PicoBlog

It might just be me, but recently I’ve noticed that clinical terminology related to the field of psychology and mental health is becoming part of everyday language, even more so than it previously has. I can’t quite prove it, but the fact that “gaslighting” was the one of the most searched terms of 2022 does lend some evidence to this observation. This is likely (again, can’t quite prove it) because people are being exposed to this kind of terminology online, predominately on social media. At the same time, I have (mostly) noticed on social media that these clinical terms are being used in ways that don’t quite fit their intended definitions, and in some respects are misused completely; which then has the predictable outcome of permeating into real-world interactions. This is something known as “concept creep”, a phrase first coined by Australian psychologist, Nick Haslam in 2016 in his paper “Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology”.

And as is the case with anything I do, I looked into this paper and started to read and write about it. But as the research and writing process progressed, I found further research which I now want to include. However, if I included it here, the outcome would be closer to an essay rather than a blog post. So, I have decided to split this piece into two parts. This first part will focus on outlining what concept creep is, while the second part will focus on something called the “looping effect”. Part two will also entail a further examination of the potential benefits and pitfalls of concept creep. So, if you liked this piece, you will have to wait a little while for the second half and its overall conclusion.

In his paper, Haslam notes that concept creep is the idea that “concepts that refer to the negative aspects of human experience and behavior [sic] have expanded their meanings so that they now encompass a much broader range of phenomena than before”, which he argues has resulted in some semantic change – which is where the modern meaning of a word may be different to the original meaning – for some of these particular concepts.

Haslam explores six psychological concepts of the human experience (abuse, bullying, trauma, addiction, “mental disorder”, and prejudice) and assesses how they have shifted horizontally, to include a broader range of experiences, and vertically to encompass less extreme forms of an experience that changes the thresholds or criterion needed to be included within the definition of a concept. Haslam observes that this has benefits and drawbacks.

In terms of drawbacks, Haslam notes that the concept of “mental disorder” (his term not mine) has changed significantly with the expansion of The Diagnostic and Statistical Manual of Mental Disorders (DSM; now I’m it’s fifth iteration and published in 2013 - three years before Haslam wrote his piece). He writes that: 

“The DSM’s precursor, War Department Technical Bulletin ‘Medical 203,’ published in 1943, listed 47 conditions, a number that more than doubled to 106 diagnoses in DSM-I (APA, 1952), leapt to 182 in DSM-II (APA, 1968), jumped to 265 in DSM-III (APA, 1980), and then hopped to more than 300 in the revised edition of the DSM-IV (DSM-IV-TR; APA, 2000). The swelling population of mental disorders has led critics of psychiatry to accuse DSM of disease-mongering.”  

This increase in the number of conditions classified in the DSM is what is considered horizontal creep, but is also a result of vertical creep which, according to the paper, “allows milder, less disabling psychological phenomena to qualify as disordered.” Towards the end of this section, Haslam concludes: 

“In sum, the evolving concept of mental disorder has not only proliferated [multiplied] conditions but also expanded sideways into new forms of psychopathology and downward into milder forms. As a result, the proportion of humanity warranting a diagnosis has risen and the proportion of human experience and behaviour that counts as disordered has swelled.” 

In terms of benefits (well what I interpret as a benefit), Haslam noted that the definition of trauma has also changed significantly since its initial conception in DSM-I. Originally “trauma was...seen within mid-20th-century psychiatry as a physical agent causing organic brain pathology”. He further noted that trauma used to be “related [to] classes of chronic brain disorders [which] were associated with infections, poisoning, and congenital conditions.” Basically, trauma used to be conceptualised as any disease that impacted the brain. 

However, since then the definition of trauma has undergone significant changes and now includes “physical and psychic injuries” and the resultant psychological symptoms. For example, the DSM-III definition introduced Criterion A, which stipulated that “a traumatic event ‘would evoke significant symptoms of distress in almost everyone’ (p. 238) and be ‘outside the range of usual human experience’ (p. 238).” Then the revised edition (DSM-III-R) adding further specificity about the nature of the distress experienced during a traumatic event (i.e., “intense fear, terror, and helplessness”; p. 250). The DSM-III-R also included the fact that trauma could be experienced indirectly, while the DSM-IV placed an increased emphasis on the subjective experience of trauma. All of this seems to have remained unchanged in DSM-5. 

Haslam writes that this expanded definition of trauma to include events outside of the body and to be “outside the range of human experience” is what could be thought of as horizontal creep. While the focus on the subjective interpretation and the inclusion of indirect events could be considered a vertical creep. Haslam makes a point of emphasising that he is not questioning the validity of these expansions, particularly the vertical changes as he recognises how they are backed up by research, but rather seeks to highlight how the original conceptualisation of trauma has changed. However, Haslam does note some concerns with a continued expansion, which will be explored further in the second part of this blog series.

In his paper, Haslam examined how concepts had changed through research and (I guess) academic investigation. However, I am not sure the current trend of concept creep and semantic change is occurring as a consequence of academic endeavour. I guess the thing I’m interested in is how this creep and change has been affected by the advent of social media and the seemingly explosive way psychology and mental health information has appeared online. This is something I will explore in the second part of this blog as it relates to a phenomenon called “looping effects”; but I would like to research it some more to make sure I present it correctly and link it to today’s current trend of concept creep.

Hopefully that’s given you something to think about and (most importantly) makes sense. Please feel free to leave any comments or get in touch on my Instagram page if you have any thoughts you want to share.

All the best,

Nice-ish.

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