"Distress"

"Distress" is arguably the single most problematic word in psychiatry. Addressing this is not semantics: its misuse has very real, very serious governance consequences that are impacting vulnerable people as we speak.

"What do you propose we use instead?"

I don't. It's the way the word is being used that is the problem. Copy-pasting a different word in does not solve a single thing.

"Distress" provides not only a universal catch-all for describing mental health problems, but a universal catch-all for justifying interventions too. Having a different universal catch-all does not solve the problem: the word can be applied to almost anything, pathological or not, and pre-justifies a medico-legal response.

Worst of all, it is sometimes misunderstood by laypeople to include physical health crises, pulling wildly inappropriate situations into a psychiatric frame — sometimes with very serious consequences.

This intellectual carelessness is not without very real consequences: police can justify literally any coercive welfare intervention with one word, and it's the same word which NGOs, clinicians, support staff and careless friends and family casually throw around on a daily basis. Authorised Psychiatrists pay extreme attention to police-initiated assessment orders; it's more of a relay than a safeguard.

If we say that there will be no single universal label which can justify these responses, we might end up in a horrific dystopia where the people wielding coercive powers have a basic understanding of what they're using them on. If they confess that they do not have the resources to achieve this, we might want to consider whether someone else should be holding those powers.

The poor use of the word stems from poor system design: one where restrictions are justified in the broadest possible terms, but freedom and autonomy are only granted narrowly and selectively.

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Version: 1

Written: 2026-03-13

Written on: 7.5mg olanzapine since 2025-11-11; taken continuously since 2006

Cognitive capacity: very poor - estimate 10% brain