'Crazy Talk': How We Characterize Mental Illness

As a writer, an editor, and an advocate for people affected by mental illness, I was deeply encouraged to learn of a new entry in the Associated Press Stylebook, offering guidelines on how to describe and characterize mental illness. As the definitive guide to using language in American journalism, the AP Stylebook guides most professional news media and others to at least to some degree. It's significant to see the stylebook offer guidance on how (and when) to address mental illness.

The entry calls for journalists to "avoid unsubstantiated statements by witnesses or first responders attributing violence to mental illness. A first responder often is quoted as saying, without direct knowledge, that a crime was committed by a person with a 'history of mental illness.' Such comments should always be attributed to someone who has knowledge of the person's history and can authoritatively speak to its relevance to the incident."

It's about time.

This is a hugely valuable step toward a national conversation that treats people affected by mental illness with dignity and respect—and accuracy. Irresponsible journalism is culpable for perpetuating myths and misconceptions about mental illness, particularly the widely held, erroneous belief that most people with mental illness are more violent and dangerous than the general population.

Studies consistently show this is not true. As with the general population, substance abuse does increase tendencies toward violence, but mental illness itself does not make people significantly more prone to violence than others. In fact, according to the U.S. Surgeon General's office, "There is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder…the overall contribution of mental disorders to the total level of violence in society is exceptionally small."

The guidelines also say, "Do not use derogatory terms, such as insane, crazy/crazed, nuts or deranged, unless they are part of a quotation that is essential to the story."

Journalists sometimes do use common derogatory terms that perpetuate the stigma attached to mental illness. But to be fair, when they do so, they're simply reflecting the speech most of us use without thinking. While journalists' voices may be amplified, their words are no more important than anyone else's. And the rest of us reinforce stigma with our own language, too.

How often do you use terms like these in everyday conversation:

psycho

demented

crazy

maniac

nutcase

headcase

insane

schizo

wacko

lunatic

Have you ever referred to yourself as "a little OCD"? Unless you have obsessive-compulsive disorder, you're not OCD… at all. Have you ever described a project, a team, or an experience as "schizophrenic"? By speaking flippantly about real and sometimes debilitating disorders, we undermine the idea that they should be taken seriously as medical conditions. By using the names of symptoms and diagnoses as insults, we reinforce the idea that people with such conditions are less than the rest of us and worthy of our derision. By whimsically attributing our character quirks to mental-health diagnoses we don't have, we suggest that such conditions barely exist. They are the stuff of legend and myth, like zombies and werewolves, and dismissing them isn't really hurting anyone who has enough awareness to know the difference.

But it is hurting someone. It's hurting a lot of people, some who keep their conditions hidden and some who are too afraid to even acknowledge them. It's hurting the families and friends on whom shame rests as well. And ultimately it hurts all of us, who pay a high price—both medically and socially—for the consequences of that shame.

Our careless language reinforces stigma. Stigma is automatic mindless, irrational rejection of people who are "tainted" by mental illness. They are labeled, stereotyped, misunderstood, and dismissed. Stigma discourages people from seeking treatment, and in some cases even acknowledging their disorders. It marginalizes people and makes it easier to dismiss them as less than others, not fully deserving of understanding, compassion, or friendship. The U.S. Surgeon General's office called stigma "the most formidable obstacle to future progress in the arena of mental illness and health."

We'd never consider it acceptable to casually mock an able-bodied but limping friend by calling her "paraplegic." We don't refer to ourselves in a self-deprecating way as "a little diabetic" or "a little cancerous." Is that because we realize that we know people who have such conditions and that our casual use of such language would trivialize their challenges and undermine their sense of value? People with mental illness are all around us—and deserve the same consideration.

All Christians should take a cue from the Associated Press and watch our own language. In fact, when it comes to treating people with compassion and speaking of them the way we would want to be spoken of, the church should be leading the way.

This is not simply about using politically correct language. It's about understanding the power of our words, as Scripture calls us to. In the most strongly worded description of this power, the apostle James wrote, "People can tame all kinds of animals, birds, reptiles, and fish, but no one can tame the tongue. It is restless and evil, full of deadly poison. Sometimes it praises our Lord and Father, and sometimes it curses those who have been made in the image of God. And so blessing and cursing come pouring out of the same mouth. Surely, my brothers and sisters, this is not right!" (James 3:7-10).

It's about remembering that the words we use reflect what's happening in our souls. As Jesus declared, "A good person produces good things from the treasury of a good heart, and an evil person produces evil things from the treasury of an evil heart. What you say flows from what is in your heart" (Luke 6:45).

It's about choosing words that show love and offer healing and grace. After all, "from a wise mind comes wise speech; the words of the wise are persuasive. Kind words are like honey—sweet to the soul and healthy for the body" (Prov. 16:23-24).

Amy Simpson is author of Troubled Minds: Mental Illness and the Church's Mission (InterVarsity Press). She also serves as editor of Christianity Today's Gifted for Leadership. You can find her at www.AmySimpsonOnline.com and on Twitter @aresimpson.