We’ve come a long way over the last few decades in understanding mental illnesses, and in shedding misconceptions and stigmas associated with them. But there is still a ways to go. Secretary Clinton, talking some months ago on the campaign trail, recognized this: “We’ve got to make clear mental health is not a personal failing”, she said. President Obama, some weeks earlier, similarly lamented that addiction is too often seen as a “character flaw” rather than a health problem. We’ll leave policy making to the politicians for now, but meanwhile, there is a small role each of us can play in helping to ensure that mental illnesses aren’t seen as personal failings or flaws. And that role may have less to do with medicine or with mental health than with English 101. That’s because words matter, and the language we use shapes the way we think about and treat our fellow human beings.
The ‘Adjective-ization’ of Mental Illness
Let’s begin with a hypothetical description of two good friends, Mary and Elizabeth. Both are in their early 40’s, live in the same town, and have two teenage children. Mary has heart disease. Elizabeth is bipolar.
It should be immediately obvious that the friends share demographics, but not diagnoses. But maybe you didn’t notice something else: in Mary’s case, we talked about her diagnosis as a noun (Mary has heart disease), but in Elizabeth’s, as an adjective (she is bipolar). This distinction is about far more than grammar or parts-of-speech, though: it reflects continuing societal differences between how we perceive illnesses of the brain and mind versus those of other parts of the body. In the case of the latter, we separate the illness from the person, but when it comes to mental disorders, we tend to personalize. By using the adjective form (“is”), illness and identity become wrapped into one, even though a person who develops bipolar disorder did no more to ‘get it’ than did a person with cancer or heart disease.
There are many such examples of this ‘adjective-ization’ of mental illness: “Diane is schizophrenic; Spencer is autistic; Susan is ADHD; Robert is alcoholic; Melissa is anorexic”; etc. Such usage is common in the news and on TV shows. You hear it in everyday water-cooler conversations, and may have even used it yourself (I certainly catch myself doing so periodically). Interestingly, the American Psychiatric Association cautions, in the preface of its diagnostic manual, the DSM: “A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are disorders that people have.” Yet, mental health professionals often lapse into the adjective too.
Perhaps most unfortunately, many people suffering from mental illnesses see themselves as being that way as well. Such a characterization can be detrimental, as it negatively impacts self-perception and takes away a sense of control and desire for treatment. For when see ourselves as having something, we think of it as something we can change; but when being something, change suddenly sounds harder.
Separate The Diagnosis from The Human Being
The next time you are talking about someone with a mental illness, try switching the “is” to “has”. Instead of “Diane is schizophrenic”, try “Diane has schizophrenia”; Robert has alcoholism; Spencer has autism; and Melissa has anorexia.
And listen to what happens...
By making this seemingly simple switch, we immediately change the tone, reinforce that these are illnesses- not flaws or failings, and that they deserve the same dignity as illnesses that originate in other parts of the body. Consider this from a different angle: would we say about someone with advanced blood cancer: “she is so leukemic”, the way we might casually toss out about someone with advanced attention problems: “he is so ADHD”?
An acquaintance recently said to me while talking about her daughter: “when she was 20, she came down with the bipolar”. I love this anecdote because the mother saw the disorder non-judgmentally, and in its medical context – just like the APA manual recommended.
To be sure, simply changing words won’t completely alter the way people with mental illnesses are seen and treated in this country. But many big changes have begun in the form of little steps, and I have found in my day-to-day experiences that speaking about mental illness in less personalizing tones helps to separate the diagnosis from the human being and to nurture a greater sense of awareness and equity.
Best of all, doing so requires little effort, and no cost, so it is something each one of us can try. This may sound like all it’s about is changing words. But the impact can be about so much more.
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Dr. Talati is an Assistant Professor of Clinical Neurobiology in Psychiatry at Columbia University and New York State Psychiatric Institute, where he studies the epidemiology and neurobiology of psychiatric and substance use disorders.