Dual diagnosis or co-morbid or co-existing or co-occurring? What’s in a name? The search for appropriate and consistent terminology The search for appropriate and consistent terminology. Phil Barker

RETHINK “Everybody working within dual diagnosis of mental health and substance misuse agrees on the importance of holistic working”

WITTGENSTEIN “ I cannot illuminate the matter by fighting against your words, but only by trying to turn you attention away from certain expressions…towards the employment of the words.

Using language How does it ‘work’? For whom? To what particular purpose?

Dual diagnosis… …describes people who have mental health problems and drug or alcohol problems. The mental health problems may include schizophrenia, depression, bipolar disorder or Personality Disorder.

Co-morbid ? pertaining to a disease or other pathological process that occurs simultaneously with another. Dorland’s Medical Dictionary

Co-existing? Existing together in time or place OED

Co-occurring ? Sometimes, people seeking relief from an addictive or mental health disorder find that despite their best efforts, they are unable to achieve long term recovery. Relapses, mood swings, patterns of replacing one addiction with another, feelings of hopelessness, fear and confusion are often indicators that there may be more than one disorder present

So, what’s in a name? Everything? Signalling reality Nothing? The name is not the thing.

Mental illness and substance misuse Madness, mental disorder, mental illness or ‘Mental health problems’ Substance use or substance abuse or misuse

Language misuse? Some signs and symptoms of substance misuse may be: Abrupt changes in work or school attendance, quality of work, grades, discipline Unusual flare-ups or outbreaks of temper Withdrawal from responsibility and prolonged depression General changes in overall attitude and personality

Language misuse? Deterioration of physical appearance and self neglect Association with known substance misusers Unusual borrowing of money from friends, co- workers or parents Stealing small items from employer, home or school Rethink

Language misuse? ‘Signs’ and ‘symptoms or Indications?

Interactions Stating the obvious? ‘Languaging’ common sense? Medicalising everyday life?

Problems in Living Where people find it difficult to live with themselves, and/or with other people, or life in general. As a result other people find it difficult to live with the person.

Substance use Whatever the nature of substance use, it should be considered in the context of the individual’s personal history and circumstances. Stereotypes of the substance user should be abandoned in favour of a more individualized, eclectic and holistic understanding of the person.

Substance use Interventions on behalf of the person whose substance use is harmful to themselves or others should be based on thorough assessment and should involve the person David B Cooper

Problematising ‘dual diagnosis’ ‘Dual diagnosis’ is more than simply ‘two problems’ or ‘diagnoses’. Individuals often experience a multitude of problems. Compared to those with a mental health problem alone, individuals with a dual diagnosis are likely to experience:

Problematising ‘dual diagnosis’ more severe mental health problems homelessness/unstable housing increased risk of being violent increased risk of victimisation more contact with the criminal justice system family problems history of childhood abuse (sexual/physical). Philip D Cooper

Avoiding weasel words? How might we help persons, as distinct from clients or users or patients ? What might we be helping those persons to do? What would be the point, in human terms?