A Phrase To Renounce For 2014: ‘The Mentally Ill’


(Carey Goldberg/WBUR)

I wince every time I read it. So does the president-elect of the American Psychiatric Association, Dr. Paul Summergrad, he says.

I saw it most recently in The New York Times, in the headline pictured above and a recent masthead editorial: “Equal Coverage For The Mentally Ill.” It’s all over, from The Boston Globe — “New Era for the Mentally Ill” – to The Wall Street Journal — “Crime and The Mentally Ill.” Just about any media outlet you care to name.

What’s so bad about “the mentally ill”? Isn’t it reasonable shorthand in the usual headline space crunch?

In a word, no, says Dr. Summergrad, psychiatrist-in-chief at Tufts Medical Center and chair of psychiatry at Tufts University School of Medicine. He sees two main problems with it. First, the definite article, “the.”

“Imagine if I said that about any other group. It suggests that people who suffer with these conditions are somehow other than us, and can be put in a discrete and often stigmatized category. It creates a sense of otherness that is not the reality, statistically, of these illnesses.”

Any other group? I try a thought experiment, the headline “Equal coverage for the women.” Weird. “New era for the gays.” Offensive. “Crime and the blacks.” I get the point.

The term creates ‘a notion that it’s a uni-modal type of thing.  We need a more inclusive and more granular language.’

Second, Dr. Summergrad said, “there’s the denotation of what mental illness means, but there’s also the connotation. When people ask me, is it really possible that 25 percent of the population is mentally ill, what do they mean by that question?”

“That they think of it as something very extreme?’” I hazarded.

“Exactly, they mean that somebody has a form of very severe psychotic illness. But the reality is, what is a mental disorder? From a clinical standpoint, it means a disorder in various forms of mental functioning: thought, speech, emotion, behavior.”

And those disorders are myriad and mixed and often of general medical origin, with a range of “everything from Autism Spectrum Disorders to Attention Deficit Hyperactivity Disorder, through Obsessive-Compulsive Disorder, anxiety disorders, post-partum depression, recurrent depressive illness, dementing illnesses which have profound effects not only on memory but on behavior. Parkinson’s disease has high rates of very severe anxiety and depression.”

So the term “the mentally ill” creates not just a notion of separateness and otherness, Dr. Summergrad said, but also “a notion that it’s a uni-modal type of thing. And I think we need a more inclusive and more granular language.”

I’d add a third argument against “the mentally ill,” gleaned several years ago when I was writing a Boston Globe story about people who recover enough from their own mental illnesses to become “peer specialists” who help others with similar challenges.

Some newly minted peer specialists sat me down and re-educated me about the wrongness of using “the mentally ill” and the rightness of using “people first” language. A person is not defined by a diagnosis, they said. If you have a mental illness it doesn’t define you any more than your heart disease defines you if you’re a cardiac patient. A person is a person who happens to have depression or schizophrenia; the correct term is “people with mental illness.”

That’s the phrase I’ve used ever since, and I’ve come across “people first” language in other contexts. I once referred to patients as “diabetics” in a story about diabetes, but quickly converted it to “people with diabetes” when a specialist corrected me.

When I was writing recently about obesity and the increasingly widespread concept that it is a chronic disease, it made instant sense to me when advocates told me that I should write “people who have obesity” instead of “the obese” or “obese people.”

Yes, “people first” language is less concise. But a couple of added words seem a small price to pay for according greater dignity to people facing extra challenges.

The Associated Press style guide, which is highly influential in journalism, moved a bit toward “people first” language last year. A summary notes:

The AP’s decision to stop using “illegal immigrant” is part of a larger shift away from labeling people and toward labeling behaviors. For example, the new entry on mental illness says to refer to people “diagnosed with schizophrenia” instead of “schizophrenics.”

Of course, there’s an even bigger problem with “the mentally ill” — the whole use of the term “mental” — but it’s too tough to solve with a couple of words.

Dr. Gene Beresin, executive director of Massachusetts General Hospital’s Clay Center for Young Healthy Minds and a regular CommonHealth contributor:

“‘Mental health,’ in my view, reinforces the mind-body-and-environment split, and that is incorrect. Mental sounds like something ethereal, something out of body. We are creatures with minds, of course, but the illness is not mental, as few understand what consciousness is about.”

Dr. Steven Schlozman, associate director of the Clay Center and also our regular contributor, adds: “I agree with Gene that it accentuates the Cartesian dualism that dogs our field.” [Translation: Descartes saw the mind as non-physical, somehow separate from the brain.]


My beef with the term “mental health” in particular is that it is not well defined.  Is it a euphemism for “psychiatric?”  If so, why do we need a euphemism?  What’s wrong with saying “psychiatric”?  There’s nothing wrong with saying “cardiac”…Once the term has its own status as something different, we decide, without quite acknowledging it, that “mental health” is a euphemism for psychiatric health, and then psychiatric health necessarily becomes something culturally and even ontologically different.

The trouble, Dr. Beresin adds, is that “mental illness” tends to be stigmatized in a way that “medical illness” usually is not. He points out that medical illnesses generally have psychological and environmental components. “For example, high blood pressure is a combination of genetics (biology), stress, obesity, cigarette smoking and numerous other factors. So why don’t we get upset when we hear ‘he has hypertension?’ The same argument should be made for so-called ‘mental illnesses.’ Post-traumatic stress disorder, for example, may be a result of a genetic vulnerability to anxiety, being trapped in a war zone, or being a survivor of a hurricane.”

“Virtually all illnesses have biological, environmental and psychological components. We could say the same for migraines, ulcers, asthma or diabetes. But it does not make one feel uneasy if we say, “He has asthma.’ On the other hand, ‘He has depression or obsessive-compulsive disorder feels so very different. Is that because it is labeled ‘mental?’ Certainly. ‘Mental’ is an arbitrary negative label that segregates something psychic, personal or ‘in the head’ from the body and the environment. It also is very scary.”

Scary? Scarier than heart disease? In a way.

“This is because of the myth that it is not treatable,” Dr. Beresin says. “And that is certainly false. We have as good results as treating hypertension overall (considering medications, diet, exercise and stress reduction measures.) And the biggest horror is ‘losing one’s mind.’ This, I think, is a fate worse than anything short of death. Once we separate mind, body and environment and believe the myth of losing one’s mind, the myth of ‘mental illness has its perpetual fuel.’

To which I would respond: Well, we don’t want to fuel a myth, but where are we left? If psychiatrists themselves say “mental illness” and “mental health” are less than optimal terms, what words are we to use? Readers?

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  • Arnold Walter

    Owning a gun, let alone operating a complicated machine is a skill that even the smartest people cannot even master. I think the mentally ill should not be allowed to carry any sort of weapon.


    Compounding Pharmacy

  • samson

    Mental disorder is
    some thing I that wish never to experience again in my life till I die and if
    if I see any one of the same problem I will do all that I can to help, because
    it some thing you do not wish for.i was down for for 2 years that was what I was
    told by my love ones who never stop looking for a cure to my problem. They said
    they came across a great doctor name DR Alaska who told them to relax that all was going to be okay with me after the
    test and treatment it only took me 7 days for me me normal again. That is why I have took some time out today to say
    thank you. i know you will not hear me
    but the world is hearing me and I know they will help me thank you.if you need
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  • samson

    Mental disorder is
    some thing I that wish never to experience again in my life till I die and if
    if I see any one of the same problem I will do all that I can to help, because
    it some thing you do not wish for.i was down for for 2 years that was what I was
    told by my love ones who never stop looking for a cure to my problem. They said
    they came across a great doctor name DR Alaska who told them to relax that all was going to be okay with me after the
    test and treatment it only took me 7 days for me me normal again. That is why I have took some time out today to say
    thank you. i know you will not hear me
    but the world is hearing me and I know they will help me thank you.if you need
    his help here is his contacts
    dralaskajohn@gmail.com or call him +2348169591194

  • nancy Alfred

    HELLO to my friends out there i am testifying about the good work of a man who help me it has been hell from the day my husband left me i am a woman with two kids my problem stated when the father of my kids travel i never help he was living but as at two weeks i did not set my eye on my husband i try calling but he was not taken my call some week he call me telling me that he has found love some where easy at first i never take to be serous but day after he came to the house to pick his things that was the time i notice that things is going bad i help he will come back but things was going bad day by day i needed to talk to someone about it so i went to his friend but there was no help so i give it up on him month later i met on the the internet a spell caster i never believe on this but i needed my men back so i gave the spell caster my problem at first i never trusted him so i was just doing it for doing sake but after three day my husband called me telling me that he his coming home i still do not believe but as at the six day the father to my kids came to the house asking me to for give him the spell work to said to my self from that day i was happy with my family thanks to the esango priest of (abamieghe)esango priest he his a great man you need to try him you can as well to tell him your problem so that he can be of help to you his content email is this esangopriest@gmail.com indeed you are a priest thank you for making my home a happy home again. remember his email is esangopriest@gmail.com

  • Obama_Lies

    (EYE ROLL)

  • Liz

    As a person with bipolar disorder, the terms “mentally ill” and “mood disorder” have come to bother me more and more. We do not classify most other illnesses by their symptoms, but rather by the area that is malfunctioning. A person with epilepsy isn’t classified as having a seizure disorder. Abnormal mood patterns are simply a symptom of my illness and not the cause. Brain or Neurological Disorder are much more appropriate categories for these conditions.

  • wildflowersmovement


    BODY and MIND (and SPIRIT or SOUL for many) are ONE and SHOULD NOT BE SEPARATED or TALKED about separately.

    LANGUAGE DOES MATTER!!! It forms our culture (written for the person below who said it doesn’t!…pure ignorance… Graciana) LANGUAGE IS THE KEY!

    should be called, “people with health issues”….if someone asks, “what
    kind”, then we can say “a medical condition which affects the brain”
    BECAUSE “mental illness” IS NOT PROVEN! There are NO TESTS, NO LAB WORK,
    NO CT SCANS or MRIs to diagnose a “mental illness”. PERIOD. It could be a hormonal issue, a traumatic event, an abusive event that affects how we feel and think! Is that “illness”?

    Let’s GET WITH IT and GET EDUCATED! Doctors: It’s about time you SPEAK THE TRUTH if you want to keep your CLIENTS.

  • http://www.ocdtalk.wordpress.com/ Janet Singer

    Yes, yes yes!! Great article with lots to think about. I am an advocate for OCD awareness and I cringe when people talk about “obsessive-compulsives.” My son is not an “oc”. He is a person who happens to have OCD.

  • Sylvia Kambouris

    How about calling it what it is- an illness with a name: bipolar, schizophrenia, depression, etc., and dropping the mental in mental illness? Imagine calling someone with heart disease or cancer as having phycial illness. How would anyone ever get diagnosed and receive treatment? Years ago, breast cancer was referred to as ‘diseases of the chest,’ which was a death sentence for many women receiving such an inadequate diagnosis. Today, many people with bipolar or borderline personality disorder,etc., live with these illnesses and endure unbearable and unnecessary suffering for many years before they receive an accurate diganosis. This is the more important issue: diagnosing these illnesses in a timely way so effective treatment can be started. Pyschiatric illnesses can be highly treatable if they are acurately diagnosed, but we are still having a hard time with the words we use. And this translates into the continuation of people being undiagnosed and/or misdiagnosed. Once diagnosed, and with treatment, a person can get their life back. Just like anyone else with an illness, you are a person living with an illness- and the key word is LIVING.

  • Greg Perkins

    This article is very helpful to the current concerns in the media. Many people who have been treated for any form of psychiatric disorders including myself are healthier (by objective criteria) than a large number of people who have would benefit from some form of treatment or therapy (with or without medications) but who have never been diagnosed or sought treatment and who nevertheless consider themselves “normal” and others as “the mentally ill”.

  • Ravi Chandra, M.D.

    “When the right to bear arms includes the unstable”. Just get rid of the words “mentally ill” altogether

  • Susan M Scherer

    terminology – mental health, “the mentally ill” etc – my feeling is that
    “brain health/illness”
    are better terms. They don’t encourage that fuzzy ethereal extra-corporeal impression that mental health/illness suggest. I feel brain illness is something you can get your hands around and do something about, more than you can with something disembodied like “mental”.

  • Stephen Rosenfeld

    This is an excellent article. As President of NAMI Massachusetts, i see the impact every day of insensitive, stigmatizing language. This article helps by promoting a conversation about perceptions of mental illness, and the ways in which language can either reinforce negative perceptions or refute them. To me, the conversation matters more than the words. When we share our stories about our loved ones and their individual struggles, we get behind the words and humanize mental illness. This is how we can replace ignorance with understanding and empathy. Please, let’s keep talking.

  • Solitaire Matthew

    I am a student at Lesley University in Cambridge Massachusetts focused in clinical psychology; after reading this article I understand that the use of terms directed to humans suffering or undergoing a specific illness is now suffering from the idea that someone acknowledges their illness. Awareness of an illness can cause psychosomatic results in the body; I believe that it is a huge part of why people feel that their self esteem is being walked on. No! People suffering from psychiatric illnesses, etc, should be aware of the order of how things happen to work in most societies. People understand better when there is a label connected to something. One should not feel degraded or less of a human because of their diagnosis. What’s the point in accepting yourself and all that is a part of you if you focus only on one part, which happens to be the part that is labeled for the understanding of others?

  • wendilee1956

    This article is a very good look at how people are labeled according to their “character flaws.” Unlike other illnesses such as diabetes or cancer, “the mentally ill” is equated with a defective character. People with diabetes or fighting cancer are considered “survivors,” a much more noble tag. I have been diagnosed with bipolar 2 (or, bipolar lite, as I like to call it) and generalized anxiety. I currently live in a house where my landlord wrote me a letter about how I used my “mental condition” to get my way and even though I had character flaws, if I apologized to him, we can start the new year fresh. I can’t even tell you how that made me feel. Not good is an understatement.When I am more stable, I want to work as an advocate for change in the fight to become more than a stigma to “normal” people. I want to create a tiny house community for those of us with mental illness who are close to homelessness and who are working on their issues. Moving is a big stressor for us and this would provide a stable base for us.

  • Cindi

    Why are alcoholics not mentioned in this New York Times article? The largest majority of murders are perpetrated by persons under the influence of alcohol or drugs. Everyday women are killed by their alcoholic husband/boyfriend/etc. (I was married to an alcoholic with an arsenal of guns). Only the multiple victim murders make the news or papers. Google: “Alcohol and Murder” and see the statistics presented about this REAL problem. If people diagnosed with a mental illness must be cleared to purchase a firearm, why then are alcoholics not required to be cleared for the same reasons? As it has been stated repeatedly, a person with a mental illness or disorder, are more likely to be the recipient of crime, rather that the perpetrator. Many of these people has been bullied, ridiculed, and ostracized throughout their lives. The majority turn their anger inward towards themselves, hence depression (anger turned inward). Very few turn their anger towards society (Columbine, Von Maur in Omaha, Newtown, Aurora, etc.). I believe it is time that the stigma of Mental Illness be eliminated. Mental Illness should be referred to as a Physical Illness, such as: a Neurological Illness or a Brain Illness.

    • Obama_Lies

      With nearly half of Americans now taking some psychiatric drug from an array of things from sleep disorders, pain management, blood pressure, anxiety, and depression, this illusion of Sandy Hook is the ticket that the Progressive New World Order needs to challenge the RIGHTS of Americans to own a firearm. There was no language in the Constitution to prevent us from owning a firearm. But, they will keep pushing and pushing until those rights are taken away, all because they know that removing that 2nd Right is the way they can remove ALL of the Rights! There was no “Adam Lanza”, and there was no 20 kids that got shot that day. The original Social Security Death Index records confirm that they didn’t die, nor existed. The ancestry sites, with SSDI records, have been modified by those pulling the 2nd biggest lie in America.. The 1st largest was 9/11, and those death records from the people that were allegedly on any of the flights can not be located on any SSDI index. Since they screwed that up when the committed the 9/11 fraud, they knew they had to fix that little problem with this new hoax. Just like Todd Beamer, “Let’s Roll” didn’t die nor didn’t show dying within the SSDI records, neither did the Sandy Hoax Kids on the ORIGINAL SSDI records

  • Cindi

    I have no problem with the phrase “Illegal Immigrants”. They are immigrants who are illegally living in our country. Enough said!!

  • Andrea Schaerf

    someone who has used mental health services, people with psychiatric illness

  • J__o__h__n

    Isn’t equating blacks and crime as the example far worse than using “the” before” mentally ill? I’m getting tired of changing terms when the current euphemism goes out of style. “Mentally ill” is accurate and not intrinsically insulting. The stigma is a result of not uncommon instances of behavior not due to a label.

  • Clearnight Sky

    I think that part of the difficulty with the terms “mental illness” and “mental health” has to do with how relatively new the science of the brain is. As the science grows, I hope thar our language about it will become more accurate. Perhaps with the growth of knowledge in brain chemistry, people will be less fearful of brain conditions and will be able to speak about them more matter-of-factly and with less need to make those with brain conditions the “other.”

  • https://twitter.com/Sigrun_ Sigrun Tømmerås

    Let people decide for themselves what they want to be called. The media could use
    various terms. I am a childhood abuse survivor. I don’t consider consequences of severe, repeated trauma to be an illness, but a natural reaction. I prefer the term psychosocial disability instead of the illness model. It’s much less stigmatizing according to stigma research. http://t.co/svbtoSe16S http://t.co/QYm1phZXnp

  • Matt Phillips

    How long a term remains in use is determined by the people who speak the language. If the term remains useful to them, then it will remain in use.
    Mental Illness will remain a useful term until enough people can differentiate and name most different forms of mental illness.
    The main reason that mental illness is stigmatized in a way that physical illness typically is not is that in some significant instances it can lead to unpredictable, costly, destructive, and even violent behavior.
    As long as people with Borderline Personality Disorder and ADHD are called by the same term, the term will have negative connotations.

  • Firma

    Surprised the paper of record for the US still doesn’t know how to appropriately characterize groups of people today. It’s not 1950.

  • gregoryabutler

    How about we stick with the plain English “Mentally Ill” and “Mental Illness” and focus on getting comprehensive free appropriate psychiatric care for all mentally ill people.

  • Louwoo

    The term “mental illness” is about as descriptive as “physical illness.” Would we broadly categorize people with everything from cancer to diabetes as “the physically ill?” It doesn’t really tell anyone anything.

    In the 21st century, we know a lot more about the origins of disease. So someone doesn’t just have “cancer,” he may have prostate cancer or bone cancer. Both might “look” the same to a casual observer — the patient is in pain, losing weight, growing weak. But we no longer call this a “wasting disease” as we might have 200 years ago. Now, we describe a disease by its origin.

    Looking for a single phrase to describe a wide range of diseases is rather lazy. If you put a person with Alzheimer’s disease next to a person with schizophrenia, they may appear to have the same illness: sometimes psychotic, often paranoid, severe memory loss, unable to function independently. Is it the same illness? No. But they have similarities so why can’t we lump them together in one phrase?

    Journalists should not be lazy in their language. If a reporter’s job is to make things clearer, then he or she has to be willing to use more words! If we are talking about insurance companies, then LIST the illnesses that they previously refused to cover. If we are talking about gun purchases, then say there are no restrictions against people who have been treated for psychotic behavior.

    If you want to educate, be specific. All these illnesses now have names.

  • Janice Schacter Lintz

    It is time we stopped viewing people with disabilities as “them” versus “us.” People have no issue with using derogatory words or labels for people with disabilities as the writer so clearly articulates yet similar references would not be acceptable for race, sexual orientation, religion or gender. It is time to shift away from antiquated labels and follow NYS’s “person first” legislation. http://colfax.cortland.edu/nysirrc/articles-handouts/NY%20Person-%20Language%20Law.pdf

    This request has been ignored by the media for far too long. It is highlighted by the lack of media coverage of people with disabilities. The Newseum in DC doesn’t even have a section for people with disabilities yet there is a section for every other civil rights group. Why?

    As President Obama said when he signed, Rosa’s law into effect, people are what you call them and lets start with calling them people…

    Janice Schacter Lintz, chair, Hearing Access Program

  • karen nilsson

    People suffering from imbalance of the mind, is better than mental illness any day. I guarantee you that 75% are imbalanced whether they want to admit it or not. Imbalance of the mind, runs on a scale of such magnitude as does Autism. So using a word like Mental Illness is demeaning.

  • careyg

    Posting for a reader:

    Thanks for the focus on how much words matter. I note though that Summergrad does the same thing, more subtly when he says “people who suffer”, co-opting the lived experience by defining it as suffering.

    I get very out of sorts when I hear the word “suffer.” Suffer is not a medical word; it is a fund-raising word.

    A person can have cancer, experience cancer, cope with cancer, manage cancer, live with cancer, …

    It’s up to that person to characterize what is being felt. It’s otherwise paternalistic and objectifying.

    Absolutely the family and community may suffer because of the fallout from alcohol abuse, addiction, illness …

    “Suffer” is not a synonym for “have.” Some suffer and speak of their situations in that way, some manage, manage well. When benefactors characterize the experience of others, they co-opt that personal experience. Portraying others as suffering, as helpless, as victims portrays people as needy and dependant which facilitates the agenda of the benefactor to intervene. When a benefactor speaks of the suffering of others, the very language creates a power imbalance, a power-over context that facilitates in the psychiatric disability arena, the agenda of the mentally well.

    Sylvia Caras

    Santa Cruz, CA

  • Carmen Render

    To some extent I don’t think the words matter, it is our attitudes towards the the mind and illnesses or disorders of the mind that matters. Societal views suggest that to suffer from a disorder of the mind that an individual is weak and lacks self control. These attitudes are Centuries-old and can be found in literature; for example, Ophelia in Shakepeare’s Hamlet, and even Hamlet, who was very likely suffereing from an adjustment disorder and/or depression. But, I digress…I don’t think it matters what we calll “it’ if the attitudes persist, we will shift our negative perception and/or attitude to the new word. We have to change our perception.

    • Paul Hoogeveen

      Our cultural attitude absolutely must change. I think the argument here is that shifting language is a means of shifting that attitude.

  • Jessica

    It is hard to put all the disorders and diseases, relating to/affecting the mind, into one category. It seems that mental illness is the category that this article and many people want to use to gather all of them up into. I think this is a mistake. I don’t think the question should be about finding a term to generalize all mental illnesses, disorders, and diseases. I think there should be specifics. If someone wants to write a persuasive article, for example, not allowing people with “mental illness” to bear arms, the author should be specific to which group of people he/she is referring to. Is it people with cognitive impairments who test lower than the 68th percentile? Is it people who have schizophrenia? Or, is it the group of people who have ADHD? All of these so called “mental illnesses” are all very different from one another. See what I mean? The problem is a little larger than the label.

  • vito33

    I sure hope all the principals in this story aren’t devoting too much time to arguing about semantics. Calling something by a different name doesn’t solve the problem, and solving the problems posed by psychiatric illness is where I want them spending their time.
    Remember George Carlin’s bit? “First we called it ‘Shell Shock’ but that was too harsh for some folks, so we changed it to ‘Combat Fatigue’, and that was still disturbing, so now we have ‘Post Traumatic Stress Disorder’.” There’s no visceral component to ‘Post Traumatic Stress Disorder’, and in minimizing that visceral component, we accidentally minimize the problem itself.
    Ask me, someone who has this condition what it FEELS like, and the best descriptor out of the bunch is ‘Shell Shock’. Trust me, that’s what it feels like. You can call it ‘Fuzzy Kittens By The Fireplace’ if you want, but it’s really still ‘Shell Shock’, and it’s a full-body experience.
    Anyway, I guess we’re going to have to have this discussion because our society is obsessed with finding more palatable names for things, but let’s not take our eyes off the prize – solving the problems.
    (I’m going to bed now, and hopefully by the time I wake up, my Roving Perambulatory Media Concierge [paper boy] will have dropped off the Sunday Times.)

  • Scot Conway

    I think the basic idea mental illness conjures in much of the population is the idea that the behavior of those with a mental illness may not appear to be rationally related to the known external stimuli, and attempting to communicate or reason with someone with a mental illness may or may not produce results that might seem logically connected to the communication attempt. I think that’s why it scares people. They feel that they “just don’t know what such a person might do and what anyone could do about it.”

    Ultimately, all a mental illness does is impact the frame of reference from which and the mental filters through which an individual views the world around them. Other than it might diagnostically be “on an outer edge of the bell curve” for what we think of as “normal,” once you understand the frame of reference and the filters, mental illnesses make as much sense as any other emotional, cultural, philosophical, or theological outlook, in my humble opinion.

    But I do admit that in matter such as gun ownership, I might be a bit more concerned about a firearm in the hands of someone with an impulse control issue or a connection to factual-reality issue – though that certainly does not require a mental illness for it to be true.

  • stilettov

    To me a mental disorder is only a disorder when it acts as a disorder, and creates internal or external chaos that can be perceived by oneself or others. In times of mental clarity (going on three years now) I like to use the term “atypical brain chemistry” to refer to my bipolar disorder. I moved from the United States to my birth country Canada a few years ago in order to be able to get and stay on medication, and stay out of mental institutions, and those subsidized harm reduction precautions have made worlds of difference. A person, not knowing me, might remark on my slightly intense personality, but would not know I had a clinical diagnosis or a history of hospitalization unless I disclosed that information. I believe in being open at the risk of encouraging a paradigm that will misrepresent me in the eyes of the person I’m making myself vulnerable to, and while it’s an unfair price to pay for refusing to internalize stigma, I refuse to allow people to comfortable buy into the systemic ignorance surrounding psychiatric disorders.

  • bbdrvr

    Well said, but there *is* at least one other group that regularly receives the same semantic treatment: “the” elderly.

    • Paul Hoogeveen

      And elderly people, too, are culturally viewed with a somewhat of a sense of “otherness.”

  • Thomas Zeller

    You used a non people phrase in your article. The term PTSD is on the way out and being replaced with PTSI with the “I” being for injury rather than the “D” of disorder. People have suffered an injury by what’s happened to them. They did not suddenly or genetically develop a disorder so why use the term? PTSI is the proper phrase to use now.

    • Sean Karlin

      ‘Disorder’ opens the term up to a broader definition. ‘Injury’ implies just that, and it may not always be the case. ‘Injury’ also implies ‘victim’ which may not be the case as well.

      • Thomas Zeller

        You’ll find though that PTSD is being dropped. Being a “broader definition” is actually part of the problem. When people are said to have a “disorder” it implies something far worse than “victim”. And I disagree with your comment that injury = victim to begin with. If I fall and break my leg I am not a “victim” nor would anybody ever think so. They would think of it as an injury. Injury is also much more accurate. The experience you had has injured you. Your lasting suffering is a post traumatic stress injury. Frankly, when you tell people you have PTSD these days unless they’re somebody close to you most will think you’re either seriously “mentally ill” or simply a crybaby faker. Trust me. I’ve been diagnosed with it and I’ve seen the reactions. And frankly, speaking as a soldier it’s one of the leading causes of the high suicide rate among our veterans. Not that they have PTSI but how people treat them once they learn they have “PTSD”. Lets destigmatize the suffering and do all we can to help our veterans and other people who suffer this problem. Stating that you have an injury and not a disorder accomplishes that. But if you don’t want to trust me then go out and do some research on the matter. You’ll find the term PTSI is rapidly replacing PTSD.

        • Sean Karlin

          Interesting. As a veteran myself from the Israeli military, we still popularly call PTSD by a term that is equivalent to “Shell Shock”, which is not of course how the medical community would refer to it. But because the military is a shared experience by almost all Israelis it does not have the same social ramifications that I imagine a returning soldier would have in American culture, both because the wars are fought so far away and because the percentage of the population that goes to the military is minuscule making that experience much less a part of the culture. But whatever you call it, as the general population learns the new term and reorients their perceptions to it, you will again have to change the name. The problem is not just what it is called but what it actually is and how that affects the subject.

          • Thomas Zeller

            While I agree about the differences between an Israeli military experience and a US military one I still disagree with you’re seeing this as merely a “term”. You ignored completely my valid points of how the word “disorder” and “injury” connote very different perceptions by the general public. There simply is no way anyone could equate “injury” to “disorder” or vice versa. So, no, people would not “reorient” and decide that somehow somebody who’s injured means the same to them as someone with a disorder. You come from a very different culture where military service and the life of the nation are a daily up close event. You said yourself that America’s experiences are far away and what you may not know is that less than 2% of Americans serve in the military. What I am talking about is a very simple means to destigmatize people who are already very much removed from society. I care about my brothers and sisters who are killing themselves at the rate of 22 a day and all you care about is semantics.

          • Sean Karlin

            Actually I think the semantics are irrelevant, while the level of care should be the issue, whether the patient is from the military or not. To quote Shakespeare; “What is in a name? That which we call a rose by any other name would smell as sweet?”

          • Thomas Zeller

            Well thanks for finally agreeing with me because that was entirely what I was saying. Describing it as an injury rather than a disorder accomplishes exactly that – it increases the level of care. People are no longer saddled with a stigma that only complicates treatment. Instead they are given a much more hopeful prognosis. An injury can be overcome. There is far less hope that a disorder ever would be. As for Shakespeare, if that’s your reference for quality care then I can see why you’ve been so confused.

  • nnyl

    I volunteer with a mental health charity; some in my group prefer to call mental illness “biological brain disorder.”

  • Guest


  • Seth Bourque

    This is ridiculous. If we’re going to persistently rename every condition because of the stigma of the name, then it’s a problem with perceptions, not names. Spend your time educating, not wasting it in a campaign to rename things.

    • disqus_gri1eC8UxO

      Yeah; I’m all for using less abrasive language, but that only applies if the language is harmful to begin with. I especially didn’t understand the distinction between “obese people” and “people who have obesity.” Just because obese is used as an adjective doesn’t make it the single, defining quality of the person, it just happens to be one way of many to describe him or her. Any stigma attached to this is the fault of the people who perceive them, just like you said, not with the words themselves.

      • Paul Hoogeveen

        So if you personally don’t feel the effects of stigma-perpetuating language, that language must not contribute to perpetuating the stigma?

  • upsideout


  • Heroic Hal

    In casting the spotlight on the use of the word “the”, the author has failed to observe the significance of the difference between singular collective nouns and plural nouns. We absolutely do speak of the rich, the poor, the bereaved, the downtrodden. Despite his observations about “the gays” and “the blacks”, there is nothing to criticize about “We should treat all people equally: the white and the black, the male and the female, the straight and the gay, the rich and the poor, the educated and the unschooled, the healthy and the sick, the young and the elderly.” This is normal, neutral English usage.

    • DRF

      I concur. By using the word “the” as the first argument, Goldberg makes the subsequent articles look trivial. This article is poorly organized.

    • nn180

      Yes, thank you. That was so glaringly fallacious, I could hardly finish the article.

  • FourQ

    Just call them Nuts or Crazy and be done with it.

  • OakenTruncheon

    Have we learned nothing of the arrogance of wonks?

  • Positively.Sue

    Great article!! Might I suggest, whatever the crime is, it’s committed by a PERSON, and should be reported simply as such. I truly feel that including a Psychiatric diagnosis in reporting does more harm than good. People are less likely to seek help if they fear being labeled, ostracized, etc. Leave the an Illness out.. It’s Time for a Change… Media Sensationalism of Mental Illness needs to stop.

  • Alison Rice

    I have been diagnosed with schizoaffective disorder, and have been thinking about this a lot. That long of an explanation is kind of a mouthful. This law has interested me because of that, though I have always been anti-gun myself, even prior to the onset of my illness. “Mentally Defective” is used in the legislation. I was unclear as to whether this was a legal term having to do with being declared mentally incompetent in a court of law, or merely having been committed to a mental institution by psychiatric professionals, or both. I don’t know whether this is case specific. I would think that the new term in the headlines should be specific to that, to better explain how these laws work. I would be comfortable with the term “psychiatrically unfit,” myself.

    • DRF

      Oooh! Psychiatrically unfit sounds usable!

  • Bradly Harmelink

    I don’t quite know what to say. I have been diagnosed with bipolar for years, and I do think that using the term, “mentally ill” carries with it a strong idea that there is something really wrong or even dangerous about me. Especially since I have been hospitalized for psychiatric reasons. I am pleased with the exposure this article brings to the subject. We need more people, possibly the peers you talked about to step up and voice our opinions to stop improper labels of our diagnosis and the way they lump us into an inaccurate category.

  • Alex Gillinson

    “the physically aggressive” would be a better way to categorize offenders.

  • seeenn

    How about “people with neurological disorders?” It’s less stigmatizing than “psychiatric” and it’s accurate, since psychiatric disorders are usually based on biochemical imbalances and/or brain injuries.

  • mkegal

    Unless I’m referring to a specific disease, I usually say “brain disease”, because that’s what they are.
    When talking about something specific, I use the name of the disease.
    And I see nothing wrong with saying “he’s a schizophrenic” – he is a person and he has the disease schizophrenia.

  • JoyAndPeaceForAll

    The house is in disorder. Everyone who lives in it or near needs to roll up their sleeves and help make order. Then the disorder is turned into order.

  • jpo321

    So why didn’t the AP use “People here by illegal means?” That’s “people first.”
    Political correctness. Make me feel good about myself or else.

  • Don Straitiff

    I suffer from anxiety and depression and fall into the category of mentally ill. I don’t see what’s wrong with calling us the mentally ill. The mentally ill are a definable group of people so a definite article would be correct. Calling us “the mentally ill” is kind of like me calling my neighbors “the people down the street.”

  • wanderingi

    Not to change the focus, but to add another insensitive category: “…he’s a quadriplegic” when in fact, “he copes with (lives with, suffers from, etc.) quadriplegia.”
    We have begun to separate physical disabilities somewhat. We no longer lump them all into the stigma of “the crippled.”

    • bbenmous

      People suffer from disorders, but disorders do not define people.

  • Priscilla Ballou

    “The Mentally Ill” doesn’t bother me nearly as much as having to see my psychiatrist in a department labeled, “Behavioral Health.” I am not badly behaved! I have a mental illness.

    • BOH1066

      that made me lol. as someone suffering from MDD, exacerbated by ADHD (or vice versa….the whole chicken or egg argument), i couldn’t agree more. the term behavioral health has always made me shake my head, cringe and chuckle simultaneously…..it’s just ridiculous.

  • Mel

    The problem begins at the top. The people who are making the decisions and developing policies more often than not, don’t have any actual working knowledge of the subject matter with which they are charged with over seeing. For instance, you have a government council on education….that includes no teachers. You also have a government council on energy….with no engineers. These councils are full of academics. Their personal opinions and book learning guides their decisions, not their experiences. I suffer from ADHD, anxiety and depression….all disorders that would be considered “mental illnesses”. I feel it’s important to note, strictly in my opinion, that while there could be a better word usage, it is an illness associated with the brain. The way in which that phrase is used in could come across as being a positive or negative connotation. Unfortunately, thanks to the media, it has been portrayed as negative because of their usage of this phrase. As someone else said, why not further educate people, including policy makers, so they see and understand that it is beatable and people can over come it. I am a special education teacher, own my house and just recently purchased a truck (a dream of mine for years). Do I still have my bad days? Of course, but even people who don’t have this diagnosis go through those as well……including those that have committed horrible acts of crime.

    Through the schools, students can be identified as being emotionally impaired, cognitively impaired, otherwise health impaired and so on. These have since replaced words such as mentally retarded, physically disabled, mentally disabled, educably mentally impaired, etc. In the end, people who suffer from these, whatever you want to call them, have choices. They can choose to let the label control them and their life and be the victims or they can be proactive and let their voices be heard that this isn’t a lifelong debilitating illness and you can be successful and lead a happy life.

  • Vickie Mariano

    Most “mental illnesses” are neurotransmitter disorders. That is a better discriptor since most people don’t even know what it is.

  • Dinah
  • http://www.wander-argentina.com ande

    It’s about economy of words for writers though. Keeping on top of all the PC terms is a bit exhausting, especially if English isn’t the language you use day-to-day. For instance we aren’t suppose to write ‘mentally retarded’ any more but it is a medical term used in textbooks.

    Sometime the terms are rather nebulous these days too, ‘special needs’ ‘special capacities’, it makes it difficult to determine exactly what population one is talking about sometimes.

    Here in South America the PC thing hasn’t caught on, if you’re fat you get called fatty, if you’re Asian you just get called ‘Chino’ and even if you’re from the southern US you get called ‘Yankee’.

    • Dan Loewy

      Usually just “Gringo”

      • http://www.wander-argentina.com ande

        Have you been to Argentina? Gringo is used but any American and sometimes even Canadians get called Yankee. Not PC at all.

        • Dan Loewy

          I’ve never been to Argentina but I lived in Chile where anyone who is light skinned with a European complexion is called a Gringo/a. Even Chileans with light skin are called by that term (affectionately).

          No, neither term is politically correct but when they are not used pejoratively in an isolated population, then it is forgivable.

        • Dan Loewy

          I replied before but my comment disappeared so forgive me if this is a duplicate. I haven’t been to Argentina although I’d love to. I lived in Chile and they call everyone with a light skin tone “Gringo”, even other Chileans. It’s not PC but since there was no malice intended in calling me gringo, it was easy to forgive.

  • sun

    There is a huge difference between mental illness and other illnesses and you can thank the mental health system for that. i have lived with depression and panic attacks for 20 years. about two years ago i had a panic attack in my psychiatrists office and he got mad and told me to come back when i could think and speak logically. i was still, quiet and crying and he was very unhappy of me showing symptoms. this is not unusual behavior for a psychiatrist.
    if i feel a stigma at all it is because of the mental health system and my family. i am treated as broken. i am treated as someone who purposefully screwed up her life.
    and what happens when i go to my psychiatrist and therapist on a regular basis? i am accused, by friends and family, of “having issues”. this is hurtful and totally false. because i seek help and because i want to be as healthy as i can i probably have healthier coping mechanisms, i am more self aware of my actions and emotions and i have learned to handle things more logically. i don’t have issues-i fix my issues.

    i don’t think the removal of the word “the” will fix anything. it is insulting, but do you really expect the media to handle the subject of mental illness sympathetically?

  • Nancy

    When my two children were diagnosed “mentally ill” I was up front about it. I felt from the beginning they were just young adults with something that needed care and dealing with.
    I didn’t ask or care what family thought about it.
    I tried to educate myself.
    The results? My son is doing well and my daughter was not so fortunate.

  • Alex

    Wow… Really? “People who have obesity?”
    Is obesity an incurable disease now? It’s not something you can have, it’s something you can be. And yes I understand that there are people with legitimate medical problems that make them more inclined to be overweight… But even that can be controlled with diet and exercise. So… are we going to start saying “people who have skinnyness?” This expectation for political correctness is seriously getting out of hand. Suck it up and eat a salad for goodness sake.

  • Zell

    “If psychiatrists themselves say ‘mental illness’ and ‘mental health’ are less than optimal terms, what words are we to use?”

    Maybe you could refrain from talking about everyone who is Bipolar, Depressed, Schizophrenic, OCD, or suffering any one or more of the conditions mentioned in a near-thousand page book, in the same sentence. It’s hubris. Write about those who act with such hubris appropriately.

  • AlicePalace

    How about CMED: Cognitive, Mental & Emotional Disorders. Then we could say, those who suffer from CMEDs, or CMED sufferers, similar to “those with pulmonary diseases” and such. Yes? No?

  • Tracy Shields

    Thanks for this. I write a health blog and have used (dare I say it) the term Diabetics and “the obese” many times. I’ll know to be a bit more senstive.

  • Bryan J. Maloney

    Follow the money. Insurers routinely refuse care for “mental illness” and the law allows it.

  • DRF

    My first reaction to this article: “…you have a problem with the word ‘the’?”

    The word “the” is a definite article, not a concrete bunker. Starting this article with complaints about one of the most neutral words in the English language, a word that refers to specificity rather than having a meaning of its own, makes it look like your other complaints are made up. The argument, “Hey, it sounds funny if you change this, that and that” could be made about almost anything. (If you say “Native Americans” backwards as “American Natives,” then it sounds funny.)

    In general, you need to support your claims in more concrete terms. Here’s an example.

    The claim: “The mentally ill” is an umbrella term that suggests that certain groups of people have more in common with each other than they really do. As the bipolar, depressed and other individuals who have also commented here have shown, people called mentally ill can differ from each other substantially, as much as they differ from people outside the term, in most of the respects that can be considered society’s business (what services or support they need, whether they’re a danger to others, etc.).

    Now let me show you how this is a real rather than an imaginary problem: A school district in PA or NJ has been putting autistic children into classroom situations designed for children with Down’s syndrome. These kids have almost completely different needs, but they’re all “mentally ill,” so they’ve been lumped together.

    It’s too easy to dismiss this article as someone raving about a pet peeve. Show me more. Tell me more. Find real-world examples.

    • Dan Loewy

      If true, and I don’t doubt it, the school district should have done a better job identifying the different needs of the students and placing them in classes based on those needs. Without knowing more specifics, it sounds like budgetary restrictions and the lack of a qualified psychological professional analyzing these children on a case-by-case basis was probably what caused the problem. Would using a different umbrella term for those suffering from mental illnesses have changed what happened? They still would have needed someone qualified to make the judgement of which class to place the children in based on whether they were autistic or had Down’s syndrome, or any other learning disability. It is complex and an umbrella term is, by definition, general.

      • DRF

        A different umbrella term, or no umbrella term at all, would have made what they were doing more obvious and therefore harder to justify to the parents and taxpayers. They would have seen that it would be harder to get away with it and therefore would have been less likely to attempt it.

        • Dan Loewy

          No matter what umbrella term is used, it will necessarily refer to all people who suffer from mental illnesses; the dangerous and the benign. Softening or otherwise altering the language will not change how people view mental illness in general.

          If divergent umbrella terms were used, how would it effectively differentiate the mental illnesses? Dangerous and non-dangerous? I think that would further stigmatize people with mental illnesses. Also, it would leave a vacuum for a yet-more general umbrella term for all mentally ill people.

          • DRF

            So here’s a thought: Don’t use an umbrella term. If you think about it, the headline didn’t need to refer to everyone who’s mentally ill (and the real problem is that it did). It only needed to refer to people who were prone to violence.

            The main purpose of my original post is to show that this article is badly written and to point out how Goldberg is discrediting his or her own arguments.

          • Dan Loewy

            Regarding the article, I agree with you that the argument against using “the mentally ill” is weakly formed.

            You used an example of a school where you claimed the umbrella term “the mentally ill” contributed to the improper classification of students with autism and Down’s syndrome being placed into a single classroom. Instead, you propose, they ought to use a different umbrella term or no umbrella term at all.

            To that point, there cannot be no umbrella term, but perhaps the umbrella term “the mentally ill” could fall out of favor by those tasked with making decisions where the distinctions between the mental illnesses is important in their process.

            However, in general parlance, which is used by most of the parents at that school and most taxpayers, the umbrella term will necessarily persist because the issues that fall under it are complex, and most people are not qualified enough and/or don’t have enough time to know the current state of all those distinctions. Myself included.

            Now, I’m sick of writing umbrella term so maybe we can agree that the article leaves too many issues unaddressed and lacks persuasive arguments.

    • HaroldAMaio

      Among the most powerful words in any language is the word “the.” Small does not mean without power.

      • DRF

        I didn’t say anything about “the” being small. I said that complaining about it makes it sound like everything in this article is made up, which it does. “The” is the small complaint, the “oh yes, and also this” complaint that should be mentioned after the reader has already been convinced that there is a real problem. Some collective nouns are used with “the” and some are not. Leading with “oh you shouldn’t use THE with this word” makes Goldberg look like a whiner who is imagining problems and making trouble. It overshadows the less frivolous arguments that were made later.

        • HaroldAMaio

          “The” is a small word, three letters. Small words can have great impact. There are other small words, one and two letters that have great impact as well.

          There is nothing “small” about small words.

          • DRF

            Well other than literally being small, but you do know that I didn’t say that there was, right? I said that the use of “the” is a small complaint, a minor matter that should have been used as to accentuate and illustrate the other complaints rather than set up to overshadow them.

          • HaroldAMaio

            Very often it is the small word “the” that leads to greater and greater discrimination. More often it is employed simply. The distinction is important.
            What followed here from “the” Blacks illustrates how far “the” can lead.

          • DRF

            Okay, we clearly differ on whether “the” is a big deal. Here’s a question for you: Is it the biggest issue that Goldberg brings up (and therefore deserving of its position in the lead)? Do you think that “the” is a MORE important issue than 1. false unimodality 2. perpetuation of the mind-body dichotomy, or 3. its status as an “arbitrarily negative label,” which were Goldberg’s other points? These things are all closer to convincing than the “the” issue is, but Goldberg put them last.

          • HaroldAMaio

            First, if I may, she fostered considerable conversation. Her article elicited many points of view.

            Which of the above do I put first? The need to label, to create an us and a them. That clouds all we do. Whatever we name it, or however we describe it, in the end it comes down to dividing. We employ all kinds of descriptors to divide. Is that a human need?
            I write a great deal on the net, and almost always it is to address language that divides. Sometimes wittingly so and sometimes (most often) not.
            Language becomes habit, we repeat much of it out of habit.

          • DRF

            From my perspective, ALL of the points made by Goldberg are about the label. The entire article is about the label. I must ask you to be more specific. Which of the four points that Goldberg made do you think is the most important? Which of those four arguments is the most convincing and therefore deserved to be in the lead?

            As for the need to create labels at all, that’s a good thing. That’s how language works. The issue is to come up with accurate labels.

  • Dan Loewy

    First, who are these specialists? Don’t you mean “people with specializations”? You need to use “people first” language. Pardon me, I’m not a “reader” but rather a “person who is reading”. (Sarcasm over.)

    2. Consider these two headlines:
    Advanced Reading and (the) Visually Impaired
    Programming for (the) Technically Gifted

    Now reread the above headlines without “the” in them. Remove the “the” and you have titles left ambiguously incomplete. The article is necessary when using an adverbial clause; no exceptions.

    How about instead of replacing “the mentally ill” with a new term to describe those who fall under the umbrella of mental illness, we instead focus on educating the populace that the definition is indeed an umbrella term for all mental afflictions large and small?

    There are already specific terms for the variety of mental illnesses that the great majority of society will never know, and it is wrong to ascribe one illness as serious and another as not serious based on public perception of that illness. For example, there is an autistic spectrum. Not all of those people who are autistic are dysfunctional. There is similarly, at least for the sake of argument, a continuum of severity of depression. Not all people who suffer from depression are gloomy and nihilistic, as popular culture would lead some to believe.

    Would you rather be mildly autistic (Asperger’s) or prone to severe depression? See, ascribing severity to mental illness is very subjective. All people who are not trained in the psychological disciplines , and many who are, are unable to objectively distinguish the severity of an affliction in one category from one in another category, as they affect their respective sufferers. This lack of an objective hierarchy for the classification of severity of mental disorders means that no matter which umbrella term we ultimately use to classify everyone who falls under that blanket, it will be necessarily vague and open to interpretation.

    Which brings me back to my original suggestion; that we focus on educating people about the complexity of mental health and its constantly growing and evolving nature. Yes, it is too bad that many people assume “the mentally ill” primarily consists of people with severe psychotic disorders. However, It is not because of the inappropriateness of the term itself.

    • tuxb

      Wow… the grammar, the reasoned logic… There is nothing about your post I do not like.

      Not being sarcastic here.

    • DRF

      I think the problem could be solved by using a more specific term. “Mentally ill” includes people with depression and non-violent schizophrenia as well as people like the Newtown shooter, but I agree with most of what you’ve said.

      • Dan Loewy

        I agree that a distinction in the popular lexicon between the two examples you use would be beneficial. However, I wonder how realistic it is to believe that such a relatively complex distinction could become popularly understood and employed, given the blurred lines between the various mental illnesses.

  • Ellie

    When a friends son recently committed suicide after battling bipolar disorder for years, my friend was concerned with how I would break the news of his death to my own 10 year old son. I told my friend that I would tell my son that he died of a terrible brain disease. My friend had a sudden look of relief and said “yes, it was a brain disease wasn’t it”. It was as if a weight had lifted her knowing he had died of a disease.

  • Cindi Cody

    I am a 55 yr old female (1st x commenting) who recently called 911 due to chest pains, I had history summary from my PCP & gave it to the paramedics when they arrived.I will admit I have a extensive list of medical problems, take a lot of meds & have many med. allergies/adverse reactions. As one person started taking my vitals he asked the other about my medical history the person with my paper work said “oh yes extensive history” of what the other one asked “well takes a lot of meds.& has Bi-Polar Disorder” well, what about cardiac history/meds, “well no but she also has OCD & a lot of med. allergies”, allergies to cardiac meds, “no, but she does have chronic pain syndrome & it looks like she takes meds for that as well”, well is the chronic pain cardiac related “no don’t think so”. Here I was alone worried I was having a heart attack while some med. professional was tearing apart my life to find some way to discount my complaints because I have a mental illness. He repeated the same info. to 2 other people that came to help. After they transported me to the hospital & he was giving my history to the nurses I stopped him about half way thru and said that I did not call 911 because I have Bi-Polar Disorder or OCD & was sorry about my meds. & allergies but please tell them about my complaints of chest pains, etc. because right now my brain is fine & I have been stable on same 2 meds for years & really don’t appreciate your first snap judgement of me being a “crazy” person who should probably just be ignored. His come back was that I had no idea the kinds of people they deal with & they have to think of their own safety too, lol. I told him that he had NO idea what I have to deal with everyday of my life & the ignorant people like him only fuel the stereotype, I was not in the kitchen with a butcher knife as is usually the case when story is written by media about some one with a mental illness. Stop the Stigma ~ whatever name is used, medical model, person first, we are all trying to do the best we can, get the best treatment that we can & be accepted members of society. Thank you, sorry for such a long story & yes I’m good bad case of acid reflux> And the nurse at ER applauded my standing up for myself and apologized for the paramedics attitude I said no problem just pass on my message that we are people too :-)

  • John Kelleher

    “the correct term is “people with mental illness.””

    much better considering its still a means of scapegoating. One
    delusional neurotic called a psychiatrist labeling another neurotic as
    defective for not having the same delusions. Till we address the
    delusion that is our society we’re all fucked.

    • tuxb

      You started out sounding pretty sane there, but man, you went all hopeless doomsday pretty fast.

      • John Kelleher

        The most popular delusion is that we live in a civilized society. We don’t and those who realize it are often labelled “mentally ill”. Those who come in direct conflict with it are labelled “severely mentally ill” because society has broken them and they can no longer face reality.

        • tuxb

          Just out of curiosity, have you checked into a mental hospital lately?

          Or should I expect to see you on the news soon?

          • John Kelleher

            I take it you can’t argue like a rational person. Don’t worry I won’t tell the authorities. ;-)

        • DRF

          So what you’re saying is that people who live by a different code of conduct than the one used in Western civilization are labelled mentally ill? On the TV show Bones, one guy was on trial for murder because he’d killed a corrupt congressman who’d threatened his family. A psychiatrist said, “This man isn’t crazy. He killed for a specific reason. In the old west, his actions would have been considered normal.” That’s what it sounds like you’re talking about.

          The headline that this article uses as an example refers to the Newtown shooter who killed his mother and several children at the school where she had worked. Those children posed no threat to him. What logical process do you think he was following? He wasn’t trying to get food or trying to rise in a hierarchy or trying to defend himself.

          No, there really are people who cannot process reality accurately. These people are mentally ill. Even if a few people who are sane but not working on the same level as the rest of us get misdiagnosed as ill when they’re not, mental illness does exist.

          • John Kelleher

            First, most people labeled “mentally ill” are no different than you and no more of a threat either. Second, we have a justice system for those that break the rules of conduct. Third, reality is a mushy thing and most people live in a dissociative state of denial. The statistical norm is pretty damn crazy. Last, everyone is capable of murder and those with the highest body count do it in the name of society and are the same people seeking to deny the “mentally ill” their inalienable rights.

            We are all just a slip of a tongue away from being labeled “mentally ill”. When you realize that, you will be a little closer to reality and a little less in denial.

          • DRF

            But you seem to be saying that there’s no difference between someone who kills for a logical but socially unacceptable reason (revenge, jealousy, pre-emptive self-protection) and people who kill because they are not capable of processing what is happening around them (delusion, imagined threat, belief that victim is one of the Knights Templar). That is not true.

            Now, HAS society locked healthy people up in mental institutions as an excuse to shut them up and discredit them? Yes. But that doesn’t mean that there are no real mental illnesses.

    • J__o__h__n

      I don’t see how adding the annoyingly lengthy “people with” before any terms substantively changes anything other than being the enemy of concise language.

  • truthy

    This is beyond Crazy. Mentally Ill people are Mentally Ill people. It is not a slur. Next we will not to be able to say people are “sick” they will be “health challenged” – until that is deemed offensive by some nut job.

    • HaroldAMaio

      Mentally Ill people are Mentally Ill people

      I have an illness, I am not it. I am a husband, father, brother, uncle, friend, retired German teacher, writer, editor, many things.

    • RD81

      The problem is that people tend to take the phrase “the mentally ill” and use it to mean “crazy” or “nut jobs”.

  • tuxb

    So… if mental health and physical health are meant to be treated equally, how many people shoot up a crowded area because they suffer a cardiac illness?

    • DRF

      True, but perhaps a contagious illness would be a better example. Someone with antibiotic-resistant TB would be more comparable to someone with a violent mental illness.

  • tuxb

    Should we also stop referring to people as “the unemployed”? Wouldn’t “people who suffer from joblessness” be more dignified?

  • Val Resh

    We need to stop psychopathologizing everything into a psychiatric disorder. Given the new DSM there is a disorder for everything.
    Please understand that there is a person behind the label. No two ‘schizophrenics’ are alike because no two people are alike.
    We have been stigmatised by society and even certain practitioners or caregivers for a very long time. If as society we are still having the same discussions over centuries without much change than there certainly is something wrong in the approaches we are making or believing that one size fits all.
    I am a person with paranoid schizophrenia and a range of other labels.
    I haven’t killed a person or hurt a fly.
    I live without medications and have a very fulfilling life now.
    When a group of doctors said they encourage their patients to talk to their voices they call it a discovery. When I said let me talk to my voices they called me crazy. – Reshma Valliappan
    I have one term for all of this ‘Constructed Madness’

  • Paula

    Stigma is an overused and ineffective way to characterize what people who have been diagnosed with mental health disorders have been treated. We are discriminated against, marginalized and victimized. Throw out ‘stigma’ and replace it with what it is- discrimination.

  • nobody

    As someone who has a mental illness(I have bipolar)… how about “People who have a mental illness”?

  • Jonathan Goldin

    In the song “Gee, Officer Krupke” from West Side Story, how to label “juvenile delinquency” as either a mental condition “so take him to a headshrinker” or a “social disease” so “take him to a Social Worker”–a humorous take on this dilemma.
    Part of the responsibility for lack of clarity lies within our profession especially the fragmented and antiquated delivery system for mental health services. The prevalence of individual treatment by one isolated provider and the overriding emphasis on confidentiality even at thr expense of other important values, leaves the general public in the dark about what psychiatry and psychotherapy is and what it does or does not do.
    Worse it can leave patients/ clients isolated and dependent.
    The communications media can help clear these cobwebs by de-mystifying terminology and methods, but the most effective antidote is as usual, “coming out of the closet” or “off the coach” as the case may be.
    In short, we’re really talking about “problems in living” as humanistic psychology pioneer Rollo May termed it.
    So yes, I too have “problems in living”, and I’m also a psychotherapist.
    Jonathan Goldin, LICSW

    • http://askanaspergirl.wordpress.com/ Kat Murry

      You know, that’s a good point — “problems in living” is an interesting descriptor. I have GAD and coming out seems to bring others with anxiety spectrum conditions out of the proverbial closet as well.

      Although I have an entire discussion about self-disclosure / outing oneself as a person with a mental health condition – “right place, right time, right person” considerations.

  • aaron

    As it happens in governings, we show-in an effort to justify our lack of humility (who can and can’t do what)-our pettiness.

  • Jocelyn Sequoia Perrin

    How about, “people with a psychiatric diagnosis”? Just use medical terms, and people will continue to understand that these conditions are medically treated.

  • http://carsnbars.tumblr.com/ joaniered

    Why is our head considered as a separate body part say versus our heart. A “mentally I’ll” person has a head disorder but I suspect that even the term “head disorder” would sound freakish. We all suffer from mental/head/brain imbalances at some time in our life, so coming up with an acceptable term which makes our head and brain like any other bodily organ is very important and inclusive to a whole health outlook.

  • Amy Blankenship

    We refer to “the poor” all the time. Maybe that’s why so many purple think they’ll never fall in thatgroup.

    • TacticalDiversion

      I certainly don’t want to be one “the purple”.

  • Bonnie Russell

    I totally agree that we should be encouraged to put ‘the person’ first. It is heartbreaking to be, or witness someone you love, be characterized by an affliction. My husband is plagued by a lower intestinal disorder. To be included in a faceless group referred to as ‘the flatulent’ is dehumanizing at best. The derivative appellations of ‘Gas Bag’, ‘Poop Popper’, ‘Winnie the Pooh’, ‘Blow Hard’, ‘Ripper’, ‘Cheese Cutter’ are thought to be terms of affectionate humor, but it is heartbreaking when others refuse to share an elevator with my life partner and refer to him as “Sir Flatus”.

  • Winter

    why not address brain malfunction as just that …”brain illness or brain dysfunction”.

    For me, the problem word is ‘mental’ in ‘the mentally ill’ … what is ‘mental’ when it’s the BRAIN that fails to function in producing realistic, productive, and socially acceptable behaviors.

  • Lindsay Lee

    Organizations’ and governments’ stark adherence to people-first language is ridiculous and worthless. If you want to get nitpicky about it, saying “a person with a disability” is implying that it is the individual person who has the problem that needs to be cured, versus saying a “disabled person,” which implies that the person is disabled by something, i.e., society. The former follows the outdated “medical model” of disability and the latter follows the modern “social model” of disability. The social model is like this: for me as a wheelchair user, it is not necessarily my own personal condition that disables me; it is the fact that all buildings do not have ramps, elevators, etc.

    But wherever we put the “person” or whether or not we leave out the “person” shouldn’t matter. I can tell you that as someone who is active in disability advocacy locally, way too often disability organizations or local governments are quick to admonish others for not using people first language but do nothing in reality to actually solve the problems that the mentally and physically disabled face. It’s used as a replacement for actual problem-solving.

    In addition, criticizing everyone for not using person-first language creates discomfort around the topic of disability, adding to the already-massive stigma surrounding it. Why is disability so special that we are not allowed to use it as an adjective? Disability is a characteristic of people (almost 20% of people in the US); the problem comes in when we view that characteristic as an inherently negative trait.

    Of course language is important, and I do agree that there are serious problems with individual phrases like the term “mentally ill,” which aggressively suggests the medical model of disability and automatically implies that individual people are problematic and sick. But person-first language is an overblown solution to the wrong problem.

    • HaroldAMaio

      A “disabled person,” is one who has no ability.

  • Keith Taft
  • Janet Colclough Bargar

    Ask the average person if they would prefer a mental/psychiatric illness to a cardiac one and I think most would chose a cardiac disease even with its greater risks of fatality.
    Psychiatric disorders are inherently “scarier” because the behaviors they manifest are more troubling than a rapid heartbeat, chest pain, shallow breathing. A child with autism, OCD, or even the ubiquitous ADHD diagnosis certainly entails a lot more care than a child with an inhaler!
    Psychiatric illnesses tend to disconnect people from others, they can break down relationships and cause the worst kind of human pain: isolation.
    So I don’t think it’s reasonable to euphemize their symptoms by saying they are just like other “treatable” diseases, they’re NOT! Dementia, for one, is a long agonizing spiral into an lonely abyss with no known cure, only weak stalling interventions. But we can certainly humanize psychiatric ilnesses in the ways that are suggested because suffering from a psychiatric disease/illness needs a much greater level of concern than our current compassion toward it. And with 2/3 of all people who are incarcerated suffering from a pschiatric disorder, we
    need more than just a few new words to refer to it.

  • phillip l radoff

    Apart from the overall merit of this article, it’s not difficult to understand why the word “the” makes more sense when followed by words such as “mentally ill” than, for example, when followed by “blacks” or “gays”: It’s simply that “ill” is normally an adjective, whereas “blacks” and “gays” are plainly nouns; the word “the” is needed to show that “ill” is intended to be a noun. Just think of how it would look if you wanted to define the group of people who are physically ill. Would you write “physically ill” to mean that group? Of course not. You would write “the physically ill,” or your readers would think you were using an adjective. By starting out with this bogus argument the author lessens the impact of what is otherwise a compelling article.

  • Ugh29464

    ‘So why don’t we get upset when we hear ‘he has hypertension?’ I would venture to guess its because people with psychiatric disorders tend to behave in ways that negatively affects those around them. Not all, not severely, but I think that’s the common denominator.

  • Tannymg

    It is admirable that caring people are concerned about the wording and labeling around people with mental illness. I support finding a way to describe the condition(s) that is less loaded. In addition, it is extremely important to destigmatize these illnesses. I think that has to be done through education. It would be helpful if the media could help in this effort by reporting on the full spectrum of illnesses, and not just mention them when a tragedy occurs. I know it’s not typical, to have positive stories, but why do a positive story about a successful person who has a mental health diagnosis every time there is a story about a horrific situation in which a person who has been diagnosed with a mental illness is involved. There is a lot of work to be done, and it will take all of us together to remove the stigma. What can you do today to educate someone?

    • Tannymg

      Typo: I meant to write: “Why not do a a positive story about a successful person who has a mental health diagnosis”.

  • Brian Scott Luke

    Did anyone actually read the article? Is it good?

  • Shirley Jackson

    The whole thing about this kind of illness is that it carries a stigma that often determines job availability and even insurance. If I were to say I needed to take a sick leave day to deal with depression or anxiety, it would taint my job. But if I said I needed a day to go for lab work or because I had a g.i. bug, there would be no problem.

  • Macmuffin

    I have had a psychiatric diagnosis (bipolar disorder with rapid cycling) for over 20 years. I am now a healthy, fully functioning member of society thanks to vigilant daily use of medication, as well as regular therapy sessions with a psychiatrist and attendance and full use of AA in my life. I have to sign up every day to choose to live by adhering to this plan. There definitely is stigma out there. I can’t count the number of times that people say, “she is bipolar” in disgusted terms about a third party in my presence. It makes my stomach turn. There is a gret book by a wonderful doctor who has bipolar disorder and went on to teach at John Hopkins Medical School and see patients, An Unquiet Mind, by Kay Redfield Jamison. Maybe if more people talked about their diagnosis who were doing well, there would not be a stigma. Like people surviving cancer, who can’t keep quiet about their miracle. Some of our diagnoses are more deadly than cancer and we never get to “remission”. We are always in treatment. I am very glad for them, don’t get me wrong, but I think that people with psychiatric illnesses need to understand this is lifelong and it would really help if we could blow away the stigma through education.

    • Cindi

      I highly recommend Kay Redfield Jamison’s book “An Unquiet Mind.” I run a support group for Depression and Bipolar, and we have many copies of her book in our library. It is a very insightful book about her struggles with Bipolar and her impressive accomplishments. A must read!! In fact, it should be a required book for all high school students, just like “The Adventures of Tom Sawyer” by Mark Twain or “The Glass Menagerie” by Tennessee Williams (both authors lived with a mental illness, as do/did many other authors – - F. Scott Fitzgerald, Sylvia Plath, Stephen King, Ann Rice, Emily Dickinson, and J. K. Rowling, author of the “Harry Potter” series of novels). Mental Illness had a definite connection with Creativity!!

  • Labyrinthia

    There’s a reasonable argument against person first language- it medicalizes disability and puts it in a negative frame. You wouldn’t say “People with same sex attraction” when talking about gay people, or “People with the ability to play piano” when talking about pianists. The deaf community especially opposes person first language, and you won’t find it used outside of the US where a social model is more commonly used over a medical model.

    Certainly, you should try to use the word people rather than ‘the’, and person first language has a place, in my opinion. Just don’t frame it as a black and white, this is the right way and this is the wrong way, idea. Respect how the person WITH the disability or illness wants to be referred. Many autistic people a very vocal about not using person first language and find it offensive.

    Certainly it’s different, but I have rather severe asthma. I am not a person with asthma in my mind, I am an asthmatic. Asthma isn’t something I carry with me, it’s something that is part of me. It’s part of who I am, it influences my everyday life. I cannot separate my asthma from who I am as a person, because after twenty years of it, we’re inextricably linked. Just like I have green eyes or brown hair, I have asthma.

    • Briana Roy

      Thanks for this post!


      An impulsive, inattentive, sometimes depressed (PMDD) lady with PTSD <3

    • careyg

      Thank you! I wasn’t aware that there was such pushback against “people first” language — Carey

      • http://askanaspergirl.wordpress.com/ Kat Murry

        Yeah, it’s interesting. Identity first language is a thing within the autistic self-advocates community, especially as they describe how being autistic shapes their sense of self.

  • mntechgirl

    I am a person who struggles with major depressive disorder and generalized anxiety disorder. I don’t define myself by my diagnoses. I am also a successful IT professional and work very hard to manage my diagnoses with medication, therapy and self-care (diet, exercise, etc.). I would qualify under the term ‘the mentally ill’ and the huge stigma associated with that phrasing. I hate it when they use that phrase on the news when someone does something terrible as if it is THE singular motivation for their actions. There are millions of us who are functioning in and contributing to society just fine. Unfortunately, we don’t make headlines. More than the phrasing, I think we need to work on removing the stigma; and the assumption that anyone with a diagnosis is just one moment away from committing heinous acts.

    • mkegal

      Any time someone in the news is labelled as being “a [group]” – a mentally ill person, a gun owner, a muslim – we should all be pointing out how wrong it is.

      It is the individual who has done whatever terrible thing landed him in the news, and I’m willing to bet that other people in whatever the group is behave differently, and within societally-acceptable limits.

      • Graciana

        I agree with you on the one person thing. No one person should be labeled as the entire group, however it doesn’t look to me like that’s what this article is getting at.

        As well intentioned this article is, it is ridiculous. I am related to
        mentally ill people that I have had to care for and I love them dearly, and the term itself is far less problematic than how people view the actual diseases that individual mentally ill people have. That should have been the focus of this article from my view.

        The word “THE” is NOT a problem. Anyone claiming this is just being idiotic. I understand the argument that it’s supposedly labeling a group as a monolith (which I don’t agree with because there’s this little thing called “context”), but here’s thing people claiming this don’t understand: Even if I just say “mentally ill people,” the “THE” is implied.

        Also, when we start squabbling over articles (in the grammatical sense), that’s when things have spiraled away from what really matters and we’re just talking nonsense. Time to talk about more important things like funding for mental health issues. That’s RARELY something I see anyone really advocating, but it’s quite necessary. I just think there’s so much more to go after that’s ACTUALLY important to the point where this article is almost embarrassing in its attempt at actually trying to improve things for ‘the’ mentally ill.

  • Anne-Marie Lepore

    The solution should be to use the label for which particular psychiatric disorder is being referred to or what aspects of some psychiatric disorders are being referred to. For example, in the newspaper article headline presented, I am certain that people are not concerned about someone who is has a simple phobia of elevators or a learning disability having the right to bear arms. Most are concerned about people with illness that can negatively impact their judgment and/ or act impulsively. Why not just say that instead? Part of the problem is that there is a stigma with psychiatric illnesses. Because people don’t learn about what they don’t want to see, these illnesses are so often misunderstood. While there are biological components involved in many, most people think of anything psychiatric as “scary” and “other” because there does not seem to be a readily understood explanation for these types of illnesses. In addition, many psychiatric illnesses seems to effect thoughts and emotions, what people identify as “the self”. For example, your thoughts and personality are not affected by having diabetes, but they are effected by having depression. If these various illnesses were better understood by most people, there would be less stigma. Less stigma could lead to better general understanding of these various illnesses, as well as better detection and treatment. Secondarily, there would be no need for the term “the mentally ill” because people would be able to communicate about what they really mean.

    • Amy Law

      The problem with this is, only a select few are alloed to label a person with a name for the psychiatric disorder. While it may be glaringly obvious to me and you when someone has an illness, we are not allowed to diagnose and label the dysfunctional behavior of the person’s body, be it a goiter, an infected wound, or a behavior disorder. One thing that facinates me with this debate is how some say people with mental illness are not dangerous. Oh ya? Then why are the prisons FULL of psychiatric patients? If have seen figures that up to 90% of all inmates are treated medically using pharmaceutical regimes of behavior disorders. I realize that the DSM books list soooooooo…many things that 100% of the earth’s poplation can be labeled with some wonderful diagnosis, but the data from the prisions show that many people with serious thought disorders are indeed dangerous. Does this mean that all people with psychology issues requiring treatment ate dangerous? Of course not. But i am extremely tired of the line of bull that psychiatric patients or people in need of psychiatric help are not dangerous. Maybe if diagnosis and treatment were easier to obtain this might not be the case. But it is WAY to hard to find help.

      • akilduff

        Well, one thing to consider is that you can’t look only at the prison population, you need to consider the general population as well. Even if a majority of prisoners qualify for psychiatric diagnoses, that doesn’t mean that everyone with the same diagnoses is dangerous. It’s the same as saying that because most prisoners are black men that all black men are inherently dangerous.

        Second, let’s look at the relationship of the disorders to the crime. Is someone in jail because the crime they committed is a result of the disorder – such as a serial killer with antisocial personality disorder (aka ‘sociopath’)? Or does it happen to be something that’s just there as part of who they happen to be – such as a thief who also has depression? Or do they have a disorder because of the prison experience – such as PTSD from prison rape or a psychotic break due to extreme isolation? I’d venture that while many prisoners indeed have psychiatric issues, that is not proof of their danger.

        Third, when we shut down the ‘asylums’ in this country, we replaced them with nothing. Certainly there were some horrid conditions in those places, but we kind of threw out the baby with the bathwater. The need for them didn’t go away. What few exist now are hardly accessible to many who could use them. The idea originally was that the community would care for those individuals, but obviously that isn’t working. When people who need supervision and access to medication don’t have it, they can easily end up on the wrong side of the justice system. Police who aren’t trained to handle that population can escalate an encounter with someone into a resisting arrest/assault on an officer situation, thus creating a “dangerous criminal.” Prisons have become our society’s de-facto residential facility for many with severe mental illness.

        For all of those reasons, that is why it is not “a line of bull” to say that most people in need of psychiatric help are not dangerous.

    • Merrilyn Finn Winters

      Very good point, except that people with Diabetes DO have episodes of thought and behavior disorder. Book WILLPOWER cites excellent research on the particular struggles of this group.
      I just noticed no- one has mentioned the “substance abuse” diagnosis that fall under Psychiatry domain
      I have just started Dr Carl Harts HIGH PRICE.
      I am grateful so many intelligent,curious are tackling these issues
      I include those addressing labels and forms of description, as the author does. It is appreciated, and also appreciated are all those who read and comment…..Thank You to all above

  • nberg2

    I tend to favor “neuro-chemical imbalance,” and I know it’s a mouthful. It seems to place the mind concretely back in the brain.

    • Ben Hucks

      The chemical imbalance theory of psychiatric disorder has not been borne out by recent research or clinical experience. It is important to recognize the physiological factors of psychiatric illness, but calling them all neuro-chemical imbalances may not be accurate and certainly downplays the significance of psychological and environmental factors.

  • Darby Penney

    I’m gratified that the president-elect of the APA recognizes that the term “the mentally ill” is hurtful and inaccurate and advises the media against using it. I’m glad Cary Goldberg has learned that over the years too.

    But I’d like to point out that “people with mental illness” is no less offensive to many. There is no scientific evidence that extreme mental or emotional states (so-called “mental illnesses”) are diseases in the way that diabetes or cancer or heart disease are. There are no biological markers for any DSM diagnosis, and all these diagnoses are arrived at through debate by committees, not by any scientific evidence.

    I prefer the term “people with psychiatric histories,” which is neutral, descriptive, and doesn’t buy into any of the hurtful labels that psychiatry puts on people.

    • Merrilyn Finn Winters

      I agree here

    • RD81

      Actually, there are several mental illness that have a direct relation to visible structural brain abnormalities. For example, both Bipolar disorder and Schizophrenia have virtually the same abnormalities in the prefrontal cortex. There are also numerous studies (conducted by the scientific and medical community, not committee debate) that are being done to determine the potential genetic connections to certain mental illnesses. More and more evidence is suggesting that at least some of the more prominent mental illnesses are more neurological than mental.

      The term “people with psychiatric histories” suggests that it is all in the past. It’s like saying “former alcoholic”. It suggests that you are someone who used to have a mental health issue (mental illness), but you don’t have it anymore.

      What really needs to be done is that people need to stop making the “correlation = causation” fallacy arguments. People assume that if someone has a mental illness and commits a crime, that the mental illness is the driving factor behind the commission of that crime. It could have absolutely nothing to do with the individual’s motivations.

      Take the mass shootings, for instance. The biggest problem there is that people see the term “mental illness” and choose not to look any further into the potential motivation behind the shooting. Also, not every mass shooter has/had a mental illness. Those that did didn’t have the same illness. The problem with that “correlation = causation” fallacy is that you could look at other factors and end up drawing the same conclusions about those factors. For instance, you could find that 9 out of the last 10 shooters drank Coke or ate at a fast-food restaurant within 48 hours of the shooting. Is that a contributing factor? What about the fact that the majority of these mass shootings have occurred in states where there were strict gun control laws in place? Should we blame that for shootings? The fact is that each action that occurs is the result of a large number of variables that are unique to that particular instance.

      The problem with “people with psychiatric histories” is that it isn’t much different from the current media favorite, “a history of mental illness.”

  • Per_Ridere

    I far preferred the good old days back when we had a sufficiency of lunatic asylums and they were simply called inmates!

  • ktj434

    Brain disorder. Whether it’s PTSD, schizophrenia, dementia, these are all brain disorders. The underlying causes vary from vascular, neurological, genetics or trauma, but they are all brain disorders. If the audience reads it enough over time, reducing the stigma of a brain disorder can be very helpful not only for the patient, but their families. Best of luck in your endeavor!

    • Darby Penney

      There is no proof that people whose behavior gets them labeled with unscientific psychiatric labels like PTSD or schizophrenia have “brain disorders.” Real brain disorders (epilepsy, parkinsons, etc) are the province of neurologists, not psychiatrists

      • ILikeSleeping

        Actually, the advances in brain imaging and genetic testing technology in the past decade or so have allowed some amazing research to happen. For example, there are studies that indicate that there are structural differences in the brains of people with depression, compared to people without it. Also, differences in a gene responsible for serotonin transportation seem to predict higher chances of getting depression.

      • Merrilyn Finn Winters

        Stunned again. There is much overlap between Neurology and Psychiatry. Jensen the use of “Behavioral”

        • Darby Penney

          Actually, once there is a recognized biological basis for a “mental condition” it becomes the province of neurology, not psychiatry. Case in point: tertiary spyhillis.

          • Merrilyn Finn Winters

            We have much “objective”data on brain differences in Schizophrenia. It has not been relegated to Neurology. And Tertiary syphilis could be the domain of Infectious disease Specialist. Our argument may be with the compartmentalism of the Professional Health Care Community. A very good point. And co-incidentally a very expensive set of divisions.

          • Darby Penney

            The work on brain differences in schizophrenia is not at all objective, since there is no objective test for “schizophrenia.” My understandiong of brain imaging studies in this area is that there is as much variation among “schizophrenic” brains as there is among “normal brains.” Also, neuroleptics cause brain atrophy

          • Rhonda Bourne

            There are so many issues here. The term mentally ill would not be so problematic if we did not feel the need to parse terms. if you take an antidepressant, anti-anxiety med, and antipsychotic than you have a mental illness. I have always felt that it would reduce stigma if everyone taking Prozac, Zoloft, ativan or klonipin said that they were part of the face of mental illness. But it will not happen because people do not want to be thought of as mentally ill.

            Two big issues that drive diagnosis are insurance and big Pharma. Insurance won’t pay of your troubled, upset, or sad. You have to have depression, which is thought of as a biologically based illness. Yet as a provider, I cannot tell you the number of times that people tell me that they have been diagnosed with depression and are treated with anti-depressants, but have no symptoms consistent with the diagnosis of depression except that they are sad, down, upset, etc. Depression is a constellation of symptoms not just feeling blue or sad that last for at least two weeks.

            I was just reading People Magazine and there was a 3 page ad for Seroquel, which is an anti-psychotic medication. No where in the ad does it say that. It talks about it stabilizing mood. So big pharma poushes meds for anything it can get FDA approval for. FDA gives approval if the drug is better than placebo, not if it is better that.

            In the past decade we have seen an explosion in the diagnoses of PTSD, ASHD, Bipolar Disorder, including in children as young as two-three. This has meant big money for Big Pharma. Dr. Sommergard should know about the dx of Bipolar Disorder in children since it was a psychiatrist at Tufts who medicated a little girl with so much medication and then she died.

            Whether or not we use the term “mentally ill,” is relatively minor and inconsequential if we do not address these larger issues. Some people do not want to be called patient. They like consumer or client. Personally, I think these kinds of arguments serve to distract us from far bigger and essential problems

          • Tia B

            Merrilyn, would you be willing to share the source for your assertion? The neuropathology of schizophrenia has not been identified to the best of my knowledge and I would be interested to see credible research you’re referencing that indicates differently. The only one I can think of is the Dutch study and that one is unsure whether the lower volume of gray matter is caused by treatment or schizophrenia. But I don’t know them all and don’t have unlimited time for research, so I am very interested in where you got what you seem to know.

        • HaroldAMaio

          Schizophrenia is not a behavior, or pneumonia is.

      • Macmuffin

        There is proof for most psychiatric diagnoses through imaging studies or post-mortem studies, which is the only method we have to diagnose Alzheimer’s. Does that make Alzheimer’s not a real brain disorder?

        • Macmuffin

          Most psychiatrists study neurology and can tell you very thoroughlly how the brain works. I don’t think all neurologists could provide you with good therapy or psychopharmacology.

        • Tia B

          You’re talking about a neurocognitive disorder when you use Alzheimer’s as an example. This discussion is about psychiatric classifications. Neurocognitive disorders is an umbrella term to describe Alzheimers, Huntington’s, traumatic brain injury or Parkinson’s. The research about these conditions cannot just be assumed to apply to other areas classifications of difference. It is unique to those conditions. I’m looking for research which confirms the biological presence for psychiatric classifications, not neurocognitive.

          • Macmuffin

            Darby mentioned epilepsy and Parkinson’s above., as REAL disorders because they were diagnosable. My point here is that not all conditions are “diagnosable”, other tan post- humously (or by imaging) and by sympyomology, but we accept them as real. It doesn’t mean the person does not have the illness.

      • NeuroAtypical

        Are you aware that neurosurgeons can treat severe OCD and depression
        with very precise surgery, much like that used to treat Parkinsons? In
        fact, treatment of Parkinsons helped researchers locate structures in the brain that can be addressed with surgery or electrical stimulation to reduce or eliminate OCD & depression.

      • http://www.architecture.net.au/ Simone McInnes

        PTSD is a very real, physical disorder resulting from altered neural pathways, and brain chemistry. The anomalous resultant behaviour is very frustrating to the sufferer. It would be a relief to see neurologists work in conjunction with the psychiatric profession on a regular basis regarding PTSD. Perhaps that would go some way towards lessening the stigma of a diagnosis.

      • Alison Rice

        I have seen imaging that indicates the working memory of Schizophrenic people doesn’t work the same as that of non Schizophrenic people. Brain imaging aside, during my most severe psychotic break I had the symptoms that I could not hear people speaking to me almost any of the time, keeping track of time was impossible, watching anything on television without repeating hallucinations or missing large chunks of the content. Just all sorts of visual perceptual chatter. I had trouble breathing. Not to mention experiencing hearing voices of other people very clearly in my mind for the first time. I didn’t go to the hospital because I thought it wouldn’t help, because it was a mental disorder, not a real problem. When I eventually allowed myself to be treated, I found that indeed, I had had something severely medically wrong with me, that could be solved with the science of medicine. This merely because I got a lot better on a lot more medicine.

    • Laurie Lasky

      Brain Disorder would be a great start – making a medical distinction that is more on par with other medical specialties. Dr. Summergrad is aiming at creating a sea change in the way people both inside and outside of medicine think about and understand what we currently call “mental illness”. Journalists have a pivotal role to play in this process – they are a unique position to educate the public about our knowledge of the brain and what we have learned about it’s functioning as an integral part of the human body. Just as importantly, journalists can help shift the conversation by providing stories and insights about the lives of people whose brains function less than optimally. Great thanks to Dr. Summergrad for getting the ball rolling.

  • Deanna

    Mental illness, like addiction, is a medical condition where the more severe one’s symptoms become, the more ostracized they become.

  • RAJ

    The doctor and Ms. Goldberg believe in the Safir-Worf hypothesis, thinking language can influences behaviors and beliefs. Bunk.

    • ILikeSleeping

      For me, the language IS the behavior. It’s a matter of respect. When I hear people say, for example, that “the mentally ill” shouldn’t own guns or that they (we, I have MDD) are all in one scary, dangerous group somehow, it makes me think some people long for the “good old days” of lunatic asylums and frontal lobotomies.

  • lynnelmiller

    as a psych nurse, i had a hard time getting people not to say “crazy!”

    • Darby Penney

      And as someone who’s been through the system, I much prefer the re-appropriated term “crazy” than the phony disease labels.

      • lynnelmiller

        has it been reappropriated? i’m sort of out of touch since i retired.

        • Darby Penney

          The late advocate Howie the Harp used to refer
          us as “crazy folks,” the same way that gay people have
          re-appropriated the word “queer.”

        • Tia B

          Mad is also reclaimed. Personally, I prefer mad to crazy because it’s less likely to still be used as a slur.

      • Merrilyn Finn Winters

        Again stunned…what label were you given you found so offensive? I have learned that denial is part of ALL disease states. Not only Psychiatric, but

        • Darby Penney

          I’m not sure what is “stunning” about people not wanting to be labeld with fake “diseases” that are arrived at by committee. My point is that there is no evidence that extreme mental and emotional states are “disease states.” While there is no hard scientific evidence of a biological basis for any so-called mental illness, there is evidence of significant correlation between mental and emotional distress and trauma, especially childhood trauma.

          • jax70

            I very much dislike the way the term “mental illness” is used as well, but there actually is scientific evidence of a biological basis for some diagnoses, including correlation between diagnoses and variations in brain structure. For example, the size of the hippocampus tends to be smaller in people with depression or a history of traumatic stress. It is a disease state, a fact which has helps some people (including myself, MDD) to understand treatment for that state in more concrete (and unstigmatized) terms.

          • Darby Penney

            While I’m not convinced of this evidence, I can understand why some people take solace in it. There is plenty of evidence that some psychiatric drugs cause brain atrophy, so it’s important to distinguish this.

          • jax70

            Thank you for your condescension toward the “solace” I take in this. I’m not the person to engage in a deep-dive scientific debate of the evidence, but I would ask what exactly you think is going on in a mental disorder if there is no correlation to brain structure or function?

          • Tia B

            jax70, I’m wondering if what falls under the umbrella of MI is so highly individualized that for some it is biologically based and for others it originated it trauma or ongoing stressor. But, I’m with you as far as the deep-dive science. I can only say that traditional approaches were physically, biologically and emotionally hostile to me. Non-traditional approaches have worked. I have friends, on the other hand, who say medications and traditional treatments either saved their lives or made it worth living and they believe it is biologically-based for them. That is their truth and I would not presume to over-rule that truth just because it is more acceptable than my truth, which is that for me and my body, psychiatry is bunk.

            If the traditional framework helps some, then it should stay for them. But we also cannot ignore the vast numbers for whom the traditional framework is not effective and whose voices are repeatedly silenced, or worse, FORCED to take medications that harm their body chemistry.

          • jax70

            Tia B, I understand what you are saying and completely agree that the same approach will not work for everyone. And I’m by no means a fan of medication, and give far more credit for long term improvement to therapy and developing a yoga and meditation practice (I’m not sure what falls under umbrella of traditional / nontraditional for you).

            I guess all I’m getting at with all of this is that biology and acknowledgement that the physical body is dynamically involved in many peoples’ mind reality (including many people with trauma histories) doesn’t have to equate to medication. There is a long and horrific history of mistreatment of people within the traditional framework, no question, but for a lot of people it’s very helpful and validating to understand that the physical body is involved in their condition. For one thing, the notion that mood disorders, PTSD and the like are “all in the head” or somehow not real are very persistent in our culture, creating tremendous shame and resistance to seeking treatment.

          • Cathy

            Trauma can trigger a mental illness. It’s very unfortunate that some doctors presume that if you behavioral issues due to logical circumstances you must also have a mental illness. On the other hand, if you keep up with research there is, in fact, evidence of chemical differences in the brain for people with real mental illnesses. This is to say that you may have two people who suffered the same trauma but have different reactions or a level of severity. And if one can’t function despite strictly behavioral therapy a brain scan will likely show similar brain activity of those who also can’t function well.

            It’s also true that some diagnoses are more scetchy like ADD. On the other hand, responsible doctors will take the time to use thoughtfulness and the latest research when making a diagnosis. As also someone who has been through the system, I’ve seen positives and negatives. I am very sorry you’ve had such a bad experience . But please do not be so arrogant as to presume you understand everyone’s situation.

          • tuxb

            I’m not a professional, and this is just me, so this won’t be arrived at by committee, but you sound pretty paranoid.

          • Guest

            Of course, tuxb. Critical thinking, questioning, challenging the status quo when it doesn’t work for many — those are qualities valued in this county as long as you’re not diagnosed. Once diagnosed though, then you’re paranoid and in denial. Got it. You’ll have to pardon me as I pass on your insulting and ignorant insight.

        • Tia B

          To frame resistance to the system that is so damaging to so many as anosognosia as you’ve tried to do here is a very handy way to try to minimize what people have to say about the problems associated with psychiatry and you’ve managed to do so in quite a patronizing way for a two line response. But that doesn’t make it valid. It makes it part of the erasure of the voices most affected. If people are helped by the system, then great. I hope they have continued access to it in respectful ways, but that does not mean that people who resist are in denial.

          And by the way, Merrilyn, it was when I walked away from psychiatry that I recovered. That this is not only possible, but necessary for many of us is YOUR denial.

      • truthy

        Do not feed this radical …

    • HaroldAMaio

      You just said it.

      “as a psych nurse, I had a hard time getting people to use respectful language.”
      As an editor, so do I. Search my name for my attempts: Harold A. Maio

  • Marydohrenwend

    Why is mental illness separated from any other physical illness. It’s a medical condition for many, particularly those with depression, bipolar disorder, and schizophrenia. Also, we don’t lump all medical conditions in the way that we do with “mental illness”. diabetes and polycystic ovarian disease are both illnesses of the endocrine system, about as much as schizophrenia and depression are related. They are two entirely different diagnoses with very different symptomology and treatment. Eliminate the grouping entirely. One who has depression should be referred to as a person with depression. One with schizophrenia should be referred to as an individual with schizophrenia. When you lump them all together, people will generally think you are referring to the most extreme examples of all of those in that category. IE you might go to an gynecologist for treatment for excessively painful periods or ovarian cancer. We wouldn’t categorize them in the same way, leaving the general public to think that all people who get treatment from a gynecologist have ovarian cancer. The stigma comes from ignorance about the vast array of “psychiatric illnesses”. People think if you have a “mental illness” that you are capable of walking into a school and shooting everyone you see, when people with mental illness are much more likely to be the victims of crime than the general public. By referring to the individual illnesses rather than the larger category, one is contributing to the stigma.

    • IT__Guy

      When people read a headline like the NYT one shown above (“When Right to Bear Arms Includes the Mentally Ill”), they know what’s implied because they’re not idiots. They have a pretty good idea that the phrase “the mentally ill” refers more to, say, schizophrenics than, say, people with OCD. They’re smart enough to figure out that the writer wasn’t talking about every single mental disorder that exists–just the ones that might cause concern if people suffering from them had guns.

      But speaking purely from a pragmatic standpoint, I can’t figure out a good alternative.You seem to argue that it’s identifying each specific condition individually, but how do you propose doing that in a headline with limited space? It’s not so easy, which I suspect is why Goldberg didn’t provide a solution.

      • Pam

        IT__Guy. The vast majority of schizophrenics wouldn’t hurt a fly. There in lies the ignorance that the majority of readers will not glean from the headline using mental illness.

        • HaroldAMaio

          Each of my acquaintances with schizophrenia hold doctoral degrees. The range of symptoms is broad.

        • IT__Guy

          Again, though, we’re back to this: What’s the proposed solution? Is there any turn of phrase that would fit within the limited space of a headline that wouldn’t cause offense to some group or another while clearly conveying the intended message?

          • mkegal

            “The criminal”? “The murderer”? “The drunk driver”?
            Name the crime, instead of the excuse.

          • MikeB

            The problem as I see it is that the criminal justice system already accentuates the term as a justification for offenses. We have been tiptoeing around this issue for way too long because of the stigmas involved. I don’t know what the answer is either.

          • Fushin

            people who suffer from mental illnesses

          • Marydohrenwend

            No. That’s the whole argument! Read the article before commenting.

          • Fushin

            I did read the article. Marydohrenwend. Furthermore, I have such an illness, and this phrase, ‘people who suffer from mental illness’ is fine for me. If you have an illness and its not fine for you, that’s you’re perogative. If you don’t have such an illness and you’re just being accusing, please take a back seat. This arrangement of words strikes me as compassionate and correct for the short byline. If you have more time to specify which illness, fine. In a short title, I stand by my comment.

          • Rachael Caruso

            People with psychosis. People prone to explode. People with emotional imbalances.

          • Marydohrenwend

            Why does it have to be a part of the headline at all?

          • Paulaff

            I agree wholeheartedly with this simple statement! Why impose your attempt to ‘identify’ a person by a label? My depression has been completely controlled by medication for the past 15 years, but if I should die hitting a tree with my car because I wasn’t looking at the road, they would probably attach the term ‘mental illness’ to the news report as if it identifies me & the reason why it occurred! The term always makes me cringe!

          • David Todak

            Because the article is about gun ownership by people who have illnesses that increase the likelihood of irrational behavior.

          • Jennifer LeQuire

            “The mentally ill” is a blanket description of psychiatric diagnoses that allows people to stay blissfully in the darkness of ignorance regarding people who have a mental illness. I agree with the terming of this or any condition as a person with ______. Termed this way gives a recognition that someone,such as myself, is a PERSON that the ignorant people can’t blanket into an anonymous group. It is frightening for people to realize that they come in contact with people with mental illness every single day and can’t always tell who they are—–they usually don’t identify mental illness as anything but causing someone unable to function in society. They are afraid that they will be in contact with a person with mental illness, not know and the person suddenly decompensate and turn on them. People with mental illness, I believe from experience, are much more likely to turn on themselves instead of others.
            In specific reference to the headline:someone who drinks alcohol yet is not an alcoholic has an increased likelihood
            of irrational behavior, someone who has a quick temper has an increased likelihood of irrational behavior as do people who are upset about something in general depending on how upsetting the situation is ——-will they be denied there constitutional right to bear arms? Who decides which mental illness will deny a person the right to have a gun?

          • Rachael Caruso

            Your question is pure wisdom.

          • heatherlouisemessinger

            People with unmanaged psychiatric conditions. An imperative point of this article is that stigma fuels the shame and myth of hopelessness of an epidemic that can be and desperately needs treatment. Headline: “The Gun Debate: Violence and Unmanaged Psychosis” That could be hallucinations or the need of a school counselor, but it’s about the conditions- not the Whole Demographic of sufferers. And personally, I’d read that article sooner than “Violence and The Mentally Ill.”

          • justathought

            “The majority of people with mental illnesses are not violent…are far more likely to be victims than perpetrators of violent crime” (Appleby, et al., 2001)…. and

            “The majority of violent crimes and homicides are committed by people who do not have mental health problems. In fact, 95 per cent of homicides are committed by people who have not been diagnosed with a mental health problem”. (www.time-to-change.org) not sure how valid these facts are but I have read the same thing elsewhere a couple times- can’t find it at the moment. But even if it is close to that- when you look at that statistic and know that at least on out of every 5 people have a mental illness, makes you think.

            So my solution, and to agree with Marydohrenwend: the article should say something like “Crime and Community involvement” or “When Community Inclusion Affects the Right to Bear Arms” or something to that effect.

          • wildflowersmovement


            BODY and MIND are ONE and SHOULD NOT BE SEPARATED or TALKED about separately.
            LANGUAGE DOES MATTER!!! It forms our culture (written for the person above who said it doesn’t!…pure ignorance… Graciana)

            People should be called, “people with health issues”….if someone asks, “what kind”, then we can say “a medical condition which affects the brain” BECAUSE “mental illness” IS NOT PROVEN! There are NO TESTS, NO LAB WORK, NO CT SCANS or MRIs to diagnose a “mental illness”. PERIOD.

            Let’s GET WITH IT and GET EDUCATED! Doctors: It’s about time you SPEAK THE TRUTH if you want to keep your CLIENTS.

          • IT__Guy

            Look at the example from the article again–the NYT article with the headline of “When Right to Bear Arms Includes the Mentally Ill.”

            You’re proposing that this headline instead read “When Right to Bear Arms Includes People with a Health Condition Which Affects the Brain”? That seems like a clearer way of communicating?

            And for the record–since I know no one wants to cause offense–if I have a problem with, say, my liver, I’m okay with you just saying I’m ill, because that’s way easier than them saying I have a health condition which affects the liver. I promise, no offense will be taken.

        • Graciana

          Which is why people need better education about mental health issues in general and that starts with schooling and educational outreach programs. Mental health has been losing public funding for a long time, and private funds have not made up the difference. It’s like an elephant in the room regarding the subject of healthcare.

          The term “mental illness” or “the mentally ill” is not the problem. The fact that people aren’t educated about it is. And I could just as easily say the same thing about other mental illnesses as well, like schizophrenia, etc. In some cases, using the actual names of the illnesses themselves is even worse in terms of stigma than just using the blanket term this article is referring to.

      • DRF

        “The violently ill”? It would need to be used for a while before people understood it as clearly as they understand “the mentally ill.”

        • wanderingi

          …which isn’t very clear at all.

        • nnyl

          I used violently ill to describe a bout of food poisoning.

          • DRF

            Yep. It only works if we keep the “the,” as in “Gun Rights and the Violently Ill.”

          • DRF

            Alison R. just suggested “psychiatrically unfit.” I like it.

          • J__o__h__n

            I’m sure “unfit” would be much more acceptable than the more judgement neutral “ill” to the easily offended.

          • Fushin

            Being ill is not the same as being unfit.

          • DRF

            Exactly. Lots of people are ill. The Newtown shooter is psychiatrically unfit.

          • Fushin

            Really derogatory! Holy moly.

      • wanderingi

        “But speaking purely from a pragmatic standpoint, I can’t figure out a good alternative.” Perhaps, to save space, this is an alternative “…includes everyone (or “anyone)!” Or, “…disregards psychotic disorders.”

        • Rachael Caruso

          Therein lies the truth. The more accurately we clarify, the more inclusive the group gets, and the perpetuation of fear needs to shift paradigms.

      • Rachael Caruso

        To the IT guy: You labeled “the people who read the newspaper” as if they all deduce their conclusions the same way. The people that read the newspaper are a large variety of people, and you cannot speak for all of them.

        • IT__Guy

          Let’s not split hairs; it accomplishes nothing. Clearly I was making a broad generalization.

          The goal here (i.e., in determining verbiage for headlines and articles) is to communicate as effectively as possible with as large an audience is possible.

          • Rachael Caruso

            I promise you that I am not merely being argumentative with you. My experience has been affected by more than one circumstance that personalizes this for me.

            I know of two instances which lead me to question the way and the reasons that we allow poor treatment of a very good person while another person, who demoralized others with labels, possibly due to conviction of his superiority, was the perpetrator of the homicide attempt.

      • Marydohrenwend

        How about When Right to Bear Arms includes a mental health check for all applicants. It’s the ones who aren’t diagnosed and treated who eventually on very very rare occasions, commit these kinds of acts.
        You are apparently not one of those readers of the NYT, or you would know better than to say what you did about people with schizophrenia, which, by the way, is usually not the diagnosis that leads to violence like you’re talking about. Find me one example. Newtown, Columbine, both kids with untreated or poorly treated depression who were ostracized, loners in their community. People do this because they do not feel part of their community. They feel rejected by the community. The pain of this eventually turns to anger, mixed with suicidal desire, not schizophrenia. One in one hundred people have a diagnosis of schizophrenia and I can’t remember one incident of one of them committing these kinds of shootings. So, you see, you have proved my point. You think that if someone is mentally ill and violent, that they are schizophrenic, but you are wrong about that, simply and factually wrong. You are stigmatizing schizophrenics. Anyone reading your comments who does not have the training to know the difference, may have their own prejudices reinforced. Those with schizophrenia or any other mental illness will interpret your comments as confirmation of the ignorance that contributes to the marginalization and lonliness and isolation that makes people afraid to get treatment, which can then spiral downward into self injury or injury to others. So, you see, comments like you have made are much more the cause of these crimes that the “mental illness” that you prefer to blame it on.

      • Gallucci

        I understand your point IT_Guy, as we are educated enough to know there are different types of illness, & one is not automatically going to assume that the focal point of an article headline is an individual with mild depression. But that’s only on the conscious level.

        Our subconscious thoughts are constantly being fed by multiple factors without our knowledge &, for that matter, our consent. In modern society, the majority of us have socially evolved to understand that violent criminals are only a sliver of the African-American population.

        Unfortunately, association is still subconsciously active because the Black identity has yet to have fully broken free from the social stereotype. It’s a contributing factor to their slow-moving societal progress & the same holds true for those with ‘mental illness’. Longstanding stereotypes created by an ‘ancient’ culture that continue to receive promotion from a ‘modern’ media.

    • Darby Penney

      That only works if you believe that these diagnoses are accurate and scientific, which they are not.

      • Merrilyn Finn Winters

        WOW…..you stunned me. You don’t think psychiatric diagnosis are scientific?

        • Darby Penney

          No, theyare not scientific. Read, for example, “They Say You’re Crazy: How The World’s Most Powerful Psychiatrists Decide Who’s Normal ” by Paula Caplan or “Mad Science: Psychiatric Coercion, Diagnosis and Drugs” by Kirk, Gomory & Cohen, or “Mad in America” by Robert Whtitaker.

          • KnowWhatYouAreSaying

            If you do any research on the topic,pretty much ANY research, you will be proved wrong instantaneously. Chemical and Electrical signals in the brain have been mapped to show where these conditions come from.

          • truthy

            Another radical nut heard from ….

          • http://www.architecture.net.au/ Simone McInnes

            The unscientific use of mental health anomalies as a term of abuse in order to dismiss the views of the person subjected to such terms is exactly why this article was written. It’s high time this kind of behaviour was called out for exactly what it is.

        • Alex

          Not exactly. In many cases we have no concrete understanding of “why” mental illnesses exist, from a biological standpoint. If you do an autopsy on someone with heart disease, you can tell they have heart disease–there are observable, structural differences in the body. With some exceptions, the same is not true for “mental” illnesses. Instead mental illnesses are diagnosed almost solely based on symptom presentation.

          This means, to a certain extent, that one could argue they are more socially constructed than other illnesses. That is to say, to an extent it’s arbitrary whether we decide a particular mental presentation is “abnormal”. Or, rather than simply arbitrary, let’s say that our idea of what is “normal”, mentally and socially, is to an extent culturally specific rather than objective. Think of how, at the turn of the 20th century, many women were labelled “hysterics” as a form of social control. Or of ADD: would such behavior really have been considered “abnormal” or a mental illness, a few hundred years ago? Maybe it is not that people with ADD are “abnormal” but that our expectations of work and productivity have evolved in the past century or so, such that normal variation becomes labelled as deviant when it no longer “fits” the system.

          This makes many people uneasy, including some psychiatric professionals (consider Thomas Szasz). The same traits which could get you labelled a sociopath, if you came into contact with the criminal justice system, will help you get ahead in Wall Street.

          • Cathy

            There is more scientific evidence that shows mental illnesses are very real. For example, people who experience severe feelings of hopelessness and despair show consistent activity in the brain that does not occur in others who have no such debilitating feelings. This is true depression that can also come on dramatically and unexpectedly. We are beginning to understand the evolution of this. But like heart disease we don’t know of the purpose of it.

            I take your point, but it’s over simplistic. It has the danger of trivializing those that are truly suffering. Additionally, you make the presumption that since societal norms change an illness may not be real. In fact, some of our societal norms may have come to cater to certain illnesses. I would not be surprised at all if several individuals on Wall Street shared the same genetic make up of criminals that are sociopaths. This is not to say all do of them do. But not all criminals are sociopaths either. Those on Wall Street have simply found a place where they can function in society. Not all societal norms are healthy.

          • Alex

            Even though in some cases, as I acknowledged, we can find statistically significant differences between a group with a diagnosis and a control group, it doesn’t the solve the problem that, if you go through the mental healthcare system, you aren’t going to be getting an objective test to decide whether you have depression, or a personality disorder, or what have you. It will be based on what you report (and whether your psychiatrist believes you!) and what your psychiatrist believes they can observe. And in some cases that period of observation isn’t all that long.

            Also, again, deciding that those variations are abnormal or unhealthy is still, to a large extent, socially constructed. You might take two groups of “healthy” people, put them in an MRi, and be able to sort them into two distinct groups.

            Fortunately, in recent times we’ve tried to move to a place of only diagnosing mental conditions in people in whom it is supposedly affecting their day to day life, though this isn’t universal. For example I believe you can only be diagnosed with an autism spectrum disorder in the US if it significantly negatively impacts your daily life — but this criteria is relaxed in international standards. This doesn’t solve the problem though, as with ADD, of the fact that the problem might not be with the person with mental illness, but the larger society! Similarly with depression, is the problem that the person is inherently “ill”, or that we live in a society that can be difficult for many people to cope with? Given the associations of mental illness as usually inherent to the person–indeed, it used to be that certain forms of depression with an “outside cause” were labelled grief not depression–this is not a trivial problem.

            You wrote that to see mental illness as a social construct has the potential to trivialize. I disagree, strongly; I have seen myself the other side of the coin–that diagnosis with mental illness, while it can be a relief to be able to “explain” some differences, can be severely othering and can lead to stigma. I also don’t think a person should have to accept the label of being “ill” to expect compassion for their differences, struggles, or limitations.

          • Tom Hamel

            Off the top of my head, I know that depression and ADHD both have observable physical effects within the brain. ADHD is essentially a missing neural link, while extended depression or severe anxiety starves and kills very specific areas of the brain. I’m sure other illnesses have similarly been observed to have consistent physical characteristics.
            And these are only the physical characteristics observable within the brain itself. Take the case of someone with general anxiety disorder who suffers from panic attacks. She would have a brain with observable physical alterations as well as high blood pressure and cardiovascular stress/damage.
            Knowing this, can you still continue to contest that “mental illnesses” are simply “illnesses?”

            ADHD: http://www.webmd.com/add-adhd/childhood-adhd/news/20041129/brain-changes-seen-in-kids-with-adhd

            Depression/Anxiety: http://www.psychologytoday.com/blog/heal-your-brain/201107/depression-and-anxiety-disorders-damage-your-brain-especially-when-untre

          • Alex

            Ah, a study on ADD with all of 20 people enrolled–seems super legit…

            There are several problems with the current psychiatric system, as I see it. One: Post-hoc physical evidence used to support a diagnosis does not justify diagnosing patients using no objective criteria, when the diagnosis can be used to control and stigmatize. Especially when such research starts from the presumption that these illnesses are real—don’t you think it might be a bit of bias to presuppose something, and then look for evidence of it?

            Two: A major problem in social sciences research, especially psychology, is that “newsworthy” results will get published and publicized more than studies which confirm the status quo or which debunk other studies. A study which “finds a difference” is simply more likely to get published than an experiment which finds no difference between two groups; which is very important to keep in mind when reading studies with extremely small sample sizes.

            Three: Which differences we choose to medicalize and which we chalk up to normal variation (e.g. sexual orientation) are still culturally constructed (consider the concept of the “culturally bound syndrome”). Also, there are differences in the brains between gay and straight people. Is one of those groups ill? What about left handed versus right handed people?

          • RoboBonobo

            “Also, there are differences in the brains between gay and straight people. Is one of those groups ill? What about left handed versus right handed people?”
            That’s an easy question to answer. It’s only an illness if it’s causing a problem for the person. Seeing a difference doesn’t make it an illness. What makes it an illness is the fact that it’s causing trouble for the person.

          • David Todak

            Wasn’t homosexuality classified as a mental illness until the 1970s? Beyond that, you’re describing a trait common across all areas of study…novel and/or controversial findings get published and lots of attention while confirming results are largely panned.

          • Rachael Caruso

            Like Alex said, even though there are physical differences that are scientifically proven, our society is whittling down who is acceptable, and someone ought to question the direction our society is going.

            Television is paid for by the corporations who sell the commercials. They have mastery in the art of manipulation. Do we personally know the agendas of these people? Are they
            promoting greed, lust, pride, envy, etc.?

            Many people conform to what they watch on tv. Television alone could shift society into such a game about greed that humans like Mother Teresa or Jesus Christ would be considered as “not normal” and negatively labeled. It is smart to question where our society is going instead of doing what everyone else is doing.

            I admire, for instance, the minority of Germans who questioned Hitler’s direction during the holocaust.

          • Geoff

            Specifically, related to your comment about ADHD; it is not society that has the problem it is me. Society is not the one that gets lost in this stuff rather than doing their work it is me. It is very true that one does not meet the criteria for a disorder unless there is a identifiable impairment in functioning.
            Related to Autism the criteria is very similar internationally and domestically. The criteria is outlined in the Diagnostic and Statistical Manual for Mental Health Disorders (DSM) and the ICD, the differences mostly are related to what treatment is available and will paid for. That is a political debate driven by private versus public funded healthcare and insurance.

          • HaroldAMaio

            What we call “mental” illnesses is very real. The suffering is very real. When we see them as physical illnesses we will have made strides. I have an illness called depression. It is not “mental” meaning my mind controls it. Doctors have sought ways to alleviate it. Vagus nerve stimulation is one, deep brain stimulation is another. For me, a drug alleviates it. It is not a mind altering drug.

          • Rachelle

            Brain Based Biological Illness

          • Dain Q. Gore

            It’s certainly a lot less scary for people to believe we have the human brain solved, but that is simply not true.

          • tuxb

            On the other hand, people used to believe that spirits would invade your soul when you sneezed, which started the tradition of saying “God Bless You.”

            Maybe we can recognize something as a disease before we know exactly what causes it.

          • Alex

            Sneezing isn’t a disease. It’s a symptom. Sometimes of disease, sometimes of something as minor as nasal irritation from pollen. So the example doesn’t quite hold.

            Also, among other things, masturbation, being gay, and being left handed were all at one time or the other considered deviant or mental illness. If you take enough random guesses, yes, you might accidentally hit upon a correct guess once or twice. It doesn’t excuse the failures.

          • Geoff

            There is actually significant scientific evidence of many psychiatric disorders. You referenced ADD, actually ADD as a diagnosis was dropped and replaced ADHD because it better describes the disorder and it’s symptomology. Anyway, it is quite easy to scientifically observe this pathology with scientific means. I for instance have ADHD, and am a therapist, if we use techniques such EEG or fMRI my brain is functioning differently than the brain of an individual without ADHD. The myth that mental health is not a science at one time was correct but not so much any longer. Is it an exact or pure science no but neither is any other area of medicine.

          • cthulu hitchhiker

            I understand the brain imaging evidence. My question is whether those scans are capturing a cause or an effect.

          • mkegal

            I think there are physical changes for more brain diseases than we currently know, but we don’t know where to look or we don’t have the tools to use to see the problems,

          • Marydohrenwend

            brain scans can be used to diagnose the illness in the majority of people with schizophrenia, depression, anxiety and bipolar illness. They simply are not done.

          • Karin Travers

            I don’t disagree with much of what you say, but I’m not following this linkage:
            “In many cases we have no concrete understanding of “why” mental illnesses exist, from a biological standpoint—->
            This means, to a certain extent, that one could argue they are more socially constructed than other illnesses.”

            Years ago people didn’t understand that infectious diseases were caused by microbes. Were such diseases therefore socially constructed until Pasteur came along, at which point they became more biological constructs?

          • Rachael Caruso

            Humanity has always been and may always be on a journey of discovery. Whereas in Medieval times they didn’t understand bacteria, today we can’t accelerate matter to the speed of light and we don’t study energy with a frequency higher than the speed of light. Yet, a great many people have experienced moments when they felt something special, which we call spiritual. Our spirits affect us but we haven’t scientifically proven this, or that anyone is anything more than physical matter.

            Can the energy vibrating faster than light be spiritual? Can it be something we haven’t scientifically proven yet? Can it be the reason why some people die and some beat odds? Can labeling people be a distraction from our spirituality?

            Science helps people that want to change, but revolving our existences around a paradigm that Scientifically Has Holes in it may also be ignorance.

          • J__o__h__n

            Just because science can’t answer every question is no reason to label it spiritual.

          • Anonymous

            I suppose the question is: are they social constructs and a symptom of social decline, or not-yet-understood biological diseases that are getting better diagnosed as medical science (hopefully) narrows in on their true nature?

          • Rachael Caruso

            And perhaps there are people who make major decisions that affect our society, maybe in the media for instance, who would benefit from psychological and spiritual help. Our society has become so unnatural that one who revolves around greed alone is praised.

          • nnyl

            They are doing research at the University of Minnesota and other universities on brain scans to detect very early physical signs of schizophrenia. Researchers have known for over a decade that there are distinct differences in the brains of people with schizophrenia and those without. I don’t think they are quite using brain scans as a diagnostic tool, but I don’t think they are that far off.

            There is similar research on using brain scans with other illnesses, but from what I’ve read, they aren’t as far along.

          • Marydohrenwend

            If we injure our leg and we are screaming in pain, you get x-rays and an MRI. The reason that they don’t give diagnostic tests like brain scans to those with “mental illnesses” is because there is not societal expectation to treat these illnesses as illnesses. If the medical field did not use scans to diagnose a broken leg, our society would be up in arms, including the person with the broken leg. When you have a “mental illness” you can’t usually advocate well for yourself, and when you can, once you “out” yourself, anything you say is written off as being crazy. You become the problem. This is directly cause by our society’s attitude, ignorance and prejudice against those with mental illness.

          • Angie Warren

            Ever hear of the DSM? Yes, you can definitely diagnose a mental illness.

          • Sue Anderson

            The DSM is not foolproof. Conditions involving the brain are the only part of the body that doctors and/or psychiatrists just throw a pill at to treat. That in itself can be dangerous.
            The Amen Clinics have done years of research including ‘Spect Scans’ (Brain Imaging) and has found patterns of various disorders & improved the lives of many. Check out their website, it’s pretty amazing!
            So why you might ask, do those struggling not just go and have a Spect Scan done? Unfortunately, it’s not currently covered by most insurances…
            The cost is upwards of $3000. which includes consultation…

          • Alex

            Yes…by symptoms which are subjectively evaluated by a doctor. Not exactly an objective measure!

          • NotApologizing

            One of the problems mentioned along with the arrival of the DSM-V is how disappointed many people in the field of neurology are with the lack of a biological understanding of psychiatric illnesses. That they are still grouped by symptoms and behavior sets instead of by biological causes is frustrating in its lack of scientific progress.


          • Lisa Rose Ferrara

            Alex, could not have said this better myself. Thank you.

          • Fushin

            Its the environment, partially. Pollution, GMOs, the horrible stress of daily life, the koonequatsi (out of balance) way humans have devoured the planet with no regard to our interconnection with life – the whole planet is operating as if humans in charge are all nuts and out of touch with nature and reality. By then end of this century, if anything is left of humanity, what will be left of our resources, our food, our freedoms? Look at our leaders. How not to be depressed and anxious when you see the madness all around you – eat it – drink it – breathe it – it’s existential.

            The problem with psychiatry is that it’s simply in bed with pharma. Medicines may be helpful, yes, but taking a pill addresses symptoms and not causes. It’s interesting to look around the world to see how different cultures understand and treat mental illnesses.

        • HaroldAMaio

          History says no. We are learning more and more by applying scientific principles, but they are not always used. We still largely confuse the mind with the brain.

        • Snikker

          No-psychiatric diagnosis is based on how a person feels, acts, thinks or perceives. There is a lot of subjective analysis that goes in to diagnosis.

      • HaroldAMaio

        It’s been long time Darby, good to hear from you.

      • Geoff

        There is quite a bit of evidence about the existence of psychiatric disorders. We are making significant strides in the area, likely the biggest strides in medicine, related to understanding, identifying, diagnosing and treatment. There will always be some that reject everything and dismiss treatment as quackery..An example that comes to mind is the parents who have a child with a brain tumor be reject any treatment because they do not believe in medical science. There will always be those people and for them not being treated is their right, up to the point that they are incapable of functioning independently and within the “norms”, no desire to debate this, of society.

      • BOH1066

        just speechless….. which, for anyone who has ever known me for even the shortest length of time, is a feat considered to be virtually unachievable. are you actually arguing that mental illness doesn’t exist or that we have, at best, a rudimentary understanding of etiology/diagnosis/treatment?

    • Richard Whitesides


    • truthy

      Simple – the goal of language is to communicate in a way that is most specific and transfer important elements of knowledge from one party to the other. If the headline read “Guns to be kept from Physically Ill people” = language and communication has been compromised – and society is harmed.

      • mkegal

        How about “severely ill people lose civil rights”? Which is also true, and more clearly communicates what is done to severely, dangerously ill people.
        Not every brain disease leads to someone being prohibited from exercising their right to self-protection.

        • Positively.Sue

          Only if “Severely Ill” encompassed all severe health issues. ;-)

    • tuxb

      How many people with physical, non-mental illness have you seen shoot up a crowded movie theater?

      • RoboBonobo

        Someone with severe anxiety or OCD or agoraphobia does not deserve to be stigmatized by being lumped in with conscienceless sociopaths who commit acts of mass violence.

      • mkegal

        We don’t know, because media generally don’t bother to report on anything except brain diseases.
        For instance, in addition to a brain disease I also have a lung disease, migraines, nearsightedness, astigmatism, and (I suspect) the beginnings of: degenerative joint disease, high blood pressure, and most likely pre-diabetes.
        But if I were to do something criminal with one of my firearms, the only one of those likely to be mentioned in media reports would be the brain disease.
        The police department in my city is also officially prejudiced against people with brain diseases, as are some judges. Had to report one to the state bar association for her wrongful acts.

      • Positively.Sue

        Mental Illness is only heard about in relation to such events because it sells news… Nobody would think of saying a heart patient robbed 3 men at gunpoint for example because it’s automatically secondary to the crime. Whatever the crime is, it’s committed by a PERSON, Not an illness.. It’s Time for a Change… Media Sensationalism of Mental Illness needs to stop.

      • Marydohrenwend

        I think that there are some, very few, people with mental illness that do pose a threat to others. But, this is extraordinarily rare. I’m not, in any way, saying that this is not a problem for those extreme cases. However, statistically, many more people with mental illness are victims of violence than all of those mass shootings by the few and rare that have done that. It’s like saying that everyone who is an addict has killed someone with their car by driving drunk. Actually, there are many many more deaths by drunks on the road than there are mass shootings. Furthermore, the stigma of mental illness is more of a cause of those mass shootings than the individual causes of each. In each of those situations, the people involved were untreated. As long as the stigma persists, people are more likely to wind up doing these things. The stigma makes those who are ill avoid therapy. For example, the kid that shot up Newtown… he was not under the care that he needed and was ostracized by society for seeming to be different. When we marginalize people who are different, whatever the reason, we exacerbate the illness. Marginalizing those with physical illness does not make their physical illness worse. If you marginalize someone because they have a visual impairment, you don’t make them more blind by marginalizing them. The vast majority of those that have “mental illnesses” are able to live completely normal and productive lives. It is only a miniscule portion of people with mental illness who commit these kind of crimes. When you stigmatize the entire sub-population of people with these types of illnesses, you contribute to the build up and lack of treatment that leads to those horrible acts. I’m not saying that they are ok or excusable by any means. But, if your concern is to prevent those things from happening, don’t treat all people with these “mental illnesses’ as if they are likely to do that. It’s just not statistically justified.

    • DRF

      Do you mean that by referring to one large category rather than to individual illnesses contributes to the stigma?

      • HaroldAMaio

        It contributes to prejudice and discrimination. See history, “the” Blacks for very clear example.
        No one’s prejudice and discrimination are my “stigma.” They are the prejudices of the person alleging them to overcome.

      • Marydohrenwend

        Yes. And, it isn’t only the person’s diagnosis that causes the crime. How about, “Teen who is ostracized, bullied and discriminated against turns his pain on society and kills mother, 26 others and self.” this would be much more accurate. By mentioning the illness in the headline at all, shouldn’t be done because it puts the blame for the crime on the illness. There are other, in my opinion, more significant factors that contribute to someone with depression might commit that kind of crime. Do you honestly think that the Newtown shooter would have committed that crime if he was not made into a loner with poor and little treatment for his illness? He was not normal. He was pushed out of his rightful place in society as a citizen. His mother contributed to that by not taking him to the hospital when she saw that he was decompensating and taking off for the weekend. Father and brother had removed themselves from his life. What did he have to live for? Should he not be angry for being treated this way as a member of the community? I’m not saying it’s ok that he did what he did. Of course, I’m not saying that in any way. But, it is not as simple as the presence of a diagnosed illness of any kind. So, to make it part of the headline, makes it entirely about the illness without qualification. So, those 99.99% of people with “mental illnesses” who do not commit these kinds of crimes, who get the treatment they need, are thought of as being capable of committing this kind of crime, which is completely untrue. This is how it contributes to the stigma.

        • DRF

          But if the fact that he was not treated is why he committed the crime–and it is–then isn’t the fact that he had something that rendered him in need of treatment relevant? The point of the article that Goldberg cites is that people whose mental illnesses/psychiatric abnormalities/specific diagnoses render them dangerous have access to guns, not that people who have been mistreated or abused have access to guns. Lord knows someone can survive years of abuse and ostracism without meriting a psychological diagnosis.

          His mother was trying to get him placed in an institution when she died. As far as I know, this shooter was diagnosed, correctly or otherwise, with Asperger syndrome, which is odd because it’s not usually associated with violence, even less so that most other conditions.

          • Marydohrenwend

            The fact that you’re saying that this is odd, further shows that you are influenced by the media’s focus on “mental illness” as being the cause of violent crime. People who are “mentally ill” are much more likely to be the victims of crime. You never hear about this though. IE headline: Another mentally ill person beaten by ignorant asses. Your basing your opinion on what the media focuses on, not the facts of crime in the US. You are conditioned to see those with mental illness as being violent to others when statistically it is only a very small segment of that population that commit violent crimes, smaller than the general population. Do you also think that all Muslims are terrorists who are looking to kill all Americans in mass murder acts? This is what discrimination looks like. Are all African Americans dangerous? Are only pretty white little girls kidnapped? That’s what the media would have us believe. Although, one huge difference is that people with one of these illnesses do not come out in public about it and so we don’t see positive role models to counterbalance the extreme few who do commit crime. A blind man climbs Mount Everes and it’s all over the news. A man with diabetes makes the top three on American Idol! When was the last time you heard any good news about a person with a “mental illness” doing something extraordinary? The public gets classically conditioned to associate “mental illness” with violence when it is factually true that they are less violent than the average public.

          • DRF

            I’m not talking about crime in general. I’m talking about the Newtown shooting. Just because the media says something doesn’t mean that it’s wrong. Are you saying that this shooter had a logical reason to kill all those kids? I’m not asking if you endorse what he did morally; you’ve made it clear that you don’t, but what, other than mental illness, explains his actions in this particular case? Do you think he saw them as a threat? Do you think he was overcome by jealousy or greed? Was he trying to cover up another crime? Those are the usual reasons for murder. Lots of people commit murders but aren’t classified as mentally ill. What do you think was going on with him if not mental illness?

            As for people with mental illness doing something extraordinary, we see that in the media all the time, even though it’s not always accurately portrayed and is often fictional. I’ve got “A Beautiful Mind,” that movie about Temple Grandin, “Community” (Abed has Asperger’s), “Monk,” “Cryptonomicon…”

          • Marydohrenwend

            I’m saying that a person with mental illness who is treated with respect and dignity and whose illness is not exacerbated by the isolation and intolerance of others will probably not commit these crimes. And, Aspberger’s is not a mental illness in the general sense of what we’re talking about. People with Aspberger’s are not any more violent than those who do not have this illness. Temple Grandin is not what people typically think of as “mentally ill”. So these are not good examples. The rest are fictional, except A Beautiful Mind. That movie is actually not a true representation of schizophrenia or typical in any way. Besides that, I’m not talking about that. I’m talking about the media in general. where to you see or hear about people with “mental illnesses” succeeding in their lives, represented as most usually live? Give me one example of tv characters that that are leading normal lives, like most people with “mental illnesses”. They don’t exist.

          • DRF

            I’m not talking in general. I’m talking about the particular case cited in the article. Do you mean to say that you think that the Newtown shooter’s illness was not relevant to his commission of the crime?

        • Cindi

          Bravo Marydohrenwend!! I am really impressed by your knowledge and insight. Your statement perfectly describes the way that I feel about the stigma of mental illness . People who perpetrate these horrible crimes

    • Rachael Caruso

      I agree. In my experience, people whose egos were on display were those that enjoyed using such labels.

      That being said, I realize that there is fear associated with disorders found in the DSM. Humans with most physical illnesses are not feared because those illnesses don’t have a history of affecting others. So little is known about psychiatric disorders, that people are in the dark, groping at labels. Public education about these problems would result in an upward spiral of benefit to humanity. People often use the accurate descriptions when those words are used in the media, and when more people know about the varieties of afflictions that exist, more of them can seek help and function better. When people aren’t afraid of being assisted on their journey, less of them will become dangerous to others.

      Right now we are perpetuating the wrong spiral.

    • nnyl

      I get what you are saying, but many people don’t have a single diagnosis, so it can be harder to separate into the individual with xyz illness.I know someone who has been diagnosed with bipolar disorder, PTSD, panic disorder, and generalized anxiety disorder for example.

      I like calling mental illness biological brain disorder. The term mental illness” implies the brain is not connected to the rest of the body.

      • Cindi

        It is very common for someone diagnosed with Bipolar Disorder or Depression to also be diagnosed with an anxiety disorder.

    • Jake McGrew

      Thank you for that truly thoughtful commentary. It is so rare to see well reasoned and compassionate statements in these “comments” sections (though NPR is better than most sites). I really like you are argument about differentiating between different metal conditions. To lump all of these together into “mental illness” is not only stigmatizing and marginalizing, it is way too simplistic.

      • Marydohrenwend

        Thank you Jake.

    • FEDUP4brain

      “mental” illness is still unfortunately and wrongly considered a “behavioral” disorder..and managed outside of physical illness under the federal agency of SAMHSA ..its needs to be under NIH along with heart, liver, other brain disorders like autism/Alzheimers, cancer..

  • Brian C. Bock

    We’re quickly getting to the point where we can’t discuss anything without unintentionally pissing someone off. I see “The Hearing Impaired” and “The Deaf” and “The Blind”. It’s a short hand for describing a group with defining characteristic. I’m gay and if someone wants to say “The Gays” I don’t mind. They’re just being redundant since grammatically, they just need to say “gays”. So is it also incorrect to refer to people by nationality: The French. The Russians. Someone really needs to put out a frequently updated chart so we can all keep track of who’s being prickly today. I don’t pretend that I’m immune to this. I hate when people refer to gays and lesbians as “homosexuals”. So I don’t have the right answers to these issues either.

    • lynnelmiller

      the women? the catholics? the boy scouts?

      • AJ French

        Lynnelmiller – - Women, Catholics and Boy Scouts are (for the most part) considered respectable populations so putting “the” in front of these groups does not have the same prejudicial connotations as “the blacks, the Jews, the gays, mentally ill.”

        Brian Bock – - It’s not about pissing people off. It’s not about political correctness either. It’s more along the lines of just trying to be respectful of how others would like to be identified. We used to use the word “handicap” but now use the word “disability.” We used to use the word black (and before that, negro) but now use the word African-American. Why? Because identity is the core of who we are as human beings and both populations had a long overdue need to be identified with respect. When media and entertainment industries continue to use language that an overwhelming majority of us feel degraded by – - and have continued to express that we feel degraded by – - this is wrong.

    • Nathalie

      Why does “homosexuals” piss you off?

  • Lee New

    My ex-girlfriend has been diagnosed with Borderline Personality Disorder, Bipolar Disorder, Major depressive Disorder and Generalized Anxiety Disorder and she is definitely mentally ill. She has been stalking and harassing me for nearly two years now. The mentally ill can be very dangerous.

    • Judy Cornelison

      Lee New: Again, the fact that a person with several psychiatric diagnoses has had a negative impact on your life does not mean that every person with a diagnosable disorder is a danger to you.

    • lex

      Yes, some mentally ill people might be dangerous; however not all are dangerous. If you have an ex that has been stalking you, that is not necessarily due to her diagnosis. I am sure that there are a lot of people that stalk that have never had those factors present. What I mean is that some people may, after a breakup, etc. become very despondent and may therefore start to exhibit unhealthy self-destructive behaviors. It can be a chicken-egg thing.
      Yes, her stalking you is fairly indicative of a person who does not handle rejection. However, I have seen people who, normally, are okay, but fall apart after certain events.
      Two years is a long time to keep that up. Isn’t there anything you can do to stop it? I am not insulting your intelligence, but just asking if you have any resources to make it stop. (Restraining order). Of course, some stalkers are pretty sneaky-making it hard to prove. Plus, a lot of cops, etc. blow it off ( until something happens). Good luck. It is not fun to be stalked.
      I have clinical depression and, when it hits me, the only person in danger is me. Depression sometimes brings about suicidal ideation. Other than me, no one is at risk. I am probably the nicest and most docile person on the planet when I feel this way.

      • Briana Roy

        “If you have an ex that has been stalking you, that is not necessarily due to her diagnosis.”

        Of course it isn’t. Her behavior created a diagnosis, not the other way around. If you were to look up the defining criteria of Borderline Personality Disorder it would become immediately apparent that people whose behavior have resulted in a diagnosis of BPD may be at risk of stalking (e.g. criteria: frantic efforts to avoid real or imagined abandonment). When and if her behavior shifts then she will no longer be considered a person with borderline personality disorder.

        I think it is unacceptable to pretend that diagnoses are unrelated to behavior just as it is unacceptable to assume that all behavior is related to a particular diagnosis.

    • Joan Sara Kelly-Marotto

      My ex-usband stalked me for two years- and he had no mental health diagnosis: he was just and ass@*&@. You are making a claim that it not statistically supported. In far more cases, a person with a major mood disorder or psychiatric illness is far more likely to be the victim of crime, rather than a perpetrator. You cannot make a case against all people with mental health issues by your one example.

  • dylan

    Oh please

    • igotnothin

      expound, please.

  • R G

    Fellow humans, Shamans… I greet you. Meditation is superior to Medication. Dancing and singing can help. Pharms and surgery (in general) should (dare I use that word) be the last resort. I agree using the word “the” does make it sound Separative (and thus wrong). Language automatically ultimately divides. Though words can soothe…sounds can heal…compassion can heal…Love can heal…Actually the Soul is perfect all we have to do is get out of our own way. Sensitive people are not mentally ill but some may be too sensitive. Us vs them or “other than” is wrong. I go for many years thinking I am beyond prejudice and racism and then I catch myself. Categorizing people into small groups is probably wrong. Yes it is wrong. Perhaps those who go through something emerge able to help others. Or may now have a gift to offer humanity and all the kingdoms of nature with which we are ALL part of. The thing that helped me was a place to sleep,rest, yogurt, 31 flavors ice cream, cannibis, tv, shopping for groceries and more care with foods I picked out, a Meditation place…Help financial and patience and compassion.

  • Scott A. Krohn

    When a person breaks their leg, we don’t label them as “broken,” do we? Perhaps we should step away from the whole concept of labeling. Labeling creates schisms instead of community. Also, I believe “People First” is a recognized self advocacy organization.

    • lynnelmiller

      those with arthritis are “the inflamed?”

      • mk quacklemeier

        Love it. I am going to call myself that!

    • Scott Thagard

      The military does—–not on an official level, but on a Unit rank and file level.Speaking as an Infantry SGT pending med discharge for PTSD, “broken” (physically) Soldiers are refered by some some as “broke” or “broke dic+’s”…….most especially w/ PTSD are ashamed and hide the diagnoses, as you may be perceived to be “weak”. After many many needless suicides.the military is working on changing this stigma. It will take time, and they seriously are trying to change perceptions within the “warrior” culture. Attempting to become a peer counselor at the VA myself currently.

  • TJDestry

    As a headline writer, I need that better phrase soon. “The mentally ill” is long, though, in a hed, the article is often dropped. Still, we’re talking about a grouping of disorders and we’re going to need an overarching term that encapsulates people with mental illness who pose a danger to themselves or others, as opposed to those who simply need extra help in school or who may dominate and disrupt an online discussion with their insistent approach.

    And I agree with the reader/listener who points out that we still use the word “rape” and, rather than come up with a less familiar term so we can start the association process over, count on people to learn to stop stigmatizing the victims.

    Similarly, I think people are beginning to realize how often the causes of the-problem-that-must-not-be-named is the result of physiological causes, including but not limited to genetics or diet. The Cartesian approach may be outdated, but, again, that’s a matter of education. I’m certainly willing to swap “obese” for the more judgmental, informal “fat,” and I would never think “crazy” was an acceptable term for someone with a mental disorder.

    But, again and strictly from a pragmatic point of view, I don’t see a time when layout will permit a headline that reads ” When Right to Bear Arms Involves Those Who, For A Variety of Reasons That May Be Physiological In Origin Have Been Adjudged Possibly Dangerous To Themselves Or Others Either Through Violent Behavior, Anger Control Issues or Lack of Clear Reasoning Abilities.”

    Particularly since I suspect the article in question was about people whose deviance from the norm, though necessitating treatment, does not pose a likely danger to anyone.

    • Christopher Wright

      good point. As medical technology, health science and research evolves,
      so should it’s language. Mental Retardation (MR) is a term that has
      almost been eliminated in medicine because it has become offensive and
      considered a ‘catch-all’ phrase to cover
      a plethora of conditions. Intellectual Disability (ID) has taken it’s
      place, just as (MR) took the place of it’s previously used terms in the
      mid twentieth century because they had become seen as in need of
      replacement. This is not PC overkill, it’s treating people like people.
      Good article.

      • Still Anonymous

        It’s called the euphemism treadmill. Today’s replacement is tomorrow’s offensive term.

        • J__o__h__n

          That’s crazy.

    • Laurie Yankowitz

      I would go with using the term “psychiatric” whenever possible, in keeping with a categorization related to treatment and medical diagnoses to describe
      conditions that deviate (in the statistical sense!) from health norms. “Equal coverage for psychiatric care;” “New Era for Psychiatric Treatment;” “Crime and Psychiatric Conditions.” I don’t see a way to trump human tendencies to generalize and failure to grasp multiple layers of nuances that are inherent in understanding just about anything with a few well chosen words. None-the-less, I suggest that targeting the condition from a more clinical perspective helps address the issue of ascribing an all-encompassing identity to people who have such a condition.

    • AJ French

      TJ Destry: I appreciate your comment here. I think the thing is, saying “the mentally ill” is like saying “the jews, the blacks, the gays, etc.” Instead of “When Right to Bear Arms include the Mentally Ill” the headline easily could have said, “Civil Rights for Whom?” which is much less word count and the real heart of the article. The NYT would never have ran the the headline “When Right to Bear Arms Exclude the Mentally Ill” (think this will be title of my next blog) and their choice in title perpetuates a mindset that it is okay to contemplate and discuss who is and is not entitled to civil rights.

    • elaimont

      Mental health professionals use a wide variety of terms other than “rape”. This includes maltreatment, sexual assault, sexual abuse. Maltreatment is growing with popularity, as it is less stigmatizing, especially for young people: (http://nij.gov/topics/crime/child-abuse/pages/welcome.aspx#note1).

      Professionals are also replacing stigmatizing phrases such as “the mentally ill” with person-first labels such as “People with serious mental illness”(http://www.nami.org/template.cfm?section=about_mental_illness).

      @disqus_01I7FZZsLP:disqus is correct in that clinicians are also adopting ID over MR. It is a more sensitive portrayal.

      Lastly, it is important to acknowledge that there is a subset of the population, both for populations with and without psychopathology that are prone to criminal and violent acts.

    • Marcelle H

      LOL, as opposed to those “who may
      dominate and disrupt an online discussion with their insistent approach.”

      I think the problem could be solved by saying “mentally unstable” or something else that emphasizes a transient condition rather than an ongoing diagnosis. As the author notes, psychiatric illnesses are as treatable as most other diseases. If you’re treating your illness and keeping it under control, then you’re just as capable as anyone else. Whether your illness is depression or diabetes if you stop treatment your behavior can become unpredictable, and in some cases dangerous to yourself or others.

      A friend of mine had his car totaled while he was parked because a person with diabetes had neglected to treat herself for so long that she went into shock while driving and lost consciousness and drove into the back of his car at 40mph.

      On the other hand I have a friend that I knew for years before she confided in me that she was diagnosed with bi-polar disorder. I never would have guessed she had a single health issue because she managed her condition so well.

      The headline writers are, in effect, struggling to compensate for society’s bias against mental illnesses. If there wasn’t a singling out in the first place then it wouldn’t be so hard to phrase it correctly. The gun control issue is a good example. I don’t have all the statistics, but as an example, there’s a report from the city of Chicago from 2011 detailing the city’s gun homicides from that year and only 2 of the 433 gun related homicides were classified as a result of “Mental Disorder”. The vast majority were violent crime related, gang related, robbery related, or domestic violence related. So why is the national debate and the front page headlines about the dangers of mentally ill people getting their hands on a gun, when there so many more present dangers at hand?

    • HaroldAMaio

      There is no specificity in “the”, whether directed at “the” Jews, “the” Blacks, or “the” mentally ill. Two would not occur in any headline, one occurs often. When the topic of the article is specific, that specificity ought appear in the headline.

  • Hubbsyo

    No one person’s prejudice creates a stigma. However, when such a perspective is so consumed and accepted by a society, then the term “stigma” seems appropriate. If not, then what is a stigma? What treatment of what behavior would be worthy of the term “stigma” that would be so different from how our society treats those with the label of mentally ill?
    Matthew Hubbs, EdD

    • Barry Adams

      That must also be true of “status” within a society? Credentials must be consumed and accepted to produce power.

      • Hubbsyo

        Would you like me to remove my degree from my signature, Barry? Would that give my post any more or less credence for you? I didn’t feel my statement was one in which power was an issue- I thought the logic would speak for itself. But perhaps I assume too much. You get back to me and let me know.

        • Barry Adams

          I found your comment interesting. Therefore, I also found your choice to include your academic credentials curious, especially if you believe your logic can stand on its own. Are credentials (another form of labeling and categorizing people), when brought into a public discussion of thoughts, ideas and opinions, rather than, say, in a private consultation for professional services requiring particular learned and authoritative expertise, not a little grab for domination (i.e. power) in public discourse; the result of an elevated social status resulting from how our society treats those labeled with them, as opposed to stigma?

          • mike michaels

            I’ve found that people who have not gone through the rigors of obtaining advanced degrees are more likely to discount their value.

          • Amy Blankenship

            Perhaps people who don’t see much value in advanced degrees are less likely to invest the time and money–especially if they observe it isn’t correlated with increased capabilities.

          • mike michaels

            perhaps. but that merely proves the point as underscored by looking at the history of GED. in brief, it was initially designed as a test for WWII combat veterans who left high school to serve, to progress into college. this year’s changes make the GED closer to the rigors of a high school education. studies have found that people unable to progress through the organized eduational system are significantly less likely to be able to meet the needs of employers. so I suggest that the observation of no value of an advanced degree may be wrong.

          • crankymate

            It’s an EdD for goodness sake. If it were a PhD in Neurology or psychiatric studies, I may have some respect. You can get an EdD as easily as opening a chip packet.

          • mike michaels

            obviously you have not gone through the process to post such nonsense.

    • HaroldAMaio

      You are correct that no one person’s claim of “stigma” creates it. Broad cooperation does, but only where that broad cooperation exists. Erving Goffman claimed society cooperates, he failed to recognize that particular society does.

      You have been trained to say “label,” I have not.

      How does society treat “people with a mental illness?” ( A longer form of “the” mentally ill)
      We are a broad demographic. We are treated the same as any broad demographic, differently. Some are treated as their illness, some as our accomplishments. Some of us are treated by some people as our illnesses, and by other people by our accomplishments. I am more often treated according to my accomplishments.

  • FEDUP4brain

    One of the most stigmatizing barrier to
    treatment is the “out dated, negative, stereotyped” use of the term
    MENTAL ILLNESS. We need to immediately update our diagnostic categories
    to more neutral classifications reflecting the underlying location and
    severity of brain illness (much like we do with cancer-stages 1-4, heart
    disease-block 1-3)

    • exitr

      But not all psychiatric disorders are “brain illnesses.” I don’t think the answer is to medicalize these conditions further; labels like “schizophrenic” or “hysteric” were once medically specific, “neutral” classifications, after all…

      • FEDUP4brain

        It depends on what your definition of “illness” is…poor health, ailment, complaint, disorder, malady, affliction…the biology of an illness is “medical”..and the diagnostic label of schizophrenia is definitely not a neutral one…times have changed my friend…brain research/neuroscience has established the biology. Physical health care can STOP the stigma that “behavioral” health/science inadequately addresses>that they are real biological illnesses, they are not just “morphed into” from environmental factors, and/or self inflicted from bad choices. ALL illness-from cancer to heart disease- has the elements of biology, environment, and psychology/mind. Its all so intertwined, who can define the line. The brain is an organ though-just like the heart, liver, kidney, lungs>it can malfunction..and this can occur at any age…not just up to 18 with autism>then jump to 65 with Alzheimer’s.

        • exitr

          The mind ≠ the brain, though. I’m skeptical that emphasizing the biological will have the de-stigmatizing effect you describe. Shame and disapproval attach as easily to bodies as to behaviors.

          And yes, I recognize that schizophrenia is not now a neutral term, which is why I stuck “were once” in there.

          • FEDUP4brain

            After working in physical health care for 35 yrs-you couldn’t be more wrong with the stigma associated with (assumed choice) “behavioral disorders” vs (no fault) physical disorders. There is little empathy with “behavioral disorders” and much higher empathy with biological disorders. I have personally witnessed this discrimination on many levels-from insurance/reimbursement-to complete ignorance by society on the neuroscience of brain/mental illness- my own son was given poor/sub level “care” with his (none drug abuse) brain disorder of schizophrenia. Never have i witnessed such ignorance and abuse as seen in the health care delivery SYSTEM of behavioral health. Its like night and day to physical health care. (and as you know BHC manages all “mental illnesses” by “authorizing and directing all in-patient, outpatient, and ongoing appointments-NOT MD’s) “Environmental/behavioral factors” cant be sued or held accountable>>but the physiology of an illness has “standards of care” which has liability and accountability-esp to provide the “after care” associated with dependent adults..plus you are aware the “mind” can go into altered states from many medical abnormalities..the brain does not have a monopoly on the functioning of the “MIND”…electrolyte imbalances, high blood sugars, sepsis, fever, kidney failure, immune deficiencies, side affects of medications..many abnormal conditions can cause confusion, delirium, psychosis-so we can blame the colon, kidneys, immune system, endocrine system, heart, lungs etc etc for dysfunctional mental states…the problem is most people can not distinguish medical symptoms from behaviors-because they are just plain uneducated concerning the nervous system, neurological symptoms and the many disorders that have accompanied agitation, confusion, delusion and aggression. Anyone who’s worked in the medical field clearly understands altered states of consciousness-whether they are extremely ill in ICU, suffering major trauma.(with head injures being the most agitated and combative) or coming out of anesthesia…the nicest little old lady with Alzheimer’s will punch you in the face out of confusion…none of the neurological symptoms are much different than whats seen in schizophrenia (which is a neurobiological developmental brain disorder extremely similar to autism)

  • HaroldAMaio

    So long as you direct any stigma, I will object. So long as you repeat any claim of stigma, I will object. Your prejudice is not my “stigma.” It is your prejudice to won, and hopefully overcome.
    NPR choosing to repeat your prejudice illustrates that it is theirs as well. Using their corporate power to do so is wholly unethical.

    • HaroldAMaio

      Sorry for the typo, I meant “own.”

      • MakeThisLookAwesome

        Just because they’re reporting on the views of others does not mean they share or participate in those views. They’re not the ones who created or even perpetuated the stigma. In fact, they’re trying here to help eliminate that stigma by drawing attention to the language we use around psychiatric issues. They’re not prejudice, not have they encouraged prejudice. Quite the opposite, in fact. The article states VERY clearly that people are people first, and a diagnosis is something you have, not who you are.

        They’re on your side!!! They agree with you, and they’re trying to help in this regard. I think this is just a big misunderstanding, and they don’t deserve the harsh words, imnsho.

        • HaroldAMaio

          Whoever directs the term “stigma” and for whatever reason, harms. You directed it above.

          • exitr

            This word you keep saying, I do not think it means what you think it means.

          • HaroldAMaio

            What does it mean to you?

          • exitr

            “Stigma” is awfully close to “prejudice,” I think: a mark of social disapproval. To describe a trait as stigmatized is not to endorse that disapproval.

          • HaroldAMaio

            Calling prejudice and discrimination by that name is an act of prejudice.

          • MakeThisLookAwesome

            Um… no. Just because someone uses the word stigma does not mean you can infer harm. No harm is done in using the word stigma.

            Just because you assume your being persecuted doesn’t make it so.

          • HaroldAMaio

            Thank you for the note.
            The term hurts, it has no other meaning. No one’s prejudice is someone else’s “stigma.” It is their prejudice to acknowledge and hopefully overcome.
            Most of the time it is used out of habit, not behavior. It is not my habit.

          • MakeThisLookAwesome

            It does have other meanings, check the dictionary. It is not their prejudice, it’s YOURS. You’re the only person upset, and the entire Internet is trying to get you to see reason.

            You cannot say “most of the time it’s used out of habit.” There’s no way you could even know that.

            Just because you thought it up doesn’t make it true.

          • HaroldAMaio

            OK, the term is your prejudice. It is not mine.

          • MakeThisLookAwesome

            Really… You’re the one who’s getting bent out of shape (what pre-judgement means) and I’m the one with the so-called problem? Just because you hang a sign on it that says: “horse,” doesn’t make it a horse.

          • HaroldAMaio

            Thank you for the note.
            You are correct, just because someone has been trained to call prejudice and discrimination on their part “stigma,” does not mean than it is.

          • Guest

            No, just using the word stigma is not harmful. No word is inherently harmful. No word inherently has meaning! WE give words meaning or choose to infer harm. This is all a world of your own design. If you don’t like it, that’s no one’s fault but your own. You decided to take issue. No one is persecuting you, nor have they.

          • HaroldAMaio

            Thanks for the note:

            —No, just using the word stigma is not harmful.

            See history, World War II, “the” Jews.

  • HaroldAMaio

    You had me completely with your article, until this:

    —The trouble, Dr. Beresin adds, is that “mental illness” is uniquely stigmatized.

    See rape/stigma for my objection, if you have forgotten:
    — No one’s prejudice is my “stigma.”
    Please change your policy on directing that term. Do not do is for anyone, nor against anyone.

    Regrettably, I could find no access to either author or editor. Please correct.

    Harold A. Maio

    • careyg

      Dear Harold — Many thanks but please explain! I’ll call to Dr. Beresin’s attention, too — happy to fix but not clear on the problem — My email is careyg@comcast.net. You can also always click on the “get in touch” button at the bottom of the home page, too –

    • @Gene BeresinMD

      Dear Harold,

      You make a very important point. When I noted that “mental Illness” is uniquely stigmatized, I did not intend to imply that it was alone in a “uniquely” stigmatized fashion. Surely there are many conditions and disorders that have unique stigma associated with them. The rape victim is far too often uniquely stigmatized as “bringing this on him or herself” – a horrifying and devastating blow to the victim. Mental Health has its own unique stigma in our country and globally. For example, in many countries, one suffering from a mental illness is viewed as possessed by demons, and is treated brutally and isolated. I apologize if my comment was misunderstood that mental health was unique in its derogatory stereotype. Far from it. I was simply pointing out a very unfortunate, and misunderstood situation for those who suffer from a psychiatric disorder, and this accounts for at least 25% of our population. I apologize if I appeared to exclude that many others in our society who are the brunt of stigma.

      Gene Berersin, MD, MA

    • lynnelmiller

      you think we should say “people who rape?”

    • Darby Penney

      Harold raises an important point. What mental health professionals and the media call “stigma” is in fact just prejudice and discrimination. No one talks about the “stigma” of being black, they talk about prejudice and discrimination against black people. The same is true about people with psychiatric histories.

      • HaroldAMaio

        It is interesting how times changes.

        A new dean for Florida Gulf Coast University and I were talking one day. Being new to the area, he needed an apartment and called around until he found a complex that told him they had exactly what he was looking for.
        When he arrived, they suddenly did not have one. He looked them square in the face and said show me the apartment or I will sue you for civil rights violation.
        There was a time he would have walked away blaming himself, his skin. They could not hear from his voice over the phone that he was African American. They could not miss it when he showed up.
        Fully empowered, he saw there prejudice, their discrimination toward , and stopped it in its tracks.
        Each time someone suggests the term “stigma” I know the prejudice and discrimination directed at me, and I do as he did.

        It is an impertinence I do not tolerate.

      • exitr

        The distinction between “stigma” and “prejudice and discrimination” isn’t really clear. Stigma is prejudice, or a form of prejudice anyway. It’s true we tend to apply it more to some attributes than others – the stigma of single motherhood, or of left-handedness, for example, but not the stigma of race. But while there may be a real difference between saying “people with mental illness are stigmatized” and “there is a prejudice against people with mental illness,” it’s not a sharp, unambiguous one.

      • wanderingi

        It feels, to me, as if the weight of a “stigma” is borne by the party with the condition. Thus the stigma of being “prejudiced” is borne by the prejudiced party.

        In the USA, I can’t agree with your assertion, “The same is true about people with psychiatric histories.” It seems that “their condition” is stigmatized; and it is much less common, for the general population, to see the impact of prejudice or discrimination.