AACP Newsletter, Volume 7,
Number 2, Spring 1993
A Consuming Controversy: Semantics and the Therapeutic Relationship
The term “consumer” has taken hold everywhere. It pervades national mental health policy documents, state and local programs and it appears in professional literature as if it were a convention not worth challenging. It is my impression that many clinicians quietly and privately wince at the term, yet adapt to using it because it seems not worth the time to raise a semantic fuss. Those I have talked to who share my misgivings with this term are the most humane and egalitarian professionals imaginable. Never would they aspire to wield power over a suffering person or demean the mentally ill. Why then are they not enthused about the label?
There is inherent in the word “consumer” an insult to both the served and the server. The words “patient” and “client” don’t carry with them such implications. One who is patient is practicing a virtue and “client” is the most neutral word available for service recipient. But the word “consumer” is loaded with negatives just with its definition. Every one of the choices in (Webster’s New International Dictionary carries with it a bad or awkward implication. To consume is to destroy. To consume is spend wastefully or to use up. To consume is to use an economic good in the satisfaction of wants. To consume is to eat or drink without measure. To consume is to engage or absorb another’s full attention. In mental health it was intended to be used as an economic term implying choice in allocating sources in a market place. But even in its most benign sense an economic term it has some negative connotations. It implies values skewed towards obtaining items voraciously, purchasing for purchasing sake. In the marked place a consumer is warned to “beware” because the one who would sell wants your money and has little regard for your welfare. A consumer implies a relationship with a vendor. We professionals often find ourselves stuck with this atrocious term as our states contract with us as vendors of services. To be "a vendor" to consumers is a notion absolutely devoid of any sense of professional responsibility or ethics. Those terms imply a repudiation of centuries of evolution of professional relationships between doctors and their patients, an ideal embraced actively by all the mental health professions. For us to accept being vendors to consumers is to scrap the loftiest of human ideals; the moral duty of those charged with responsibility for tending the suffering and ill to behave in their interest. Those I serve who need to find trust in our relationship and those like me who serve ill and hurting people while holding dear certain ideals guiding professional relationships are harmed by the implications of vendor and consumer. These are the notions that fill my mind as I try to utter the word “consumer” without choking in my dialogue with colleagues in mental health. It becomes difficult to avoid being a bit inappropriate and awkward if one has one’s sensitivity intact.
My sensitivity worked against me recently at my center. A new Continuing Stay Review form was adopted reflecting changes mandated by our county mental health office. I set out to review treatment summaries as is my duty at the center. As usual I was proud to sign off on a plan by a colleague whose work I knew well. However, I couldn’t stomach putting my signature under a new word on the form; “consumer.” With only my visceral instincts guiding me I scratched out this word and wrote “client.” I proceeded to do this on all subsequent Continuing Stay Reviews. In retrospect mine was a futile gesture. The program manager with whom I enjoyed a wonderful working relationship but who comfortably embraces the term “consumer” discovered my alterations on the firms and asked me to stop doing it. I told her I didn’t know if I could sign the new forms with their new wording. I spoke with her supervisor who after a spirited discussion ordered me to not alter the forms. I challenged him to share with me what possible harm could come from my Quixotic gesture. If he was worried about the state and county reviewers I suggested he step aside and let them excoriate me if they wanted to. Let the center write me off as a retrograde crank. He was incensed at my recalcitrance and we left the discussion with no resolution but with my credibility with the administration crumbling. I found myself alone and with little sympathy for my having taken a moral stance on this issue. I succumbed of course. I wasn’t about to let my credibility and good relationships be destroyed over a semantic complaint. Nor did I want to place my center in tough spot with the county and state auditors who have little regard for deviance. But I did get some winks and approving gestures on the sly from mental health clinicians on the line. And I was left with motivation to write down my thoughts and experiences for the Newsletter and to ask the readers if others share my reaction to the designation of our clientele as “consumers.”
Charles Huffine, M.D.
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