Tag Archives: mental illness

A Few Words: Why it matters how we talk about what happens


First of all, let me say that as I write today, we have no idea at all yet what caused the tragic shootings in Aurora, Colorado this week.  So I’m not going to jump to the conclusion that the shooter is mentally ill.  I don’t have to—plenty of folks have already done it for me!  There are various opinions on whether we should or shouldn’t “use” horrible events to promote various political agendas.  I’m not going to do that, not because it isn’t legitimate but because something just feels off about the idea.  Instead I want to talk about our responses to the events.  The words we use about them can either stimulate needed discussions or cause further harm—it really does matter.

Second, I’ll say right off that I’m not much of a politically correct word purist.  I am a member of NAMI (National Alliance on Mental Illness) and have more than one family member with serious mental illness. We are taught to stop using words like “crazy”, “loony”, “nutcase”, etc, because these are quite hurtful to people we love.  I still use the word “crazy”, a lot, but I use it to mean “something that doesn’t make sense to me” or is over the top, as in “I had a crazy day at work” or “the phone is ringing like crazy”. Yes, I occasionally even use it in a teasing way, towards a person.  I am probably not supposed to do that.

We have a lot of words and phrases in English to describe a person who is behaving foolishly or irrationally.   Some of them are colorful and spot-on, and I see no compelling reason to eliminate them.  “She’s fallen off the deep end”, “he’s taken leave of his senses”, or “lights on but no one home.”  Most people don’t say this stuff when they know a person is actually sick—that would be cruel.  It’s just our way of talking about the sometimes incomprehensible behavior of humans.

There’s a certain line we can cross, though, where our thoughtless speech habits can cause unintentional pain.  To me, that is most likely to happen when we use words like “crazies” as shorthand for groups of people, especially people who might actually be mentally ill.

For example, a newspaper article this weekend made the statement “You can’t let the crazies win” and compared it to not letting the terrorists win (by going shopping).  My understanding was that the writer meant we couldn’t let fears of highly unlikely events keep us from doing ordinary things, like going to the movies.  Instead, he hurt the feelings of many families, including mine, and inadvertently perpetuated stereotypes about those with mental illness.  What are people with mental illness trying to win—a game? A war?  Of course not—they want what we all want, a good life.  Are we supposed to fight them, so they don’t win?  We should be fighting instead on their behalf, for better treatment and access to treatment.  That was a clear line-crosser.  I’m surprised no one caught it before it went to print.

I expect professional journalists to do better.  I’ve commented on several Facebook posts also, for people who are not paid to do better.  There is no reason to use comments like “this is about nuts and ignoring nuts” or talk about “the crazies running around shooting people.” I’ve tried to rein in my irritation and just comment that this kind of talk is hurtful.  Most people just apologize, which is all I want.  Others get offended. In the words of an old friend, “I’m sorry but I’m not going to apologize” about speaking out, any more than I would for calling someone on a racial slur.  It is the same thing. We need to make it socially unacceptable.

Why does it matter?  People with certain mental illnesses, if untreated, are clearly at increased risk of doing violent things.  Those who are treated are zero percent more likely than the rest of us to hurt people. They are, however, at significantly increased risk of becoming the target of violence by others.  When we disparage groups of people with mental illness as “the crazies”, we fuel stereotypes that in turn fuel violence.  Who wants to go to the doctor and be labeled a “crazy”?

Many, many people with serious mental illnesses respond well to treatment and go on to live productive, happy lives.  Many don’t tell others, because they are afraid of stigma.  When people use the term “crazies” around them (or their families), they may feel battered by those words internally but not feel they have enough likelihood of acceptance to respond. Some of those folks smiling and laughing at your words are gasping on the inside.  Whenever events like this happen, they have to deal with the ignorant, hurtful language.  Their fears of being ostracized or rejected (or even attacked) go up. They have trouble sleeping.  Their families feel more stress, which means we are more sensitive than usual to such talk and may over-react.  Please remember that.

I know people get frustrated with the ever-changing rules of politically correct speech.  As John Steinbeck said, “A writer lives in awe of words, for they can be cruel or kind, and they can change their meanings right in front of you. They pick up flavors and odors like butter in a refrigerator.”  For some conditions, it is hard to keep up with which term we are supposed to use and which ones are rude—Steven Pinker calls it the Euphemism Treadmill.  I think of it as a process—words get stinky sometimes and can’t always be rehabilitated, so we change them, but attitudes lag behind and can contaminate the new words too. 

Another problem with ignoring the language?  If people can use derogatory words about an entire group without social disapproval, it tells them something big—it says they might also disregard or even target this group through actions, like defunding mental health care or ostracizing them from the community. Others might just look the other way, the same as they do in conversation.

It would probably be too much to expect us all to pretest our speech constantly—is it true?  Is it necessary?  Is it kind? We don’t need to be the PC speech police either.  But there’s quite a distance between being ridiculously perfect and giving a pass to “You can’t let the crazies win.”

We can’t just change the words, or nothing will get better—we have to change the underlying attitudes.  It is all of a piece.  Reminding ourselves to consider our words gives us a chance to examine our thinking as well. It is not ok to use these words.  We are not that kind of people.

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Criminalization of the Mentally Ill


This post is not from either a left or right political perspective– it is political only in one of Webster’s definitions of politics as the total complex of relations between all people in a society.  But as a NAMI member (National Alliance on Mental Illness, an advocacy group comprised largely of family members of people with serious mental illness) and also as a general pediatrician who cares for some children and teens with serious mental illness, I feel obligated to speak up.

The shootings in Arizona last weekend were tragic from every angle.  I do not know if the shooter will turn out to be diagnosed with a mental illness that caused him to act this way or not– I am not his doctor.  But in any case, there are some very important things we need to know.

First, studies have been done on the percentage of mentally ill people who commit violent acts compared to the percent of non-ill people, and it is actually about the same.  The difference is only that mentally ill people, if they commit violent acts while ill, are likely to have done so as a direct result of their illnesses.  So we do not need to be afraid of people who are mentally ill, in general, more than we are afraid of any other group.  Humans have the unfortunate capacity for violence (thankfully, we also have a great capacity for compassion).

Second, if people with mental illnesses get the appropriate and timely treatment they need, they are very, very unlikely to be violent.

So what we need to do as a society, to lessen the risk of such violence, is to work for easily accessible and effective treatment for mental illness.  We need to know the warning signs of possible mental illness, so that we can recognize them in others, and we need to know what to do if we suspect a problem.  But this will not be possible, I believe, unless we also work to reduce the terrible stigma of mental illness.  Because of this stigma, persons and family members not only lack knowledge about what to do, but they are often too embarrassed to seek help.  The possibility of being judged and socially penalized if others find out is real.

Young adulthood is a high risk time for people to develop illnesses like schizophrenia.  Families may not understand what is happening– some try to get help but can’t afford or find it, and instead live in fear that their loved ones will do something terrible that would never happen without the illness.  When bad things do happen, others who don’t know them often blame these suffering families.

Please go to www.nami.org and educate yourself.  Donate if you can, and join a local chapter. There are so many things we could do to improve mental illness treatment in our country.

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