UAB Medicine News


When It Comes to Mental Illness, Words Matter

Mental Wellness

Words can hurt. They can form the cornerstone of cyber-bullying, the cracks in the foundation of marital harmony, and the scars of friendships long forsaken. Hurtful words spoken intentionally can wound deeply. But so can words that are simply part of our vocabulary – words that aren’t meant to be hurtful but nevertheless cause others pain.

This is particularly true when it comes to words associated with mental health. We might not think twice about saying, “Amanda’s crazy to think that her in-laws will get along with her parents,” Or “Brian is so OCD when he cleans the grill.” Dubbing a friend “schizo” about her on-again, off-again relationship with her boyfriend can seem like the perfect descriptor. Imagine, though, what a friend or family member with a mental illness might feel when they hear words such as “crazy,” “OCD,” and “schizo” used as shorthand.

Taylor Preston, MD, director of Ambulatory Psychiatry at UAB Medicine, says the words we choose can reverberate in a variety of unintended ways. “’Crazy’ stigmatizes individuals with mental illness,” he says. “It can make them feel ‘less than’ or like it is a personal failing to seek treatment for mental health care.”

Dr. Preston suspects that the root of that feeling is our culture of self-reliance. “When people ask for mental health treatment, they can believe they’re weak and can’t handle their lives themselves,” he says. This stigma, he adds, can cause people who need help to instead feel ashamed. “Some of the shame is self-imposed, but some is from family members or friends, as well as from the culture around them.”

Like an infection caught early, mental illness can be treated, so treatment shouldn’t be delayed. “It can get increasingly worse and lead to a worse outcome,” Dr. Preston says of avoiding treatment. For example, he notes that people often self-medicate instead of seeking help with mental health issues. “All too often, that’s in the form of substances that can lead to addiction issues.”

Choosing Our Words

Simple changes to the language we choose can go a long way in helping de-stigmatize mental illness. Here are some examples to illustrate different words to use for the scenarios described earlier:

  • Instead of “Amanda’s crazy to think that her in-laws will get along with her parents,” try “I can’t understand why Amanda thinks that her in-laws will get along with her parents.”
  • Instead of “Brian is so OCD when he cleans the grill,” try, “Brian’s such a perfectionist about cleaning the grill.”
  • Instead of “Tonya’s acting schizo about DeShawn again,” try “Tonya’s back on the DeShawn merry-go-round.”

Removing stigmatizing language from our vocabulary can be difficult, but even being aware of the words we use can be a good first step. Here are some words that are commonly used, along with alternatives to consider:

  • “PTSD” and “triggered”: When people who have PTSD (post-traumatic stress disorder) are triggered by sights, smells, tastes, sounds, or thoughts, they can re-experience the feelings associated with the traumatic event. They can have flashbacks or nightmares and can experience adrenaline surges and other physical or psychological symptoms. Instead of referring to an uncomfortable situation as “triggering” or “gives me PTSD,” try “That upsets me” or “That guy reminds me of my ex-husband.”
  • “Depressed”: People who have clinical depression can feel worthless, hopeless, and even suicidal. They can have trouble concentrating. They can sleep too little or too much. Instead of saying, “I’m so depressed,” try describing what you’re feeling – maybe sadness, heartbreak, or loneliness.
  • “Paranoid”: Someone with paranoid personality disorder has a range of thinking patterns. These can include doubting others’ trustworthiness, believing that others are attacking them, and being hypersensitive to criticism. Instead of saying, “I know I’m being paranoid, but…”, try “I’m really suspicious of her.”

Other words and phrases worth finding substitutions for include:

  • Psycho
  • Nuts
  • Delusional
  • Mental
  • Loony
  • Manic
  • Wacko
  • Insane
  • Split personality
  • Deranged

People-First Language

When people do have mental illness, labels can be devastating. Referring to someone who has been diagnosed with schizophrenia as “a schizophrenic” reduces the person to that label. According to Dr. Preston, “I always teach my students and residents to call them ‘people with schizophrenia.’” Similarly, he says, people aren’t “bipolar”; they struggle with bipolar disorder. “There’s so much more to an individual than the illness they struggle with. For a person with mental illness, that is just one of the many things that make up who that person is.”

Supporting Loved Ones with Mental Illnesses

Language is one important aspect of lessening the stigma of mental illness, but friends and family members can do even more. “It’s important to have an open mind about seeking mental health treatment from a qualified professional,” Dr. Preston says. “Reserve judgment and instead encourage them to seek treatment.”

Dr. Preston notes that loved ones should view the decision to seek help as a courageous decision. “Realize that the person had to overcome a great deal of stigma to take that first step in addressing their mental health,” he says. “Instead of being expected to change on their own or being isolated and ostracized, they should be encouraged to obtain mental health care.” Ideally, that kind of positive reaction will give them peace of mind in knowing that they can also rely on a network of support among family and friends.

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