Semantic Shifts in Mental Health-Related Concepts (2023)

Abstract: The present study evaluates semantic shifts in mental health-related concepts in two diachronic corpora spanning 1970-2016, one academic and one general. It evaluates whether their meanings have broadened to encompass less severe phenomena and whether they have become more pathology related. It applies a recently proposed methodology (Baes et al., 2023) to examine whether words collocating with a sample of mental health concepts have become less emotionally intense and develops a new way to examine whether the concepts increasingly co-occur with pathology-related terms. In support of the first hypothesis, mental health-related concepts became associated with less emotionally intense language in the psychology corpus (addiction, anger, stress, worry) and in the general corpus (addiction, grief, stress, worry). In support of the second hypothesis, mental health-related concepts came to be more associated with pathology-related language in psychology (addiction, grief, stress, worry) and in the general corpus (grief, stress). Findings demonstrate that some mental health concepts have become normalized and/or pathologized, a conclusion with important social and cultural implications.

## introduction mental health has become more culturally salient in recent years. concurrently, concepts of mental illness have expanded their meanings to include new and milder phenomena @xcite . critics have argued that psychiatry has transformed everyday sadness into major depression @xcite and adaptive worries and inhibitions into anxiety disorders @xcite . others argue that this pattern extends to colloquial language, where people use 'depression' to refer to ordinary sadness or low mood @xcite . @xcite explains this trend as an ongoing cultural process of 'pathologization', where traits and behaviors that were once considered normal human problems (e.g., inattentiveness) are now conceptualized as mental disorders (e.g., attention-deficit/hyperactivity disorder) to be diagnosed and treated. critics argue that pathologization leads to increasing vulnerability, which can partly be explained by the adoption of illness identities @xcite , and to false positive diagnoses, resulting in the misallocation of treatment resources @xcite . despite these arguments, whether people are indeed normalizing mental illness and pathologizing everyday life remains a largely untested empirical question. the present study aims to clarify the nature of these semantic shifts in a new sample of mental health-related concepts: addiction, anger, distress, grief, stress, and worry. it first investigates whether they have undergone vertical concept creep (come to include less severe phenomena) and then tests whether they have become pathologized using a new index based on a dictionary of pathologyrelated terms. it hypothesizes that words collocating with mental health-related concepts have (1) become less emotionally severe (vertical concept creep) and (2) come to co-occur with pathologyrelated terms (pathologization). ## concept creep theory according to concept creep theory @xcite , harm-related concepts are susceptible to two kinds of semantic expansion, broadening to encompass qualitatively new phenomena (horizontal creep) and quantitatively less severe phenomena (vertical creep). linguistically, horizontal creep resembles semantic widening, including via metaphorical extension, while vertical creep resembles hyperbole, where words shift from a stronger to a weaker meaning @xcite . both forms of creep can occur simultaneously. theorized causes of concept creep include cultural shifts towards greater sensitivity to harm, postmaterialist values and diminished exposure to adversity @xcite . as with other harm concepts, the consequences of inflated concepts of mental illness are mixed. negative consequences include excessive self-diagnosis, prescription of inappropriate health services and treatments @xcite and heightened emotional vulnerability @xcite . positive consequences include recognizing and addressing previously neglected forms of suffering @xcite . ## related work advances in computational linguistics have facilitated the detection and quantification of diachronic lexical semantic shifts @xcite , as outlined in pioneering survey papers @xcite . new techniques to digitize, process, store, and quantify written language worldwide have enabled non-computational disciplines to use text corpora to explore questions with a social dimension. for instance, linguist price (2022) used methods from computational linguistics to track the construction of mental illness in the uk press. in psychological science, text mining approaches are gaining traction as researchers begin to harness the advances in modern computational technologies and digital data sources by using natural language processing (nlp) as a tool to understand people and culture at an unprecedented scale. for reviews explaining this paradigm shift in psychology, see @xcite ; @xcite ; @xcite ; @xcite . nevertheless, the field is only beginning to reap the benefits of using nlp to examine social and cultural change @xcite . concept creep research provides an innovative engagement between social psychology and nlp. as the only theory in social psychology with a focus on lexical semantic change and its nonlinguistic (societal, politically motivated, and cultural) causes and social consequences, researchers have employed nlp techniques to characterize and to track the theorized causes of concept creep @xcite . studies have revealed increases in the relative frequency of words reflecting harm-based morality since 1900 in the google books english corpus @xcite , and of prejudice-denoting terms in popular u.s. newspapers @xcite . these trends align with the claims of concept creep theory regarding an increase in harm-based morality @xcite and a rising cultural sensitivity to harm. prior empirical work characterizing concept creep has focused on evaluating its horizontal expansion as increases in the semantic breadth of target concepts, evaluated as the average cosine (dis)similarity of a concept's semantic vectors. it has demonstrated that addiction, bullying, empathy, harassment, prejudice, racism, and trauma have broadened in recent decades @xcite @xcite . @xcite recently developed a noncomputationally intensive method to evaluate vertical creep by capturing whether a concept has come to be used in less severe contexts. it tests whether words collocating with a centre term have become less intensely negative in their connotation. research using this new method has yielded mixed findings to date. trauma came to be used in less emotionally severe semantic contexts from 1970-2019 in a corpus of psychology article abstracts @xcite . however, anxiety and depression showed the opposite trend in the abstracts corpus and in a corpus of everyday american english @xcite . subsequent analyses suggested a rising tendency to view these terms through a pathological (i.e., disease-related) lens in academic psychology and society at large. ## results the linear regression models testing the hypothesized declining trend for the severity index showed some support for the concept creep hypothesis (see figure 3 ). irregularities in the data in earlier years are due to low sample size. in the psychology corpus, there was a significant declining trend in the severity of words related to two of the six concepts: addiction and anger, and a significant increasing trend in the severity of words related to stress. in the general corpus, there was a significant declining trend in the severity of words related to four of the six concepts: addiction, grief, stress, worry. the linear regression models testing the hypothesized rising trend for the pathologization index showed some support for the hypothesis that mental health-related terms have become pathologized, as figure 4 illustrates. irregularities in the data in earlier years are due to low instances of pathology terms in respective context windows. in the psychology corpus, there were significant increases in the pathologization index for four of the six concepts (addiction, grief, stress, worry). for the general corpus, there was a significant increasing pathologization trend for two of the six concepts (grief, stress). . control analyses were then run, holding the pathologization index and then the severity index constant (see post hoc correlation analyses indicated no relationship between rising pathologization and decreasing severity, except for in the psychology corpus for stress-related terminology, where there was a significant positive association (see appendix c), likely influenced by the presence of high severity pathology terms (e.g., "disorder", "symptom") among top ranked collocates in later decades. results indicate that the two indices rise and fall independently, apart from when (high severity) pathologization terms make up part of the severity index. ## discussion the present findings support the concept creep hypothesis, which predicted that mental health concepts are increasingly used in the context of less emotionally intense language. addiction, stress, and worry were normalized in this way within academic psychology and in the general corpus, whereas anger was only normalized in the former, and grief only in the latter. only distress did not support the hypothesis in either corpus. findings also support the pathologization hypothesis, which predicted that mental healthrelated concepts are increasingly associated with pathology-related terminology. grief and stress became pathologized in both academic psychology and the general corpus, whereas addiction and worry only became pathologized in the psychology corpus. anger and distress showed no signs of pathologization. our findings indicate that the meanings of some mental health-related concepts have broadened to be used in less emotionally intense contexts and in more pathology-related contexts. this pattern can be observed in academic and general language. the semantic expansion of some mental health concepts in psychology (addiction, anger, worry) may have contributed to similar trends for these concepts and others (grief, stress) in non-academic language use. previous work on the cultural dynamics of concept creep @xcite demonstrates that semantic shifts of harm related concepts in psychology can influence those observed in society at large. trends like these have social and cultural implications. concept creep and a rising tendency to view unpleasant emotional states through the lens of pathology may lead people to self-diagnose inappropriately and to seek unnecessary or even harmful treatments. some evidence indicates that rates of mental illness have risen, alongside increased mental health service utilization, over-diagnosis, over-treatment, and over-prescription @xcite . critics argue that the 'psychiatrization' of society @xcite leads people to view ordinary problems in living as medical illnesses @xcite . growing awareness of mental ill health may be causing mental health concepts to broaden in ways that may have some benefits (e.g., reductions in stigma) but it may have significant costs as well @xcite .