Ten Commandments for How to Talk About Mental Health

I was giving a lecture to a group of college students and I described how to show respect toward people with mental health concerns by using appropriate language. As one example, I noted it’s better to say “John has schizophrenia” instead of “John is schizophrenic.”

I explained how “John has schizophrenia” puts the emphasis on the person, not his illness, while “John is schizophrenic” equates the person with their illness and perpetuates negative labels and stereotypes about having a mental health condition.

“I’m a person, not a diagnosis!”

At this point, a young woman in the class raised her hand and said, “I was diagnosed with bipolar disorder about a year ago, and since then I’ve always said, ‘I’m bipolar.’ It never occurred to me to say ‘I have bipolar disorder.’ But I do see the difference. I’m a person, not a diagnosis! I may have a mental illness, but it doesn’t define me. I have goals in my life, including a career, a family, and so much more. This diagnosis won’t stop me, and I shouldn’t limit myself by implying that I’m just an illness.”

I praised her for this insightful comment and I believe it underscores an incredibly important issue. How we talk about mental health and people who are living with mental health conditions is often just plain wrong.

How to talk about mental health

Just like that bright young woman indicated, I’m convinced a large part of this problem is many well-meaning people simply aren’t aware of this issue. But when you bring it to their attention and describe a more respectful way to talk about mental health, they get it. (Of course, there are still some folks out there who aren’t going to get it even if it is brought to their attention. But we can’t change the whole world overnight.)

So, here’s a quick and easy lesson on how to talk about mental health issues. I’m offering a handy list of “ten commandments” suitable for copying, displaying, sharing, and teaching others. Remember, this isn’t an exhaustive list and these aren’t just my preferences. They reflect the preferred language recommended by several leading mental health groups and the Associated Press (see references below). I’ll also include the disclaimer that today’s ‘politically correct’ language may not be ok at some point in the future since terminology and its usage continues to evolve.

Ten Commandments for How to Talk About Mental Health

I. When using diagnostic terms, put the person first, not the illness. ‘Person-first’ language is “Mary has ______” (e.g., “schizophrenia,” ”bipolar disorder”), not “Mary is _____ (e.g., “schizophrenic,” ”bipolar”). This standard can also be applied to many other conditions, such as diabetes (not ‘diabetic’), epilepsy (not ‘epileptic’), and autism (not ‘autistic’).

II. Don’t say “mentally disabled,” “mentally handicapped” or “mentally ill.” Say “has a psychiatric disability” or “has a mental illness.” It can also be appropriate to say “mental health condition” since many people deal with mental health concerns but may not have a formal diagnosis or a full-fledged illness.

III. Don’t use the terms “retarded” or “mentally retarded.” The currently preferred language is to say the person “has an intellectual or developmental disability.”

IV. Don’t use insensitive terms (“crazy,” “insane,” “psycho,” “nuts,” “deranged,” etc.) to describe someone who displays unusual behaviors or who may have a mental illness.

V. Don’t say “addict,” “junkie,” “drunk,” or any of the many other derogatory terms related to addiction or misuse of drugs and alcohol. Say “has a substance use disorder” or “has an alcohol or drug problem.”

VI. Don’t say “brain damaged” or “demented.” Say “has a brain injury” or “has dementia.”

VII. Don’t say “committed suicide”; say “died by suicide.” Don’t say a suicide attempt was “failed” or “successful.”

VIII. Don’t use terms that suggest pity, like “suffering from,” “victim of,” or “afflicted with” when referring to someone’s illness or disability. Instead say “has a history of,” “being treated for” or “lives with.”

IX. Don’t use diagnostic or mental health terms to explain individual idiosyncrasies or behavior common to many people, such as “that’s my OCD” or “I’m so ADHD” or “you’re so paranoid.”

X. Respect each person’s preference for how they wish to refer to their own mental health status. A wide variety of terms may be used when someone refers to their mental health issues, including “consumer,” “survivor,” “person with lived experience,” “person in recovery,” and more. Finally, mental health providers still routinely use the terms “client” and “patient” depending on the specific treatment setting.

Let’s make a difference

Despite widespread distribution of these types of guidelines, you will still encounter lots of very well-informed mental health consumers and experienced, caring providers who routinely use inappropriate or insensitive language. When this happens, be polite but let them know your concerns about their choice of words. Or better yet, just send them a copy of this article and say, “This is very interesting; thought you might enjoy it!”

There’s one final point, which I’ve mentioned in previous writings. Let’s turn our focus away from only referring to the “stigma” of mental illness and call it what is really is: prejudice and discrimination. By changing how we talk about mental health issues, we can begin to impact the negative attitudes and behaviors which adversely affect so many people. Let’s all make a difference, starting today.

Here’s a question: How can you promote appropriate ways to talk about mental health issues? Please leave a comment. Also please consider subscribing to my blog and feel free to follow me on Twitter, “like” my Facebook page, or connect on LinkedIn. Thanks!

References:

Guidelines for Nonhandicapping Language in APA Journals, American Psychological Association.

Mental Health Terminology: Words Matter, American Psychiatric Association.

Entry on mental illness is added to AP Stylebook, Associated Press.

2003 Language Guidelines, US Psychiatric Rehabilitation Association.

Guide to Engaging the Media in Suicide Prevention, Suicide Prevention Action Network USA & Suicide Prevention Resource Center.

  • Jan Cottrell

    Excellent. Thank you!

  • DavidSusman

    Jan, thanks for your continued support!
    David

  • Sometimes I hate tiptoeing around political correctness – but these terms really make a difference in how we see ourselves and others. Thank you

  • Patrick Snell

    Good article. Just curious, why not say “Committed suicide”?

  • DavidSusman

    Hi. ‘Committed’ is associated with doing wrong such as committing a grave error or committing a crime. That connotation shouldn’t be associated with a mental health tragedy. Thanks.

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