What’s in a Word?

The North editorial team explains its choice in terminology and the hope that it will lead to a more inclusive discussion of behavioral health topics.

Illustration of the issues and disorders categorized under behavioral health
Tayrine Cruz

Words are important; words shape our understanding of the world around us and our understanding of ourselves. Just as easily as they can empower us, words can inevitably pigeonhole, stigmatize and reduce us to a single aspect of our complete being. This is why, as we launch North, we have taken special care in how we speak about mental health, and more specifically, why we’ll often use the umbrella term “behavioral health” in our conversations focusing on mental health and associated behavioral concerns.

People often use the two terms interchangeably, as there is a strong overlap in their meaning and the topics they encompass. In the public conversation about mental health, there have been tremendous strides toward selecting the words used to discuss people’s experiences with the associated issues and disorders (a topic we will expand on in a future post). So when it came time to decide whether we would be using the term behavioral health or mental health to cover all related topics, we felt like it was a decision worth explaining to our readers.

Mental health is the term most familiar to people when discussing subjects like suicide, depression, and other disorders. The World Health Organization (WHO) and the Center for Disease Control (CDC) both define mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively or fruitfully, and is able to make a contribution to her or his community.” This definition emphasizes well-being as it pertains to one’s ability to achieve goals individually and as a part of a greater community. Not too dissimilarly, Mental Health.gov and Medline Plus offer a definition which focuses on what we might traditionally associate with the term: well-being of a person’s mind or psyche, or more specifically a person’s “emotional, psychological, and social well-being”. Both Mental Health.gov and Medline Plus also characterize mental illnesses as those which affect “thinking, mood, and behavior” and can be caused by genetics and/or life experiences. While mental health as a term undoubtedly aims to be as inclusive as possible, it doesn’t necessarily include behavioral issues that also affect one’s mental wellbeing.

The term “behavioral health” is an umbrella term that encompasses “mental health.” Behavioral health includes behavioral factors such as medication non-compliance or eating habits that might not traditionally be associated with one’s mental health, but certainly can be the result of it or impact it. Carolinas Healthcare echoes this definition, characterizing behavioral health as “mental and emotional well-being”, but also includes substance abuse or other addictive behaviors. The Substance Abuse and Mental Health Services Administration (SAMHSA) also explains behavioral health as “refer[ing] to mental/emotional well-being and/or actions that affect wellness,” and lists associated issues and disorders as including substance abuse, alcohol and drug addiction, as well as those more commonly listed under the mental health umbrella: psychological distress, suicide, and mental disorders.

At North, we consider the definition of mental health to draw upon these above-mentioned ideas of “emotional, psychological, and social well-being” or anything related to a person’s psyche, and believe that it falls under the definition of “behavioral health," much like the SAMHSA definition suggests. Even after defining these two terms, we recognize that there are still limitations and obstacles when selecting the correct term. After all, words will always be limiting, in that they oftentimes fall short of adequately describing aspects and experiences of the human condition; there are always those “intangible” things that words cannot do justice to. One of the most significant limitations when using the term “behavioral health” is the very word “behavioral” - or more specifically its root, “behavior”. In employing the term “behavior”, there’s a certain implication of control over one’s actions and behaviors, despite many (perhaps even most) of our behaviors being involuntary or nonconscious. From a scientific perspective, “behavior” relates to a reaction or “response to stimulation,” but when used in the public vernacular, most people generally use the word “behavior” to describe “the way in which someone conducts oneself,” which suggests a degree of control or agency over one’s actions. In fact, people often assign the labels of “good” or “bad” to many voluntary behaviors, which can become problematic when trying to apply a similar understanding to those nonconscious or involuntary behaviors.

When these two definitions get confused in the discussion of behavioral health, a misconception emerges that people living with behavioral health issues have agency to command or manage their symptoms, which we know isn’t the case. Someone living with behavioral health issues does not do so because of a choice; it is nonconscious or involuntary. As we know from many of the above-mentioned definitions, there are a myriad of factors that can contribute to a behavioral health disorder diagnosis - most of which are out of a person’s control. Despite this sometimes problematic association, we are still choosing to use the term behavioral health because we want to include the stories that aren’t always addressed when we discuss “mental health”, but that certainly deserve a place in our conversation. We will be focusing on these kinds of issues and associated behavioral concerns, as they are all equally important to understanding topics like suicide and depression, and other traditionally-identified “mental health” topics.

North is a space for everyone with a behavioral or mental health disorder, along with their families and communities. While we have made this decision in terminology - to use “behavioral health” to speak broadly to both mental and behavioral health issues - we want to emphasize that North will continue to evolve as we develop our community and our understanding of behavioral health. If at any time we find that our usage of the term is no longer serving our mission - or you, our readers - we will find a way to better describe and represent these human experiences in the most accurate way possible.