Stigmatising language in academic manuscripts: the view from a reader and peer-reviewer

Dr. Stephen Parkin shares his observations about the use of stigmatising words and phrases in academic writing, and offers a list of person-centred and pragmatic alternatives.

Throughout the last two decades, there has been a societal shift towards more person-centred language and terms of expression that seek to avoid offending, marginalising and stigmatising particular groups of people. Yet, as part of my academic role, I frequently read articles in peer-reviewed academic journals that make banal references to people such as ‘drug users’, ‘sex workers and their clients’ who interact with ‘drug dealers’ in ‘trap houses’, in which ‘users’ ‘struggle to find a vein’, conceal ‘track marks’ and dispose of ‘dirty needles’ in a ‘chaotic’ manner, while ‘using on top’ of their treatment prescriptions and who then ‘beg’ on the street or engage in ‘criminality’ to ‘finance their use of drugs’.

Recognising the stigmatising consequences of language

The use of words and phrases that stigmatise people and populations is well-established – perhaps most notably by Erving Goffman in his classic (1963) text on “Stigma: Notes on the Management of Spoiled Identity”. In the academic/applied fields of substance use research and treatment, the body of knowledge includes many sociological studies of substance use that demonstrate the ways in which people who use drugs both respond to and appropriate stigmatising labels. There have also been numerous academic publications in peer-reviewed journals that highlight the use of contested terms and labels contained within academic texts (1 2), including publications that have challenged the use of “inadvertent stigma and pejorative language in addiction scholarship”.

Add to this the wider cultural opposition to the everyday language of hegemony, homophobia, misogyny, racism, and sexism (as advocated by the Black Lives Matter, #MeToo, Pride movements), and it should be apparent that language used to describe people and their behaviours in 2022 have clear boundaries regarding acceptability and unacceptability – boundaries that continue to be crossed.

How stigma is perpetuated in the writing, editing and publication process

In my role as peer reviewer, I frequently make requests for authors to change their language. For example, of the last 10 manuscripts I reviewed, 5 of them included terms that I considered stigmatising or did not use person-first vocabulary. In addition, all were written by teams of authors (3–8 per team), which suggests that there was apparent agreement within the team about the language used in work to be submitted for peer review in advance of possible publication.

This lack of internal scrutiny may even be noted in the opening words of some manuscripts. For example, I occasionally see qualitative research articles with pejorative or hyper-sensationalist headlines that feature negative words/phrases originating from research participants; they can be soundbites from a single person, and typically reflect the most extreme point of view in the most gratuitous of ways. Whilst I recognise that the authors’ use of participants’ words in such a way is usually meant to be ‘ironic’ – and to ‘emphasise’ how one person’s understanding of an issue at hand neatly summarises the key problem in a few simple words – it seems equally evident that the authors do not recognise their own re-production of stigma through their reporting/use of the stigmatising terms that headline work submitted to or published in academic journals.

Although derogatory terms in research headlines might seem to be more aligned with a certain kind of journalism, their presence in this context demonstrates how academia has apparently normalised the language of stigma and uses stigmatising terms as part of everyday scholarship to re-present not only research findings, but to describe and define the people who typically gave their time to research.

Stigmatising words and phrases as ‘everyday practice’

The most common stigmatising words or phrases I have come across as a peer reviewer are the seemingly thoughtless and casual inclusion of ‘users’, ‘drug users’, ‘injectors’, ‘public injectors’, ‘homeless people’, ‘sex workers’ and their ‘clients’ to describe and define research participants by a given lifestyle or behaviour. On occasion, and somewhat bizarrely, these articles may actually be on topics such as harm reduction and the experiences of stigma encountered by those involved in the study.

I have also read and reviewed work that makes reference to ‘victims’ of overdose – which appears to be a standard term of expression in the field for people who have experienced an overdose (or experienced the effects of drug poisoning). The term victim in the context of drug use is stigmatising as it infers ‘victimhood’; it suggests a lack of agency and lack of choice in peoples’ decisions to use drugs, which relegates them to ‘helpless casualties’ of drugs/drug use. People who experience sexual assault, domestic violence, political violence, or the effects of military ordnance are victims. People who use drugs, including to the point of overdose/poisoning, are not victims. People who use drugs are typically risk-aware and are cognisant of the possibility of overdose/poisoning.

Another, albeit less frequent, term I have encountered in peer review, is the everyday use of ‘disabled’ or ‘disability’ (and worst of all, ‘disabled people’), which, to those with mobility/cognitive issues, can be exclusionary terms that define people by what they cannot do; the terms can serve as constant reminders of people’s diminished level of participation. Instead, the entire narrative about this issue should be framed around ‘accessibility’ and ‘inclusion’, in which people (individuals and collectives) are not defined by their specific limitations. For example, manuscripts that describe ‘drug users injecting in disabled people’s toilets’ perpetuates stigma on numerous levels, whereas ‘people who inject drugs within accessible facilities’ would have a less stigmatising message for all concerned.

These observations about stigma in academic writing raise a number of concerns:

• They suggest that authors/researchers simply aren’t paying attention to the way in which they re-present the people they study, and are not paying attention to the global state of contested language. This is particularly worrisome when it concerns work written by multiple authors, suggesting that there has been no internal discussion regarding the content of work submitted for publication.
• They suggest that peer review is not rigorous enough and that peer reviewers are not critically assessing the work in a way that fully considers the implications of terms and expressions within the material.
• They suggest that journals are accepting of the everyday language of stigma at the editorial level, and as such, the cycle of stigma – from keyboard to digital print – is repeated. This is especially the case when there are no checks and balances to ensure that the language of journal articles is fully person-centred post-peer review and prior to publication, but may even be evident in journals that have a protocol around person-centred language within their author guidelines.

Breaking the cycle of stigma in academic writing

The use of stigmatising words and phrases by scholars and authors as everyday practice reinforces a type of language that marginalises people and normalises exclusion.

The flipbook below (available to scroll through or download) provides a list of stigmatising terms and expressions that I believe should be avoided in academic publications, unless they are being used as verbatim quotes from research participants. Some of the items are drawn from guidance for health professionals in the United States, but most are drawn from my own observations during fieldwork and through reading and reviewing academic work. I hope the suggested alternatives may be one step towards breaking the aforementioned cycle of stigma in academic writing.

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