder
1. Formerly manic-depression, a serious recurrent illness characterised
by uncontrolled, dangerous highs and profound lows: stigma-heavy
2. An elastic designer description for changeability of mood, occasionally used to describe bad behaviour: stigma-lite
BNF British National Formulary
The prescriber’s bible, a book which says most psychotropic drugs can kill you.
BNF Limit
BNF non-limit.
BPD Borderline Personality Disorder
A late 20th century invention, now applied to those who would have been described as “a bit of a case”: a diagnosis resisted vigorously by some and embraced enthusiastically by others.
C
Cannabis misuse Cannabis use
Canteen (Generally) the only place in the hospital where genuine collaboration and exchange of ideas take place. Seen by senior management as an expensive hotbed of subversion.
Care co-ordination An aspiration
Care management Ditto
Care pathway What happens to you and where you go if you have ceded power to professional helpers. See below.
Carer Relative (see below)
Carespeak A special language containing a hidden message – that you are ill but I’m not and saying I have lots of power but you don’t have much at all.
CBT Cognitive Behaviour Therapy
Either the all-curing elixir of life or an overrated technique of limited benefit and disproportionate influence.
CMHT Community Mental Health Team
A team that is multi-disciplinary but also mono-lingual, usually speaking the language of medicine
Commissioning Rumoured to be connected with setting up health and social care services. An impenetrable concept for clinical staff, an industry of limitless possibility for those who report that this is what they do.
Cooperative Does what we want
Cost improvements Cuts
CPA Care Programme Approach
A puzzling invention, like Lymeswold cheese, which is likely to disappear very soon. Also, one of a small but important group of carespeak shibboleths: that is to say, merely voicing the word can allay anxiety and convince the listener that the service is clearly on the right track.
CPN Community Psychiatric Nurse
For basic-grade nurses, the first rung on the escape-ladder from the acute admission ward. They are necessary to replace the canny old-stagers who have made enough money to retire to the houses they have built in Mauritius or Cyprus, a real brain-drain which is seldom acknowledged.
Care Quality Commission Filing and Form Commission
Crisis resolution Muddling through when things get sticky
Cuts Cuts
D
Delayed discharge As in “she’s a delayed discharge”: formerly, bed-blocker, meaning that all interest in the patient has been lost
Depot Anti-psychotic medication given by painful injection
(Figuratively: an important symbol or leitmotiv denoting power)
Depression What you’ve got if you’re white and middle-class (cf Schizophrenia What you’ve got if you’re black)
Difficult This patient makes me feel inadequate
Discontinuation syndrome Being a lot worse, when you stop taking a drug, than you ever were before you started taking it
Dysthymic A bit down
DLA An extra allowance from HMG for the purchase of tobacco, cocaine and other materials necessary to mitigate the effects of mental illness, hospital admission etc
DSM-IV The US Diagnostic and Statistical Manual
The American version of ICD-10, speeding the journey to a world where normality is seen as deviant, being well as being deluded.
Dual diagnosis This person treats his angst, ennui and/or other psychological states with alcohol or other readily available drugs.
E
ECT Electroconvulsive Therapy
What most mental health professionals would want to be given if they were catatonically depressed: what everyone else sees as barbaric.
Emotional dysregulation A bit all over the place
Empowerment This is what I think you should do
Euthymic Sort of OK
H
Hard to engage Doesn’t like being a psychiatric patient
High-quality Lacks real quality
Homicide Inquiry
1. Are there any extra procedures we can add in here?
2. Is there a member of staff we can suspend here?
HTT Home Treatment Team
A radical idea but generally Meals-on-Wheels, only with medication instead of food.
I
ICD-10 International Classification of Diseases
The Gideon Bible of mental health – on every psychiatrist’s shelf but rarely opened.
Illness
1. A universally recognised and useful concept
2. A dirty word (see Issues)
Inappropriate Incorrect, wrong
Informal admission (also known as voluntary admission)
“You can agree to come into hospital but if you try to leave, we’ll section you” (First reported in Hotel California: “you can check out any time you like but you can never leave”).
Insight As in – “he lacks insight”, carespeak for “he disagrees with me” or “he dislikes my explanation for what he’s going through”.
Interpreter Someone ready to join in the pretence that the patient doesn’t speak English
Intensive Care Unit (formerly “the lock-up”) An intensive surveillance ward
Issues (as in “mental health issues”) Unpleasant feelings, thoughts or experiences which those who have them want to go away as quickly as possible
L
Lead professional As in “lead psychologist” or “lead nurse”
A powerful vested interest with undue influence
M
Management problem He won’t do what we tell him
Manipulative This patient won’t leave the manipulation to staff
Medication regime He’s on quite a lot of stuff already
Medium Secure Unit (MSU) A not very secure ward
Mental State Examination Finding the symptoms I already know are there
MHAC Mental Health Act Commission (now absorbed into the CQC – Care Quality Commission): a watchdog that barked up the wrong tree
N
Needs Assessment Usually a long form perpetuating the myth that the needs of people with mental illness are somehow different from everyone else’s
NHS Formerly a response to illness and pathology, now a market organisation which needs to stimulate dependency and demand
Non-adherent He won’t take his medication
Non-compliant He won’t take his medication
Non-concordant He won’t take his medication
Nurses’ Office Where nurses go to socialise while writing or typing.
O
One-to-one(1:1) Having a nurse reading the Daily Mirror outside your room
Open ward A locked ward
Occupational Therapist(OT) Someone called Kate, Emma, Sarah or occasionally Kieron
Overarching Vision My version of reality to which I expect everyone, eventually, to subscribe.
P
Patient Journey Patient struggle
PD Personality Disorder , as in “she’s a real PD”: meaning “she always seems to be one step ahead of us”
Performance indicators Whatever happens to be easy to measure
Person-centred care IT-centred care
Personalisation Making everything like shopping
Pharmacotherapy Giving people chemicals to alter their minds
Placement panel A device for undermining clinical staff and diffusing responsibility
Psychologist The person to whom talking to patients is generally delegated
Psychology The art of well-intentioned obfuscation
Psychosocial intervention The wheel, reinvented
Psychotherapeutic Wealth-altering
Psychotropic Mind-altering
R
Reactive engagement This patient is stroppy
Readiness for change model Now will the patient do what I tell him to do?
Rebound psychosis Symptoms which develop, when someone stops taking a drug, which are much worse than those it was originally prescribed for. This is treated with higher doses which will lead to a worse rebound psychosis when the person inevitably stops taking the drug again.
Recovery Model A popular new-ish brand-name for getting on with your life like everyone else
Resource centre A centre
Rehabilitation (theoretically) the promotion of recovery: (in practice) the promotion of chronicity
Relative A person further down the hierarchy of importance than the professional
S
Second opinion An opinion which confirms the first opinion
Senior-level Senior
Side-effect For patients, the main effect. For doctors, a minor irritant
Smoking-room (archaic) The hub of the ward, largely avoided by staff, where the real business was done
Specifically targeted Targeted
Stepdown facility His next home
Sub-optimally groomed Scruffy
Supra-maximally treated Hoping for the best
T
Tardive dyskinesia A very unpleasant and irreversible condition attached to the process of getting better
Therapeutic relationship (archaic) A relationship which helped the patient get better and the professional feel better
Therapeutic community (archaic) A democratic institution run for the equal benefit of patients or residents and staff
Training A largely recreational, market- or anxiety-driven activity which seemed to make sense at the time
U
Unit Carespeak for “ward”