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.
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.