“Practitioners use language as a way of creating distance. Occasionally this may arise from lack of confidence and institutional expectations. These causes of “othering” merit attention.”

John Sell [1]

When I posted a link to my previous blog post on Twitter, John Sell responded with the comment above.

I’ve written a lot about why language matters. About what the words and phrases we use reveal and perpetuate about our attitudes and behaviours, and how changing this language can help shift our practice to be more relational, rights-based, and human. But maybe I haven’t really delved far enough into the reasons why we continue to use this vocabulary.

Why we still think it’s ok.

So, here are ten reasons I believe lie behind our use of dehumanising, stigmatising, and ‘othering’ language.

They are reasons – not excuses.

There is no excuse.

1. It’s everywhere

Dehumanising, stigmatising, and othering language is everywhere in social work and social care.

It forms the content of our job descriptions and job adverts (‘you will be required to work with complex cases’, ‘you will be working with vulnerable service users’) and the structure of our departments (‘Complex needs team’, ‘Challenging behaviour unit’).

It’s written into local and national policies, procedures, and practice guidance (‘Death of a service user policy’. ‘Working with uncooperative and hard to engage families’).

It’s built into our ‘case management systems’ – including in that term itself.

It’s embedded in the national data collections and statutory reporting requirements (‘Client level data’. ‘Cohorts of service users’. ‘Care settings’.)

It features in media coverage of social care (‘Care for UK’s most vulnerable faces ‘collapse’’) and in government press releases (‘NHS to expand services to keep vulnerable out of hospital’).

The ubiquity of this language offers some legitimacy to its use.

When something is so prolific, so ingrained, we easily accept it without challenge.

Without thought.

2. We learn it

Social work degrees are advertised as ‘allowing you to make a positive difference in vulnerable and disadvantaged people’s lives’ and ‘helping you build the knowledge and skills to help shape the lives of vulnerable people’. ‘You’ll learn how to work with vulnerable adults’ and ‘gain first-hand experience from service users’.

University departments ‘work closely with service users when recruiting students’ and ‘collaborate with a wide range of service users’ to develop course content.

Entry requirements include relevant social care experience, which could include experience in a ‘care setting’ or ‘personal experience as a service-user’.

You’ll prepare for the ‘challenging role of a social worker’ through simulations including ‘engaging a service user’, ‘assessed role play interviews with a service user’ and have the ‘opportunity to interact with service users and their carers’.

Placements include ‘working with people with complex needs’.

We teach this language.

We are taught these words.

3. We like it

This ‘professional’ language offers us an identity. Using these words demonstrates we’re in the gang. We’re true, genuine members of the profession.

We belong.

Affirming and validating, albeit at the expense of ‘others’, who definitely don’t belong.

These words also offer us and our teams and organisations credibility.

Give purpose to our roles.

‘Protecting our most vulnerable’. ‘Caring for the elderly’. ‘Supporting the disabled’. ‘Looking after those with learning disabilities’. ‘Safeguarding vulnerable groups’. ‘Keeping those with dementia safe and sound’. ‘Helping the frail out of hospital’. ‘Maintaining the disabled, elderly and those otherwise in need of care within the community.’

Protecting. Looking after. Caring for. Safeguarding.

Assisting weak, helpless ‘others’.

That’s our job.

Isn’t it?

And using this language demonstrates our expertise. Shows that we have all the knowledge and all the answers.

But this notion that we’re the experts doesn’t sit at all well in a relational approach, where lived experience should be valued just as highly as learned experience. Where people are recognised as the experts in their own lives. Where listening and curiosity and being alongside and learning together is key. Where it’s often much better to say, ‘I don’t know – let’s find out together’ than ‘I know, I’ll tell you what you need to do’.

4. It’s efficient

Our social care sorting offices prioritise efficiency over empathy. We measure how many how much how long. We work in ‘fast-paced’, ‘busy’ teams. We have targets for the number of ‘assessments’ or ‘reviews’ completed in a week. Support is ‘commissioned’ and ‘delivered’ with just enough time for ‘tasks’, not conversations and compassion.

And when we have deadlines and targets to meet, it’s quicker to make assumptions and to categorise than it is to ask how are you? What would you like to talk about today? What’s important to you right now?

It’s quicker to use acronyms and labels and reliable stock phrases in our assessments and our reviews.

Labelling people means we can process them more quickly through our system, and slot them more easily into our standard service solutions.

“The majority will be your four calls a day stuff.”

It’s also quicker to say ‘my cases’ than ‘the people I’m working with’. ‘The LD team’ than ‘the Learning Disabilities Team’. ‘Customers’ rather than ‘the people we serve’. ‘Our service users’ rather than ‘the people we support’. ‘Chair 7’ rather than ‘the person sitting in chair 7’. ‘Mum’ rather than asking and remembering people’s names.

And anyway, you know who I mean when I refer to ‘the vulnerable’ don’t you?

You know.

Them.

Those.

Not us.

5. It’s effective

Often, we apply labels like ‘vulnerable’ and ‘complex’ and ‘high risk’ to people to make sure they gain entry to our system. To demonstrate eligibility for services and support. These labels help us to screen and ‘RAG rate’ and prioritise and triage. They help us justify decisions and costs to panels. Their inclusion in reports and funding bids helps us evidence ‘demand’, ‘need’ and the ‘worthiness’ of our proposals.

Without these labels, no one passes go.

While some terms open doors to services and support, we use those same terms – and others – to quickly slam doors shut. We label people as ‘too vulnerable’, ‘too complex’, ‘too high risk’ as a way of saying ‘go away, you can’t come in’.

To shift responsibility elsewhere.

Phew.

This language helps to give us a sense of control. It ensures we can frame people’s experiences and behaviour and identity through our own lens. Helps us assert our power and authority over ‘users’, kept submissive by our approach.

Sometimes we feel powerless within ‘the system’.

Feel we’re drowning.

These familiar words help anchor us.

Keep us safe.

6. It justifies our actions

This language is deployed to legitimise. During the COVID-19 pandemic, decisions were made to ‘protect our most vulnerable’. And more recently, councils declaring or facing bankruptcy have noted that all new spending will cease, except for ‘protecting vulnerable people’ / ‘looking after vulnerable residents’ / ‘safeguarding the most vulnerable’ – validating actions while simultaneously blaming precarious budget situations on ‘the increased complexity of vulnerable adults, children and families needing support’, ‘an ageing population’, ‘elderly care’ and ‘growing demand for core services like social care for vulnerable children and adults’.

Dehumanising people helps reduce empathy. Seeing ‘cases’ rather than people makes it easier to do to and for, not with. To assess and to judge and to place and to exclude.

This language helps us to defend our practice and our systems and our institutions.

To justify our prejudices and priorities.

The blaming labels we apply to people (‘difficult’, ‘hard to reach’, ‘refusing to engage’…) allow us to place the ‘problem’ firmly with them.

Nothing to do with us.

And classifying people’s behaviour as ‘challenging’ or ‘aggressive’ makes it easier to gloss over the causes, and to rationalise restrictions and restraint.

Our dehumanising language helps us justify actions that are inhumane.

But in removing the humanity from other people, we diminish our own humanity.

And excusing current practice by deflecting and defending means there’s never any challenge.

Never any change.

7. It helps us cope

Distancing people from us by applying labels that remove their humanity can make it easier to cope. In the same way that we turn off the news when everything just feels overwhelmingly awful and hopeless, ensuring this element of separation is our survival mechanism. It shields us from the pain and trauma of people’s lives. It protects us from acknowledging that their reality could just as easily be ours too.

‘The elderly.’ ‘Those who are vulnerable’. Them. Not us.

This detachment also means we don’t have to show our own emotions or be vulnerable ourselves.

8. We’re not challenged

Maybe we’re not aware of the impact or the implications of our words, or maybe we’re using them with deliberate intent or disregard. Either way, our continued use of these labels and this jargon suggests we’re spending time with people who aren’t challenging our language. Maybe we’re comfortably surrounding ourselves with people who are using it too. Maybe the people we’re communicating with are too daunted to question or object. Maybe we’re just not working closely with and alongside people with cause to draw on care and support and their allies and advocates, who would call out this vocabulary in an instant if they were granted a seat at our table.

9. We don’t challenge

It’s not easy to admit that we don’t understand the language people around us are using. Especially when we feel that everyone else ‘gets’ the jargon and acronyms that remain alien and meaningless to us. And it can be hard to question the language someone else is using, even if we feel it’s damaging.

So sometimes it’s less scary to stay quiet and not ask what certain words mean, or why certain phrases are used so casually and so callously.

Sometimes it’s easier just to use them too.

10. Prejudice

Though we’ll undoubtedly be reluctant to admit it, or even appalled at the thought, much of this language results from, and exposes, prejudice and ableist beliefs.

Our automatic labelling of older and disabled people as ‘vulnerable’, who need ‘looking after’, ‘protecting’, ‘caring for’.

Describing where people live as ‘settings’, ‘facilities’, ‘units’. Institutions to ‘place’ people in. Not ‘home’ – not like us.

Referring to the things people do as ‘activities’. ‘Accessing the community’ – but not part of a community.

Defining the way people behave as ‘risky’. ‘Challenging’. ‘Non-compliant’. Not human.

I’ve heard and read claims like ‘I don’t like the term ‘service user’ / ‘case’ / ‘vulnerable’… but I don’t know what to use instead’ so many times. As I demonstrated in my blog post about labels, the search for the perfect ‘label’ and the ‘what do we call ‘them’?’ debate has spanned both decades and continents.[2]

The fact that we can’t possibly consider substituting the word ‘person’ for service user / client / customer / patient / case, or use ‘us’ instead of ‘them’, speaks volumes about how distant and detached we’ve become.

Desensitised.

Dehumanised.

Flipping the narrative

“Systems built for humans are not necessarily humane systems. They can be disempowering and humiliating. They can overlook lives instead of witnessing them… While hope and healing lie in relationships, too often our human systems are cool, distant and transactional. Murmurs of apology can be heard everywhere, admissions that these are just the rules and roles and hopefully others can appreciate that. Systems like that are hard on those who seek help, and hard on those who deliver it.”

Gord Tulloch and Sarah Schulman [3]

Principles of social justice, human rights, collective responsibility, and respect for diversities are central to social work.[4] And yet so much of our language is oppressive, designed to exclude rather than include. Eroding rather than upholding people’s rights and identity.

In a session facilitated by Tricia Nicoll at the recent #SocialCareFuture gathering in Manchester, there was a conversation about flipping the idea of ‘professional language’, so it becomes ‘professional’ to use kind, respectful and plain language, and unprofessional to use, or not to challenge, words that dehumanise and other and blame.

One of Tricia’s four tests for gloriously ordinary lives is a test about language. She asks us to ask ourselves whether we would use this language in our kitchen with our family, or at the café or pub with our mates. [5]

If the words we use with and about the people we support and serve aren’t words we’d use with and about the people we love, they’re probably words that get in the way of gloriously ordinary lives.

There’s always a more human, humane word.

There’s always a more human, humane world.

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References

[1] Practitioners use language… John Sell, Twitter, 14 October 2023

[2] Labels, Bryony Shannon, Rewriting Social Care, 20 December 2019

[3] The trampoline effect: redesigning our social safety nets, Gord Tulloch and Sarah Schulman, Reach Press, 2020

[4] Global definition of social work International Federation of Social Workers, July 2014

[5] The four tests, Tricia Nicoll, Gloriously Ordinary Lives, 2023