Caregiving: Talking About Mental Illness

Or at least, my feelings on talking about mental illness and disability.

There is one point I want to make before I go any further and that is the reminder that I’m in the United Kingdom, unlike the considerable portion of Persephone readers who are in the USA. The reason for pointing this out? That there can be differences in language. Sometimes these are big differences and sometimes they’re more subtle.

For instance, take these two words: retard and spastic. Both these terms originate in medicine. “Retard” being the shortened version of mental retardation and “spastic” being an old-fashioned term for cerebral palsy.

Here in the UK, “retard” and “spastic” are considered offensive. “Spastic” in particular is considered offensive, with the only accepted usage being in medicine. “Retard” doesn’t appear to have quite the same force of offense. Perhaps because it’s a word that is very close to those which can be used appropriately in non-medical settings (retardant, for instance). “Retard” is also a word that doesn’t appear to have quite the same “playground” history as “spastic” does, in terms of usage to insult and offend. At least, that’s my experience. In the U.S. however, “spastic” doesn’t appear to have nearly the same history or power as it does in the UK. And instead, “retard” appears to be considered one of the most offensive words available.

There is then the other side of talking about mental illness and disability: words that are still very much legitimate terms that are used inappropriately.

There’s another point that I feel is worth making: I don’t have an issue with people who misuse words. What I have an issue with is people who misuse words when they know they are doing so. And also the instances of using a word with the knowledge that it’s harmful. And context. Context can be so important.

I’m not fond of seeing people ripped apart for how they use language, either. Sometimes people truly don’t know any different, haven’t had the privilege of being educated with respect to illness and disability, or trip up in a field which isn’t one they’re familiar with. Sure, hate crimes need to be dealt with as such, but much misuse of language is by no means always going to be a hate crime.

So. Onwards to my actual points. I think they can be broken down into: misuse of appropriate language and use of inappropriate language.

Onto the first, since it’s foremost in my mind. Schizophrenia, for all the discussions going on around the name and diagnosis as a whole, is still generally accepted as a legitimate medical term. It does, however, get horribly misused. A current example of this is in the Heroes of Olympus series by Rick Riordan. In the three books of the series that have been published, schizophrenia is used in each book to mean – going by context – “split personality” or Dissociative Identity Disorder. That this misuse happened at all is one I find surprising to say the least, even more so given that Riordan is university educated and was a teacher, too. Sure, the etymological history of schizophrenia is the “split mind” but this is in reference to a split between reality and fantasy, not personalities.

The “split personality” idea seems to be a common misconception of schizophrenia and it is a horribly unhelpful one. Why? Because it’s not what the condition is about. There can be co-morbidities within mental illness, but that does not make them the same. Nor is misdiagnosis an excuse for allowing conditions to be forced together in their definitions. And the end result tends to be that conditions have their stigma furthered and understanding hampered.

Going with the theme of currently used medical terms and misuse, well, I think many conditions are liable to be treated in the same way. There’s also a middle-ground of sorts, where conditions are described using inappropriate terms. This is something I came across a lot on support sites. Many of those people appear to be angry or bitter and resort to venting those feelings with language that is perhaps not appropriate. There’s a famous quote (so famous, I can’t recall who said it) which goes something along the lines of: “The only way to talk about mental illness is in metaphor.” I think that’s pretty accurate. That doesn’t however – to me, at least – make it okay for a person to refer to someone as that “psycho bastard/bitch.” Out of interest, I did a search on a support forum I used to use:

Crazy ““ 179,000,000 hits

Psycho ““ 22,400,000 hits

Lunatic ““ 5,280,000 hits

If people want to use that kind of language then, sure, that’s up to them. I’m just inclined to think it’s unhelpful on many levels. In the support environment, one of my greatest concerns is that this kind of language leads people to believe that “jerk” is a symptom of mental illness. That isn’t to say that a person with a mental illness can’t be a jerk, but that being a jerk isn’t something diagnosable.

There is then the type of language which doesn’t really have any appropriate use apart from possible historical context. Again, it’s up to people whether or not they choose to use these words, but I do wonder if they appreciate the background to them. For instance: idiot. It’s a word that is incredibly common and certainly, I’ve used it in the past, but once I became more aware of the history of the word, I reminded myself that there are other words in the world than idiot.

There is one word, however, that I find nothing short of distressing to hear used inappropriately: lunatic. There is the appropriate use: i.e. talking about historical asylums. But when “lunatic” is used in contemporary instances? I… I just find it very difficult. Psychiatric hospitals were, in the UK, known (officially) as asylums as late as the mid-twentieth century. Our local psychiatric hospital is more than 200 years old. To think of what went on when it was a lunatic asylum? When the patients were lunatics up until a 100 years ago? I just can’t see any justification for using the term outside of a historical context. When I hear lunatic, loony, I think of things like this. I don’t expect everyone to know the history of the word “lunatic” but I do have something of an expectation that people know there’s good reason it’s often considered an unpleasant word.

I have written about my feelings on the word “psycho” when I wrote about stigma, but rather than the distress I feel on hearing “lunatic,” “psycho” and its dear friend “nutter” when referencing mental illness, tend to induce feelings of wanting to fling a thesaurus in the general direction of whoever uttered the words.

There are then two words that have been on my mind for days now: “mad” and “crazy.” Mad is a word I use. I don’t use crazy. Or rather I do use crazy, but in specific situations. As an example, there have been “changes” here in the UK in the welfare and support available to those with illnesses and disabilities. This has led to one or two social-network rants in which I have wondered aloud about our politicians’ attitudes to mental illness in that they appear to be treating people with mental illnesses as “crazies” rather than human beings with a medical condition. As for mad, well, like crazy it’s synonymous with “insanity.” But unlike crazy, mad seems to have become a term with a much wider definition. More synonymous with chaos, than with insanity. At least, that is how I feel about it at the moment. As for insanity itself. I’m not so sure. It’s a loaded term, that’s something I feel, at least. Insanity (and in turn, sanity) can be used appropriately and I think that’s where my feelings lie: in appropriate use.

So there you have it: my feelings on how we talk about mental illness. I think it’s important to reiterate that these are my feelings, rather than a declaration on how we should talk about mental illness, because everyone’s going to feel different. My experiences inevitably affect how I think about certain words, just as other peoples’ experiences affect their views. Indeed, it mustn’t be forgotten that similar experiences can have different impacts. There are some people who want to reclaim words that I’d rather not hear, and there are people who would take a much firmer stances than I would. I guess my hope is that when talking mental illness, whatever words people use, that they can be aware of the background to those words. And also that, perhaps, if there’s doubt, then to remember there’s a world of other words out there.

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Rarely to be found without herbal tea nearby. Team Unicorn. Often in pyjamas. Also: TEAM KATNISS!

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