Using respectful language for persons with mental illness

One out of every four persons is diagnosed with a mental illness in his or her lifetime. (Picture:

When speaking of people with mental health conditions, it’s usually easy to stay away from the worst of the pejoratives. We know that “crazy,” “psycho,” “head case,” and the rest are no better than “towelhead,” “kike,” “spic” or “beaner.” (See Part 1 of this article.)

But what do we say instead? Is “mentally ill” okay, for instance?

To find out, we asked Portlanders in the mental health community. The responses varied widely:

* “Call it what it is. ‘Mentally ill’ is the best so far.”
* “I’m not in love with [the term “mentally ill”]… my humble opinion is that those things that are too difficult and unpleasant defy definition.”
* “I have a mental illness and I’m fine calling it that. “
* “The term ‘mentally ill’ has a long, sordid past that evokes a distorted image… I tend to use the term ‘psychological disorder.’”
* “I agree that ‘mental health disorder’ or ‘psychological disorder’ is more appropriate… Ill/not ill is very restrictive.”
* “The current medical terminology is best… strength should be derived from ownership.”
* “Mental health issues.”
* “Chemical imbalance.”
* “I prefer ‘experiencing [specific symptoms].’”
* “I have epilepsy as well – both are brain disorders.”
* “I wish we didn’t have to call them ‘illnesses’ at all. That’s what attracted me to The Icarus Project, since they say ‘dangerous gifts,’ which acknowledges the positive and negative aspects of these issues without implying that we’re ‘sick.’

Where does that leave us? There are three important points to remember when talking about, or talking to, someone with a mental health issue.

1. Use “People First Language” (PFL), as described by the group Disability is Natural. According to the members of that group, PFL is a more respectful and accurate way of communicating. It emphasizes that people are not their diagnoses or disabilities; they are people, first. It’s not about being politically correct. It’s about being respectful, accurate, and using good manners and the golden rule. You would never define other individuals by their disease. We say, “People with cancer,” not “the cancerous.”

* Instead of: Mentally ill person OR the mentally ill
* Use: A person with a mental illness
* Try: My co-worker, who’s a computer whiz and married 10 years… he also happens to be diagnosed with bipolar disorder.

2. Use a paragraph, not a sentence. According to Portland therapist Casadi Marino, LCSW, “Descriptive language and context are important and improvements over labels.”

* Instead of: Bob is a schizophrenic
* Use: Bob is a person with schizophrenia
* Try: Bob reports hearing voices that are distressing and cause him to feel afraid. He may isolate out of fear that others mean him harm. At times he listens to loud music to try to distract from the voices he hears and his distress…

* Instead of: Lisa is a drug addict/junkie/drunk
* Use: Lisa has a substance abuse problem
* Try: Lisa has used substances in a manner that has led to significant issues.

3. Ask your friend. Get to know the person first – this is not a question for a passing acquaintance. Wait until it comes up naturally. Tell your friend you want to learn more about their experiences, if they’re comfortable sharing. When it’s appropriate, ask what they think of as “respectful language.”

For more information:

* Anti-Stigma: Do You Know the Facts?
* SAMHSA: Transformational Language
* “Facts About Stigma” NAMI MAC Brochure
* “The Rhetoric of Recovery Advocacy: An Essay On the Power of Language,” William L. White