People-first language (PFL), also called person-first language, is a type of

linguistic prescription Linguistic prescription, or prescriptive grammar, is the establishment of rules defining preferred usage of language. These rules may address such linguistic aspects as spelling, pronunciation, vocabulary, syntax, and semantics. Sometimes infor ...

which puts a person before a

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...

, describing what condition a person "has" rather than asserting what a person "is". It is intended to avoid

marginalization Social exclusion or social marginalisation is the social disadvantage and relegation to the fringe of society. It is a term that has been used widely in Europe and was first used in France in the late 20th century. It is used across discipline ...

dehumanization Dehumanization is the denial of full humanness in others and the cruelty and suffering that accompanies it. A practical definition refers to it as the viewing and treatment of other persons as though they lack the mental capacities that are c ...

(either

conscious Consciousness, at its simplest, is sentience and awareness of internal and external existence. However, the lack of definitions has led to millennia of analyses, explanations and debates by philosophers, theologians, linguisticians, and scien ...

ly or subconsciously) when discussing people with a

chronic illness A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three m ...

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...

. It can be seen as a type of disability etiquette but person-first language can also be more generally applied to any group that would otherwise be defined or mentally categorized by a condition or trait (for example, race, age, or appearance). Person-first language avoids using labels or

adjectives In linguistics, an adjective (abbreviated ) is a word that generally modifies a noun or noun phrase or describes its referent. Its semantic role is to change information given by the noun. Traditionally, adjectives were considered one of the ...

to define someone, using terms such as "a person with

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

" instead of "a diabetic" or "a person with

alcoholism Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomi ...

" instead of "an alcoholic". The intention is that a person is seen foremost as a person and only secondly as a person with some trait, which does not ''inevitably'' define their essence; it avoids essentializing the condition as their prime identity as a human being. Advocates of person-first language point to the failure to mentally separate the person from the trait as reinforcing a sense that both the trait and the person are inherently bad or inferior, leading to

discrimination Discrimination is the act of making unjustified distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong. People may be discriminated on the basis of Racial discrimination, r ...

whilst also implicitly reinforcing a sense of permanency even regarding issues that are likely to be temporary. For example, a person with a

substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...

has a fair chance of achieving long-term

remission Remission often refers to: *Forgiveness Remission may also refer to: Healthcare and science *Remission (medicine), the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity *R ...

—many years in which they are healthy and productive—but calling them a "substance abuser" reinforces an unspoken sense that they are inherently and permanently tainted and casts doubt on maintenance of remission.

Definition

People-first language is a type of

. It aims to avoid perceived and subconscious

when discussing people with

disabilities Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...

and is sometimes referred to (e.g. by

NHS England NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...

's style guide) as a type of disability etiquette. People-first language can also be applied to any group that is defined by a condition rather than as a people: for example, "those that are homeless" rather than "the homeless." Rather than using labels to define individuals with a health issue, it is more appropriate to use terminology that describes individuals as being diagnosed with an illness or disorder. People first language puts the person before the diagnosis and describes what the person has not what the person is.Lynn, V. A. (2017). Language and HIV communication. HIV/AIDS (Auckland, NZ), 9, 183." The basic idea is to use a sentence structure that names the person first and the condition second, for example, "people with disabilities" rather than "disabled people" or "disabled," to emphasize that they are people first. Because it is a common practice in English to place an adjective before a noun, the adjective might be replaced with a relative clause, e.g., from "an asthmatic person" to "a person who has asthma." By using such a sentence structure, the speaker articulates the idea of a disability as a secondary attribute, not a characteristic of a person's identity. (See also: '' Distancing (psychology)''.)

History

Recommendations and explanations to use person-first language date back as early as around 1960. In her classic textbook, Beatrice Wright (1960) abegan her rationale for avoiding the dangers of terminological short cuts like "disabled person" by citing studies from the field of semantics that "show that language is not merely an instrument for voicing ideas but that it also plays a role in ''shaping'' ideas" (p. 7). She concludes her arguments thus: "Since physique does stimulate value judgments, it is particularly important to use expressions insofar as feasible that separate physical attributes from the total person" (p. 8). Another influential rehabilitation psychologist, Carolyn Vash, who also spoke from the perspective of her experience living with quadriplegia from polio, advanced similar arguments for person-first language in an unpublished address in 1959. The term '' people-first language'' first appeared in 1988 as recommended by

advocacy group Advocacy groups, also known as interest groups, special interest groups, lobbying groups or pressure groups use various forms of advocacy in order to influence public opinion and ultimately policy. They play an important role in the develop ...

s in the United States. The usage has been widely adopted by speech-language pathologists and researchers, with "person who stutters" (PWS) replacing "stutterer". It has been used in AIDS activism, appearing in the Denver Principles (1983), which stated in part, "We condemn attempts to label us as 'victims', a term which implies defeat, and we are only occasionally 'patients', a term which implies passivity, helplessness, and dependence upon the care of others. We are 'People With AIDS'." Use has been recommended in other increasingly common chronic conditions, such as asthma and diabetes. Non-profit organizations, such as the Obesity Action Coalition have expanded advocacy for People-First Language to

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...

. , 5 U.S. medical societies had pledged for it, and use it in their communications: the American Society for Metabolic and Bariatric Surgery, The Obesity Society, American Society of Bariatric Physicians, Academy of Nutrition and Dietetics, and the American Academy of Orthopaedic Surgeons.

Competing models

The most common alternative to person-first language is usually called identity-first language. For example, while someone who advocates for person-first language might refer to a client as a "person with autism", that same client may prefer identity-first language, and ask to be called an "autistic person". Others have proposed "person-centered language", which, instead of being a replacement linguistic rule, promotes prioritizing the preferences of those who are being referred to and argues for greater nuance in the language used to describe people and groups of people.

Rationale

The Sapir–Whorf hypothesis is the basis for ideologically motivated linguistic prescriptivism. The hypothesis states that language use significantly shapes perceptions of the world and forms ideological preconceptions. In people-first language, preconceptions judged to be negative arise from placing the name of the condition before the term "person" or "people", such as "white person" or "Jewish people". Proponents of people-first language argue that this places an undue focus on the condition which distracts from the humanity of the members of the community of people with the condition. A 2008 experiment researched teenagers' perception of

epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrica ...

with respect to people-first language. Teenagers from a summer camp were divided into two groups. One group was asked questions using the term "people with epilepsy", and the other group was asked using the term "epileptics", with questions including "Do you think that people with epilepsy/epileptics have more difficulties at school?" and "Do you have prejudice toward people with epilepsy/epileptics?". The study showed that the teenagers had higher "stigma perception" on the Stigma Scale of Epilepsy when hearing the phrase "epileptics" as opposed to "people with epilepsy".

Usage guidelines

United States

Some U.S. organizations like the United Spinal Association have published disability etiquette guides, which prescribe people-first language. The 2007 ''

For Dummies ''For Dummies'' is an extensive series of instructional reference books which are intended to present non-intimidating guides for readers new to the various topics covered. The series has been a worldwide success with editions in numerous lang ...

'' guide to

etiquette Etiquette () is the set of norms of personal behaviour in polite society, usually occurring in the form of an ethical code of the expected and accepted social behaviours that accord with the conventions and norms observed and practised by a ...

prescribed people-first language. , the rules of people-first language have become normative in US governmental institutions on the federal (e.g. CDC) and on state levels in the health departments' Developmental Disabilities Councils e.g. Michigan West Virginia Idaho, Missouri Georgia, or Texas. As of 2007, it has been a requirement in AMA Manual of Style for

academic journal An academic journal or scholarly journal is a periodical publication in which scholarship relating to a particular academic discipline is published. Academic journals serve as permanent and transparent forums for the presentation, scrutiny, and ...

s. APA style says that both people-first and identity-first language are acceptable, but stresses using the preferred style of the group or individuals involved (if they have one).

United Kingdom

's style guide calls for the use of identity-first language in most instances (preferring "disabled person" over "person with a disability", but referring to people "with a

learning disability Learning disability, learning disorder, or learning difficulty (British English) is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficult ...

"). The UK government also uses the term "disabled people" (or "people with health conditions or impairments" if it is more appropriate for people receiving

disability benefits Disability benefits are funds provided from public or private sources to a person who is ill or who has a disability. United Kingdom In the United Kingdom disability benefits are covered by Department for Work and Pensions. There are numerous be ...

), but deprecates "an epileptic, diabetic, depressive" in favour of "person with epilepsy, diabetes, depression".

Criticism

Critics have objected that people-first language is awkward, repetitive and makes for tiresome writing and reading. C. Edwin Vaughan, a sociologist and longtime activist for the blind, argues that since "in common usage positive pronouns usually precede nouns", "the awkwardness of the preferred language focuses on the disability in a new and potentially negative way". According to Vaughan, it only serves to "focus on disability in an ungainly new way" and "calls attention to a person as having some type of 'marred identity in terms of

Erving Goffman Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociologist, social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth century". In 2007 '' The Times Higher Ed ...

's theory of identity. In the social model of disability, a person "is" disabled by societal and environmental factors. In 1993, the National Federation of the Blind in the US adopted a resolution condemning people-first language. The resolution dismissed the notion that "the word 'person' must invariably precede the word 'blind' to emphasize the fact that a blind person is first and foremost a person" as "totally unacceptable and pernicious" and resulting in the exact opposite of its purported aim, since "it is overly defensive, implies shame instead of true equality, and portrays the blind as touchy and belligerent". In deaf culture, person-first language has long been rejected. Instead, deaf culture uses deaf-first language since being culturally deaf is a source of positive identity and pride. Correct terms to use for this group would be "Deaf person" or "hard of hearing person". The phrase "hearing impaired" is not acceptable to most Deaf or hard of hearing people because it emphasizes what they cannot do. Autism activist Jim Sinclair rejects person-first language, on the grounds that saying "person with autism" suggests that autism can be separated from the person. Identity-first language is preferred by many autistic people and organizations run by them. Some advocacy groups and organizations such as Autism Speaks, The Arc and Disability Is Natural support using people-first language. Others including the

Autistic Self Advocacy Network The Autistic Self Advocacy Network (ASAN) is an American 501(c)(3) nonprofit advocacy organization run by and for individuals on the autism spectrum. ASAN advocates for the inclusion of autistic people in decisions that affect them, including: ...

do not, saying: