Language and patients


The question of whether to call the people we see "patient" or "client" was discussed in my graduate program more than 25 years ago. I think it was Carl Rogers who introduced the term, right? In his book Client Centered Therapy? "Client" came to represent in my mind the Rogerian approach. At that time, everyone else was calling the client a "patient" as we diagnosed our "patients" with a DSM II diagnosis such as "neurasthenia". And if we go back a few decades before that we find people wanting to be "neurasthenic" and checking themselves into asylums (which were once wonderful places of refreshment) at their own expense.

The problem is, I think, that the connotation of these terms change in the culture and it is hard to evaluate what things meant then from our perspective now. Most interesting, I think, is the evolution of terms having to do with low intelligence. At one point "moron", "imbecile", and "idiot" were professionally applied labels, each with a different technical meaning. Then we switched to "mentally retarded" which I recall having the sound of trying to give things a positive spin. It just meant that you were "not as fast at this moment", or something like that. Then it took on a negative connotation, too, and the children started calling each other "retards". Remember? The people who invented "special education" were trying to change the meaning in a positive way, but, woops, now "special education" means "a class of retards", in kid talk. Doesn't it?

It is more difficult to control the meaning of things than just switching the vocabulary. Often language has its way with us.

Lois Shawver, 30 August 1996