How do you respond to stigmatized language?

Man weighed down by stigmatized words

Crazy.  Psycho.  Schizo.  Nutbar.  

Mad.  Retard.  Lunatic.  Loony tunes.  

Insane.  F***ed in the head.  Bonkers.  

Whack job.  Batshit crazy.  Certifiable.

These are just a few examples, but when it comes to derogatory, stigmatized mental-health related terms, there are many of them and we hear them often.  Sometimes we even use them ourselves. A study by Rose and colleagues identified 250 stigmatizing terms used by 14-year-old students in England to describe people with mental illness, including some I’d never heard of before (e.g. “window licker”).  Clearly these terms are quite pervasive if they’re already well known in 14-year-olds.

So how do we address the use of these words that have become entrenched in common usage?  Is it as simple as advocating for these words to be completed removed from the social lexicon?  Perhaps a good place to start is by asking a few more questions to figure out exactly what we’re talking about.

Does it make a difference when terms are reclaimed by the target group?  

A term like “nigger” is highly racially charged, but the connotations are far more nuanced when it’s used within the black community.  “Dyke” was considered a derogatory term, but has since been reclaimed by people in the lesbian community.  “Queer” is another term reclaimed by the LGBT community.  “Bitch” is sometimes used to describe strong feminist women.  Is this sort of language reclamation happening within the mental illness community?  I sometimes use “crazy” as a humorous way to refer to myself and other members of my in-group (i.e. mentally ill).  Does that contribute to stigmatization?  Does it make a difference that I’m applying that language to myself as well?

Does it matter how close we are to the person talking?

I think the closeness of one’s acquaintance can affect both the ease and importance of calling out discriminating language, but there are other factors as well.  My 101-year-old Grandma grew up in a time when people with mental illness were locked up in institutions, and there was really no such thing as political correctness.  She’s unable to remember that I have a mental illness, and even when she was aware of it she really had no frame of reference to understand it.  Sometimes stigmatized language will pop out in relation to something we’re talking about, but in that context I don’t see any real reason to point it out.  With other family members I would be quick to call out inappropriate language, whereas with strangers I might be more likely to let it go, depending on the situation.

What if we overhear it at work?

This is probably the context that is most likely to cause challenges.  I recently read a post on Dangerous Voyage about a colleague using the term “retard”.  Clearly the use of the term was offensive and inappropriate, but to be honest, I doubt I would have said anything in that situation.  However, had a colleague used the term retard to refer to someone with an intellectual or other disability, it would be quite a different situation.

Still, even when highly inappropriate language is used, multiple factors come into play.  Is the stigmatized language being used to discriminate against a disadvantaged group the target belongs to?  Would speaking up be likely to create positive change?  Is there a power differential that could lead to negative consequences not just for calling out the stigma but also simply because you’ve challenged them?  While it would be nice to think that we would take the moral high ground and challenge offensive language, pragmatic considerations often weigh heavily on us.

I work in mental health, and don’t hear a lot of slang terms used by colleagues, probably because of the level of familiarity with proper medical terminology.  What I do hear, though, is stigmatized descriptions, such as patients with borderline personality disorder being described as attention-seeking or manipulative.  In situations like this I would generally express my disagreement in interpretation of the behaviour, but I don’t think I’ve ever actually called anyone out on the underlying stigma.  Mostly that’s because I feel like it has little likelihood of bringing about change, but also for selfish reasons – I don’t want someone pissed off at me for calling out their BS.  I also feel that reinterpreting a client’s behaviour is actually more productive, not to mention client-centred, than calling out the professional on their bad attitude, which would likely result in them getting defensive.

What if it’s directed at us or others online??

Luckily I haven’t been the direct target of overtly stigmatized, insulting language online, which probably has a lot to do with my relatively limited social media presence.  The stigma that I’ve experienced has been more subtle than that, and has tended to happen in “real life” rather than online.  There have been multiple occasions where I’ve witnessed others in the mental illness community being targeted with stigmatized language, and they have reacted strongly to condemn it.  More of than not, though, this can get into a feeding the troll kind of situation that becomes very upsetting for the person targeted.  So how do we decide when to speak up and when to block and ignore?

Personally, I believe that people who are ignorant due to a lack of information are worth trying to talk some sense into.  People who deliberately choose ignorance are probably a lost cause.  They’re not going to listen to reason, and they’re probably going to actively fight back against attempts to get them to see the light.  Is that giving up?  Maybe.  But by picking our battles we can divert our energy to the areas where it’s likely to have the greatest effect.

Do words used as insults become disconnected from their original meaning?

I have a potty mouth.  Motherf***er tends to come flying out of my mouth inadvertently. When I use that word I’m not talking about incest and I don’t imagine anyone around me is likely to interpret it that way.  Canadian French has some quirky profanity related to the Catholic Church, such as câlice (chalice) and tabarnak (tabernacle).  So if I say “Tabarnak!  That crazy ass mofo just cut me off!” does the actual meaning of each individual word come into play?  Or maybe the original meaning begins to disappear, especially when terms are used in combination with other insults.

Donald Trump, particularly in relation to his bizarre Twitter behaviour, is often accused of poor decision-making, and mental illness-related terms get thrown around quite often by his critics. Personally my term of choice would be batshit crazy to describe his Twitter carryings-on.  Yet this is a situation there is a potential blurring of that line between insult and literal meaning, as some people do question whether he has a mental illness.  Personally I think that’s very unlikely, but it’s problematic if his erratic statements/behaviours are seen as being what mental illness looks like on a broader scale.  Regardless of one’s political affiliation, I don’t think that’s a good thing.

The simple answer to all of this would be to try to eradicate the use of this kind of stigmatized language entirely, but I’m not sure that will ever be possible.  Perhaps the next best thing is to focus our efforts in the areas where we can bring about change, and focus less on the language itself and more on the stigma and lack of information that underlies discriminatory language.

book cover: Making Sense of Psychiatric Diagnosis by Ashley L Peterson

 

My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses.  It’s available on the MH@H Store, as well as Amazon and other major retailers.

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17 thoughts on “How do you respond to stigmatized language?

  1. Luftmentsch says:

    This is something I’ve thought about quite a bit without really thinking of answers. It’s easy to say, “We should always call out inappropriate language” but sometimes it doesn’t seem likely to go well if we do. I’ve heard people say moderately racist or Islamophobic things and sometimes I will call it out, but a lot of the time I’m worried about getting into a big argument with someone who won’t change their mind because they’re not open to the possibility that what they’re saying might be problematic.

    I don’t think I’ve had inappropriate language used against me because of my mental health, but I’ve had quite a bit of antisemitic stuff thrown at me over the years. Minor things I would let go, if I know the person means well and is just not thinking (like the person who thought that all Jews are clever). Sometimes I get graphic language shouted at me on the street by strangers; I usually don’t stick around long enough to see where they want to take that.

    • ashleyleia says:

      It’s interesting with comments like all Jews are clever, probably a lot of people wouldn’t see that as anti-semitic, but it’s that acceptance of stereotypes that helps to fuel the more extreme stereotyping. It’s mind-boggling that people would ever think that it’s acceptable behaviour to shout discriminatory garbage at random strangers on the street.

  2. Melanie B Cee says:

    I’m reblogging this because I think it’s something people need to think about. Think about thoroughly. I’ve heard or been called a number of those names you listed, and I’ve used more of them than is prudent. BUT. I learned over time that using that sort of language only makes me look more ‘crazy’ than is necessary and I’ve stopped. In fact, the other night I was watching a movie where a child with Down Syndrome was featured in a minor role. The point of his participation had to be the radiant joy that just burst out of the little boy…he had one of the cheeriest grins I’ve ever seen, and you could see that he was just so happy. Infectious. And someone used the “R” word to describe him. I grew up hearing ‘retard’ as a word to describe anyone who had physical or mental challenges. It’s a contextual thing…that word now is known to be degrading and nasty. At the time? It was what was used. Same with the “N” word you mentioned. I had a discussion with someone about the usage of that word in certain classic novels. I have a big problem with those in charge of that stuff changing the words to something more PC because “N” or “R” isn’t used any longer. It’s (to me anyway) an exercise for people to learn how to put things in context. My thoughts anyway. Thanks Ashleyleia for providing such thought provoking and well written posts. I really enjoy them!

    • ashleyleia says:

      I totally agree with you about not changing words in novels. We learn and grow by seeing what has come before, and it helps in understanding why these things are considered unacceptable now.

  3. Meg says:

    This is really interesting. Personally, I’ve always hated the word “retard” (or “retarded”). And that part of me likes how we’ve changed terms to “developmentally delayed,” etc. I guess words take on connotations and become hurtful somehow?

    Hilarious but true: if you read the opening pages of Pollyanna, the author was using words back then that meant something different than they mean today. Pollyanna’s having a conversation with a man she doesn’t know, and it goes something like this:

    “What are you looking at, little girl,” the queer man ejaculated.

    You can’t make this stuff up. (Yeah, “ejaculated” used to mean to spit out, like to exclaim something out loud vehemently.)

    Anyway, I strayed off the point there. I like how you pointed out that within a group, people can claim those words and make them less offensive. Like, I can call myself batshit crazy, right? It’s like with stand-up comedy–you can make fun of any condition that applies to you, yourself; and others can’t really take offense. So I’m always like, “I’m schizophrenic and half-deaf. Often, the voices I hear don’t belong to the people around me,” and no one can get offended. (Granted, I’m the only person who finds that amusing.)

    My sister, the evil one who works as a social worker, is always telling me that I shouldn’t call myself “schizophrenic.” Rather, I should say I “have schizophrenia,” so that I’m not identifying myself as BEING mentally ill, but as HAVING a mental illness. But it ultimately doesn’t upset me to identify with it; however, if it were upsetting to someone, I’d definitely use whatever terminology they wanted. It doesn’t hurt me any to make an extra effort, ya know?

    Also, that sounds like quite the interesting list of British slang you stumbled upon.

    • ashleyleia says:

      When it comes to identifying with illness terms, I think we should have the right to use whatever the heck we want when it comes to ourselves. At the same time, I don’t think someone else should be calling you schizophrenic, for example, unless they know that you identify that way.
      Interestingly, mental retardation was still a diagnosis in the DSM-IV, and just changed in the DSM-5 to intellectual disability. A few of my patients in the past had a diagnosis of mild mental retardation, but somehow that had a very different feel to it than “retard”. Maybe because the DSM uses retardation in other contexts (e.g. psychomotor retardation) to simply mean slowing.

  4. marandarussell says:

    I use some of these terms myself, but in a self-humor kind of way. I often joke I’m crazy or weird, in a sense, I think taking the terms, turning them into a joke and using them yourself makes you feel like you have power of the words and they lose any sting they have.

  5. DV says:

    It has a whole different feel to apply terms to yourself than to have other people do it. For me it’s actually a way of minimising to myself the impact of my mental illness, like calling myself “crazy” gives me the power to project an amusing image of “crazy cat lady” and conceals the bit where I’m crying my eyes out in a meditation class or planning suicide.

  6. Isabella says:

    A very interesting article, it made me reflect on so many things! Words can have a devastating effect on someone emotionally fragile. I know it too well…One thing that always puzzles me is the reaction I get when I say I have BPD. It’s like “Nooo, you don’t! You’re so kind, you cannot possibly be borderline!” And yet I am…These are the stereotypes that harm the most and the stigmatized language only reflects them.
    I also wanted to thank you for following my blog, it means the world to me!

  7. Pam Taylor says:

    Jesus said that the mouth speaks forth what’s in the heart. If someone’s heart is judging someone else, I am immediately aware that something is going on in their heart too – well, sometimes I am aware of it.

  8. my dream walden says:

    We were having a work discussion yesterday about the different types of people using our support service. One of them has BPD and a co-worker commented that people with BPD are the most difficult because they just want to make you feel bad about yourself. I believe my co-worker has well intentions but I wonder if I should have interrupted for a second to clarify it is their BPD which makes them feel/behave in a certain way, but then I still don’t know much about BPD so I didn’t speak. I was even thinking, at least my co-worker didn’t use the word ‘manipulative’. I agree, sometimes we inadvertently stigmatize a group because of the way we describe them.

    • ashleyleia says:

      That’s a tough situation, and if you point out that the behaviours are related to their BPD the other person may not see that as being any different from what they originally said.

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