Stigmatizing Slurs About Mental Illness By Folks On All Sides Should Stop



(5-22-17) From the White House down, politicians on both sides of the aisle, celebrities, and even mental health therapists need to stop using language inappropriately that increases stigma and marginalizes mental illnesses. 

Unfortunately, there has been a shameful increase of such remarks recently, especially last week. The use of inappropriate language showed up internationally, as well, with Russian President Vladimir Putin misusing the word “schizophrenia” when talking about American politics. 

One way to fight this is for responsible media outlets to explain when these words are used erroneously. Repeating them unchallenged fosters stigma.

I’ve posted an excerpt at the bottom of this post from the Associated Press style-book, which most publications use as their ethics standards.


1.  President Donald Trump reportedly told Russian diplomats that ex-FBI Director James Comey is a “nut job…” according to The New York Times… “He was crazy, a real nut job.”

2.  Trump directed the term at “wacky Glenn Beck.” Trump said the nationally syndicated radio host is a “real nut job” because he “always seems to be crying.”

3. Trump said North Korean leader Kim Jong Un “could be a total nut job.” “I mean, you’ve got this madman playing around with the nukes, and it has got to end. He’s certainly — he could be a total nut job, frankly,” Trump said on Fox News’ “On The Record” in January 2016.

4.”You know, I call him crazy Bernie because he’s not very good,” Trump said.

Here’s the flip side.

5.  “We know he’s crazy.” David Letterman said referencing Trump.

6. The New York Times is reporting that FBI Director James Comey called President Donald Trump “crazy” before he was fired. In a story posted on May 10, the Times reported, “The president, Mr. Comey told associates, was ‘outside the realm of normal,’ even ‘crazy.’”

7. More than 30,000 mental health professionals have signed on to an online petition, directed to Sen. Charles Schumer, arguing that Trump “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States” and “he must be removed from office.” (Not one of these professionals had interviewed Trump.)

8. The author, therapist Sherry Amatenstein, penned: “The other day I added my name to a petition signed by thousands of mental health professionals calling on Trump to be removed from office due to his apparent mental illness.” She called Mr. Trump’s supposed disorder “Malignant Narcissism,” which has “four toxic components: narcissism, paranoia, anti-social personality disorder, and sadism.” (To my knowledge, she had not interviewed Trump.)

9.  “I’ve been in this town for 26 years. I have never seen anything like this. I genuinely do not think this is a mentally healthy president,” Republican Eliot Cohen.

Writing in the New York Times, Robert Klitzman a professor of psychiatry and the director of the bioethics master’s program at Columbia University, noted:

 The American Psychiatric Association (A.P.A.) prohibits its members from giving professional opinions about public figures we have not interviewed.

This ban stems from a bad incident in my field. In 1964, Fact magazine published an article, announced on its cover as “1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President”. The magazine surveyed these professionals, and 49 percent of respondents said Barry M. Goldwater was unfit for the job, describing him as “unbalanced,” “immature,” “paranoid,” “psychotic” and “schizophrenic,” and questioning his “manliness.” Leading psychiatrists were among those quoted. A famous Johns Hopkins professor said Mr. Goldwater’s utterances should “disqualify him from the presidency…” (BTW Goldwater sued the magazine and won.)

…In response, the A.P.A. issued “The Goldwater Rule”:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

To diagnose conditions in someone we’ve never met — let alone offer treatment recommendations — is fraught both ethically and scientifically. Assessing patients face to face and finding out their experiences and history, much of which is private, and has perhaps never been disclosed to anyone, is essential. Otherwise, we risk making big errors and fostering confusion.

Psychiatric diagnoses are after all stigmatized (calling someone “narcissistic,” “psychotic” or “in denial” is commonly a denigration), and are frequently misunderstood, very high moral standards and respect privacy and confidentiality, partly to gain and preserve patients’ trust.

One of my favorite Washington Post writers,   noted:

“When Donald Trump disparaged Mexican immigrants, women, prisoners of war, Muslims, and briefly even Pope Francis, his comments were roundly dissected and critiqued. While many would argue he ultimately “got away” with them, there were plenty of expressions of outrage.  But when Trump attacks people using demeaning slang long associated with mental health, there is no similar outcry.”

Few think twice about throwing around words like “crazy” and “insane” to describe an individual’s out-of-the-ordinary behavior or mental state…And so it perpetuates the social stigma that people with mental illness are inferior.

“This is the legacy of mental illness,” said Gail Saltz, a psychiatrist in New York City. “When we knew nothing about brain wiring and causes of mental illness and we believed it was a moral weakness rather than an illness and it was scary to people to see more extreme cases of it – that is where those words come from. Those words still hold that meaning. It is a way of deprecating your behavior, it’s a way of dismissing you.”

“A person diagnosed with mental illness absorbs that disparagement themselves,” said Bob Carolla, spokesman for the National Alliance on Mental Illness. “It’s a loss of self-esteem, self-devaluation, and creates a barrier to recovery. People in general come to recognize and feel the stigma that exists, and if they think they might need help, they don’t seek help because they don’t want to be isolated or rejected..Stigmatizing words, stereotypes and portrayals end up helping to shape society’s attitudes,” Carolla said. “You can’t say it’s harmless, because it isn’t.”

Here is what the Associated Press says about mental heath in the AP Stylebook Online and will appear in the new print edition and Stylebook Mobile.

Do not describe an individual as mentally ill unless it is clearly pertinent to a story and the diagnosis is properly sourced.

When used, identify the source for the diagnosis. Seek firsthand knowledge; ask how the source knows. Don’t rely on hearsay or speculate on a diagnosis. Specify the time frame for the diagnosis and ask about treatment. A person’s condition can change over time, so a diagnosis of mental illness might not apply anymore. Avoid anonymous sources. On-the-record sources can be family members, mental health professionals, medical authorities, law enforcement officials and court records. Be sure they have accurate information to make the diagnosis. Provide examples of symptoms.

Mental illness is a general condition. Specific disorders are types of mental illness and should be used whenever possible: He was diagnosed with schizophrenia, according to court documents. She was diagnosed with anorexia, according to her parents. He was treated for depression.

Some common mental disorders, according to the National Institute of Mental Health (mental illnesses or disorders are lowercase, except when known by the name of a person, such as Asperger’s syndrome):

– Autism spectrum disorders. These include Asperger’s syndrome, a mild form of autism. Many experts consider autism a developmental disorder, not a mental illness.
– Bipolar disorder (manic-depressive illness)
– Depression
– Obsessive-compulsive disorder (OCD)
– Post-traumatic stress disorder (PTSD)
– Schizophrenia

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

Do not assume that mental illness is a factor in a violent crime, and verify statements to that effect. A past history of mental illness is not necessarily a reliable indicator. Studies have shown that the vast majority of people with mental illness are not violent, and experts say most people who are violent do not suffer from mental illness.

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

Avoid descriptions that connote pity, such as afflicted with, suffers from or victim of. Rather, he has obsessive-compulsive disorder.

Double-check specific symptoms and diagnoses. Avoid interpreting behavior common to many people as symptoms of mental illness. Sadness, anger, exuberance and the occasional desire to be alone are normal emotions experienced by people who have mental illness as well as those who don’t.

Wherever possible, rely on people with mental illness to talk about their own diagnoses.

Avoid using mental health terms to describe non-health issues. Don’t say that an awards show, for example, was schizophrenic.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.