Saturday 24 April 2021

The language of disability

This is an interesting post for me. I get to wear several hats at once!

At work I'm working on the staff network for people with disabilities and other long term health conditions. At the moment we're doing a bit of a push around disabilities and trying to increase awareness generally across the board, as part of a general movement around ED&I (Equality, Diversity and Inclusion).

(Plug: Interested in my company? - I work for Atkins, and we've recently become a disability confident employer. You can read about our staff networks here, and search for jobs here!) 

Now, back to the topic in hand...

Part of increasing awareness about disability is around the language which people should use. In the UK it seems that there is a bit of a culture around not wanting to say the wrong thing and unintentionally cause offence. Consequently many choose not to say anything at all. This post explores some of the language choices people can make. There are two main models for talking about disability, the social model and the medical model. Each has pro's and con's, and each has supporters and opponents.

Social Model

The social model is a 'people first' model. The general principle is that people are disabled by the barriers in society. Those barriers can be physical things, like not being able to use/access places, they might be barriers caused by attitudes. Essentially, equality occurs when those barriers are removed.

You would say: people with disabilities.

By putting people first, the model focuses on the needs of the person and highlights what they can do. But, (to coin a phrase) no amount of polite talking has ever turned a staircase into an accessible ramp!

Medical Model

In this model people are identified as disabled by their differences - it is a 'problem first' model. The focus is to look at what is 'wrong' and find a fix for that problem, with society providing the fixes. Equality occurs when the fix allows the person do whatever they couldn't without the fix.

You would say: disabled people.  

Focussing on fixes for specific problems has potential to avoid addressing what the person actually needs, and can set low expectations by assuming that the 'fixes' address ALL of the persons needs.

Which Model?

For me, I draw on both models. Regular readers will know that my more recent surveys have looked at which factors are more strongly associated with higher and lower wellbeing. Good wellbeing is centred around the person and having their needs met well, which appears to sit on the social model side. However, some of those factors are things like depression, sleep and pain, which there are 'fixes' available for, which comes more from the medical model side. On the other side, some of the factors could well be indicative of societal barriers - stress, loneliness, isolation and embarrassment.

I think that for the speed of progression of HSP, it is important to use both models, particularly when selecting mobility aids. It is relatively easy to get a conflict here - on the physical side the need to retain independence or freedom goes against the need to go further/faster than your body will allow, and at the same time there are conflicts with your own pride and how you feel about using these aids, in the context of how you have previously felt about others using these/similar aids. 

Each person has to resolve these conflicts and make their own call about when to change mobility aids, and I often hear the phrase "I wish I'd done this a few years ago". This essentially is a journey of acceptance:

  • firstly accepting that mobility has changed (or is changing), 
  • then accepting that you could use a new mobility aid to 'help', 
  • then the acceptance that you're content to use that aid,
  • then acceptance that other people will have perceptions about you using that aid. 
For many, the acceptance of change is a long process.

My key thrust is about understanding. I try to understand what HSP has in store (or potentially has in store) for me. By understanding that early, I (theoretically) have time to accept each change before it happens. I can make choices about how I live in order to maximise the use of my mobility before it goes. I can test and push myself so I know where my limits are. I am also able to use 'fixes' for some  'problems' to give me a greater quality of life. Knowledge is one of the factors making me less embarrassed about talking about my HSP, about the barriers I face, and about the fixes I use to get over/around those barriers.

Language Guidelines

So, that's quite a journey I've been on there! The idea started with looking at language. There are some simple 'rules' you can follow:

  • It is better to say something rather than to say nothing.
  • If you have a disability you are free to use any words you like to describe yourself!
  • When talking about others, try to stick to factual, non-emotive language.
  • Never make any assumptions!

Golden rule 1: People are not "confined to a wheelchair" or "wheelchair-bound" - being in a wheelchair can be the greatest freedom that person has had in many years. They are "wheelchair users."

Golden rule 2: People do not "suffer from" conditions, they "have" conditions. Their condition may have consequences, but it is wrong to assume that there is suffering associated with that consequence.

Golden rule 3: When talking about someone's condition, it is bad form to ask "what is wrong with...?" because of the negative connotations. It is much better to ask "why is .... different?" Never assume that people will get better from their disability, some will, others will not.

Golden rule 4: Always avoid offensive language: "mad", "freak", "psycho", "imbecile", "crazy" and so on. These are all terms which are or were associated with conditions on the "disability spectrum", and it is wrong to refer to people in this way, or to joke that people have those characteristics.

Conversation Context

Beyond those golden rules it is better to try your best and say something rather than avoid saying anything. As long as your heart is in the right place it is better to have the conversation and learn another perspective, even if you say something which someone else isn't so happy with. It often feels like this is a 'difficult' topic, and there are few role models. It is easy to be worried about what others will think about what you say, but in practice your choice of words doesn't really matter that much.   

Think of the conversation from the perspective of the person with the disability. Having a disability can be hard work, emotional, lonely, isolating, frustrating (etc.). Some people find talking about their disabilities very difficult. Good conversations can reduce depression, loneliness, isolation, stress and so on. So, listen carefully and show empathy.

People with disabilities may wish to engage with you for many different reasons. Some examples are:

  • Feeling frustrated about something - just want to have a rant,
  • Feeling emotional - just want a friendly ear to sympathise with,
  • Seeking help/advice - they would like you to help with something,
  • Checking - they want your opinion about something,
  • Normality - they want just a conversation about something other than their disability!

There are, of course, many other possible reasons(!) but I spot that these general types of conversations crop up fairly frequently in HSP groups on FaceBook.  

Further information 

The following paragraphs give a few more points of view about language which you may want to bear in mind when talking. These are here for context, and I find myself using some of these terms myself some of the time. Different people have different perspectives on how important these words/terms are to them. Consider this section as background context.

There is plenty of disability language with negative connotations, like "handicapped", and there is plenty of language where the negative is implied - "differently abled". See if you can use a different term.

Referring to someone as a "patient" implies a medical situation. people are only patients when they are visiting a medical professional or a hospital. At all other times they are just a person, like everyone else.

Referring to conditions as "illnesses" can be problematic because there is an inference that there is a cure available and the person will not be ill in the future. For many conditions there are no cures, and their conditions are not "illnesses" - if you want a different term from "condition" the term "diseased" might be more appropriate, but that can also have negative connotations (and positive, there is a  large positive "rare disease" community) so think about the context. There are many who embrace their disabilities as a key part of their identities and do not consider that they need to be "cured".

Similar to "illness", some people cannot "overcome" their disabilities - but they may be able to overcome some of the barriers they encounter. Be careful with the word "overcome".

The term "impairment" can have negative connotations because it focuses on differences, which can be problematic. The term impairment is often used in a medical context, and using this word outside a medical context can draw attention to the persons condition in a negative way. Again, be careful.

They are not "disabled toilets", they are accessible toilets. You should try to refer to things as accessible... rather than disabled...., like parking spaces. Deciding if you are "disabled" or not is a subject for another post, but if you decide you are not disabled, it should not prevent you from using these facilities if you need them.

<note added 8th May> Remember that different people have different opinions on language. A term which one person likes will be hated by another. I think it is impossible to please everyone! Beyond those golden rules, find language which you are comfortable using. Respect that others may use different choices from you. If you end up in this situation see if you can find a mutual term for the purposes of your conversation. Hopefully they also respect that your language choice is different from theirs!

This post is based on my observations, experiences and these websites:
(and other pages!)


Saturday 10 April 2021

Wellbeing Factor Overview

Introduction

I have been collecting wellbeing data over the last four of my surveys (2017-2020) and in each I have analysed the factors which are identified with the highest and lowest wellbeing. This post looks at the aggregate of all data to identify which factors have the greatest effects on wellbeing. I have highlighted the top seven issues.

At the bottom of this post are two tables, one showing all the factors which have the greatest wellbeing and one showing all the factors with the lowest wellbeing. The tables are restricted to factors which affected at least 15% of the respondents of the survey in question, and the tables report the difference from the average wellbeing score of each survey. Each factor shows the year of the survey where this was investigated more fully.

Readers should note that whilst the text below may read like medical advice, it is not! I am not a trained medical professional, and I have simply collated relevant information for each topic and posted it below, mostly from the UK NHS websites. If you are seeking to make changes in any of the areas listed below you may wish to seek the advice of your doctor beforehand.

1) Depression

The factor at the top of each table is depression, i.e. it is the single factor which causes the lowest wellbeing, and is the single factor whose absence gives rise to the gratest wellbeing. This suggests that seeking help to treat any depression has the potential to make the greatest positive change in wellbeing. If you wish to self-assess your level of depression you could use either the PHQ2 or PHQ9 tools, which are available free-of-charge on-line. You may also choose to talk to your doctor, a helpline (e.g. Samaritans in the UK: https://www.samaritans.org/) or someone you trust. You may also want to read advice here: https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/low-mood-sadness-depression/. Depression was assessed in both my 2017 and 2018 surveys.

PHQ2: https://qxmd.com/calculate/calculator_458/patient-health-questionnaire-2-phq-2

PHQ9: https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

2) Sleep Quality

The second factor associated with low wellbeing is where sadness, anxiousness or worry affect sleep always or usually. Similarly being affected by six or more sleep factors gave rise to lower wellbeing, and good sleep (either being affected by none or one sleep factor or not having difficulties falling asleep) is associated with better wellbeing. There are many factors which can affect sleep quality, including mood, routine, noise, temperature, comfort/discomfort, light and others (https://www.nhs.uk/live-well/sleep-and-tiredness/). You have more control over some of these factors more than others. You may need to talk to your doctor to identify how your sleep is being affected to identify options to improve it. Sleep was examined in my 2018 survey.

3) Loneliness and Isolation

Those feeling lonely and/or isolated were also shown to have a lower wellbeing than those who do not feel lonely or isolated.  If you are feeling lonely or isolated you could try talking about your feelings with a friend or someone you can trust, or you could take part in an activity you enjoy, seeking small positive changes (https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/feeling-lonely/). If your feelings are related to your HSP diagnosis, then you could consider joining a support group where you will often find others with HSP who understand your position and you can listen to, talk about or share your collective experiences. Loneliness and isolation were examined in my 2019 survey.

4) Stress

Those who feel stressed have a lower wellbeing than those who do not. Stress may lead to different mental symptoms, physical symptoms or changes in behaviours (https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/). Approaches for dealing with stress can be similar to those already described for depression, loneliness and isolation, but you may alternatively want to take part in stress-busting activities such as exercise (within the limits of your HSP of course), planning and managing your time, mindfulness or relaxation. Similarly, taking small steps at a time. Stress was a symptom in my 2018 survey.

5) Embarrassment

My 2020 survey identified that people who had delayed or avoided seeking medical advice because they felt embarrassed about their HSP had a lower wellbeing. The survey did not explore reasons for the embarrassment, however it is quite common for people with long-term illnesses to find it difficult to talk to people about their conditions. If conversations are difficult, this page from the NHS in Scotland gives some useful information: https://www.nhsinform.scot/care-support-and-rights/palliative-care/talking-to-people-about-your-condition/talking-about-your-condition. Don’t be put off by the palliative care heading!

6) Pain

Those without pain from their HSP have a higher wellbeing than those with pain. If you are affected by pain from your HSP you can take some action to reduce this: https://www.nhs.uk/live-well/healthy-body/ways-to-manage-chronic-pain/. If you pain is more severe then I suggest that a conversation with your doctor would be in order.

7) Understanding HSP

Those who considered that they knew HSP very well had a higher wellbeing than those who knew HSP somewhat. Whilst HSP is a rare disease, there are plenty of information sources which you can use to increase your understanding of HSP. My 2016 survey examined information sources for HSP. also asked respondents where they got their information on HSP.

This survey showed that: most people get their information about HSP from social media, doctors and neurologists. Medical websites, support groups, physiotherapists and friends/family with HSP form another important group of information sources. The sources which people regarded as most trustworthy were neurologists, support groups and physiotherapists. Social Media and friends/family with HSP form another important group. Of sources used by more than half of respondents, the ones with people being most unsure were doctors and other medical professionals.

Overall, people need to be selective in what they believe on social media – and check out the author. Support groups can be a good source of information. People may need to work on relationships with doctors so they understand people’s situations better. Talking about your situation with friends/family with HSP may be useful for you and them.

I will finish this post with a shameless plug that there is a fair bit of HSP information on the other pages of this blog (https://hspjourney.blogspot.com/), so you are welcome to read around. You should note that there is a search tool allowing you to find posts with particular keywords. There is also an index page (https://hspjourney.blogspot.com/p/index.html) where all but the most recent pages are grouped together, and a page showing which posts are more popular (https://hspjourney.blogspot.com/p/blog-statis.html). Enjoy!

Positive Wellbeing Factors

Factor

Percent

Points Above Average

Respondents

Not suffering from depression (symptoms, 2018)

26.0%

6.8

79 / 304

Not suffering from stress (symptoms, 2018)

16.1%

6.6

49 / 304

No Pain from HSP (pain, 2017)

18.5%

5.8

41 / 222

Understanding HSP very well (2020)

18.3%

5.5

58 / 317

Not suffering from poor-coordination (symptoms, 2018)

20.4%

4.6

62 / 304

Good sleep (affected by up to 1 sleep factor, 2018)

32.9%

4.5

100 / 304

Already take part in digital exercise classes (2020)

17.7%

4.5

56 / 317

Travel to town daily (life-space, 2019)

18.8%

4.2

69 / 367

Not feeling lonely (life with HSP, 2019)

66.8%

3.9

245 / 367

Not feeling isolated (life with HSP, 2019)

69.5%

3.5

255 / 367

Not having difficulty falling/staying asleep (sleep, 2018)

49.3%

3.5

150 / 304

No depression (PHQ2 score 0-2, 2017)

22.1%

3.5

49 / 222

Not affected by learning/memory issues (symptoms, 2018)

45.7%

3.3

139 / 304

Not feeling vulnerable (life with HSP, 2019)

45.2%

3.2

166 / 367

See physiotherapist more than monthly (2020)

50.5%

3.2

160 / 317

Getting adequate treatment after having been taken seriously (2020)

43.8%

3.1

139 / 317

 

Negative Wellbeing Factors

Factor

Percent

Points Below Average

Respondents

Depression (PHQ2 score 3-6, 2017)

59.0%

9.0

131 / 222

Being sad/anxious interfering with sleep always/usually (sleep, 2018)

24.3%

8.6

74 / 304

Feeling isolated (life with HSP, 2019)

29.2%

8.4

107 / 367

Feeling lonely (life with HSP, 2019)

31.6%

7.9

116 / 367

Delaying or avoiding advice due to embarrassment about HSP (2020)

15.1%

7.3

48 / 317

Suffering from stress all or most of the time (symptoms, 2018)

22.4%

6.9

68 / 304

Worries affecting sleep always/usually (sleep, 2018)

20.7%

6.1

63 / 304

Poor sleep (Having six or more sleep factors always/usually, sleep 2018)

23.0%

6.0

70 / 304

Medical professionals not understanding your HSP at all (2020)

20.8%

5.8

66 / 317

Not content with employment/occupation situation (employment, 2017)

31.1%

5.5

69 / 222

Understanding HSP somewhat (2020)

19.9%

3.2

63 / 317

Seeing a physiotherapist a few times (2020)

23.3%

3.1

74 / 317