In The Man Who Mistook His Wife for a Hat, British neurologist and author Oliver Sacks zeroes in on neurology’s favourite word: “deficit”. The word used in this sense denotes “an impairment or incapacity of neurological function: loss of speech, loss of language, loss of memory, loss of vision, loss of dexterity, loss of identity and myriad other lacks and losses of specific functions (or faculties)”.

Over time, these “deficits” and their manifestations in people have taken myriad words, turns of phrases and expressions that fracture the self-esteem, confidence and identities of people living with mental illnesses. These written or spoken words – often employed without a second thought – include “schizo”, “bipolar”, “OCD” and “psycho”. When I typed the word “psycho” into WhatsApp’s GIF section, I found scenes from Alfred Hitchcock’s The Birds and people judgementally mouthing the word in scenes from a well-known Netflix series.

Conversations in which these words are carelessly bandied about usually take the form of commiseration, expressions of frustration or plain mean-spiritedness. What we sometimes don’t realise is that the way in which we use language can have a substantial impact on people’s lives because it relies on certain biases, which we mistake for shared belief systems. What this means is that how we express ourselves in comfortable conversation with one another implies that whatever we impart is a shared belief born from the same reference frameworks, backgrounds and lived experiences.

Condescending and stigmatising

The use of words like “psycho” (short for psychotic), “bipolar” (short for bipolar disorder) and “schizo” (short for schizophrenia) in everyday conversation comes at the expense of people living with mental illnesses because it diminishes their chances of seeking treatment. In 2018, the medical journal The Lancet found that in the context of mental illnesses, mental health and well-being, “negative words can be experienced as condescending, isolating and stigmatising”.

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Discrimination against people living with a mental illness has a long history and conditions such as mania and hysteria, which would be considered mental illnesses today, have figured in classifications of disease since the time of Hippocrates. A general lack of knowledge – partially as a consequence of the centuries-old distinction between physical and mental illnesses – has been identified as one of the origins of stigmatisation and associated discrimination.  

Mental illness stigmatisation may originate in various forms, but over the course of the past few decades researchers have focused on social interactions through which people generally tend to generate and share meaning across contexts, cultures, media and channels. A number of examinations of exposure to stigmatising words found that they lead to prejudice, which results in people not seeking treatment for their mental health condition for fear of being shamed and treated differently.

The confines of supposed abilities

A few years ago, Stanford linguists and psychologists studying the interpretation of languages found that even the most minor alteration to sentences can correspond with the biased beliefs of speakers. For example, a relatively innocuous utterance like “girls are as good as boys at maths” is actually a subtle perpetuation of a sexist stereotype. Why? Because the grammatical structure of that sentence implies that excelling at maths is something boys are naturally good at. If we speak about boys and girls in these terms, girls, through simply taking in these turns of phrase, may “live” and “behave” within the confines of what they’ve been told about their abilities.

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Imagine then the effect of calling someone who behaves in a frustrating way a “psycho”, when that person has been seeing a psychiatrist as part of their treatment plan.

One of the biggest factors empowering a changed outlook in the mental health field is language. Just like we’ve started to eradicate derogatory and problematic language in other spheres of society, so too do we need to look at our speaking and meme and GIF collections and assess what needs to change.

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In 2021, the mental health resource Psycom released a list of common phrases and sayings and explained how we can go about updating it. Using short-form terms like “schizo” and “bipolar” is out of the question and the malleability of forms of expression means we can update how we convey something and validate thousands of people’s lived experiences.

The examples below show how verbs and descriptions must change to help us better relate to one another.

Anxiety, suicide and disorders

Whereas we used to say “my colleague has social anxiety disorder”, we’d now say “my colleague experiences social anxiety”. That’s because using the term “disorder” in everyday language is out. This example helps normalise feelings that are actually quite common and natural. It also helps to frame the symptoms or situation in a way that sounds less permanent and more able to be  worked through.

Instead of saying “she committed suicide” or “took her own life”, we’d now say “she died by suicide” or “we lost her to suicide”.

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It changed because saying someone took their own life implies a conscious choice. We know that when people get to the point where they are hopeless and depressed enough that they die by suicide, they’re not really thinking clearly – at least that’s how we look at it in mental health. Instead, saying “we lost them to suicide” highlights the tragedy of it.

We used to say someone is “a victim of an eating disorder” or “suffering from an eating disorder”. Now we’d say the person is “in eating recovery”. That’s because using terminologies like “victim” or “suffering” in reference to people who are experiencing or working through an issue can suggest a lack of quality of life. Instead, we focus on the positive fact that they’re in treatment and learning ways to cope and heal. DM168

Florence de Vries is a communications specialist and journalist whose primary research interests are in the fields of mental health and the ethics of care.

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R25.