A mental health diagnosis is linked to one’s social identity in too many cases and, in my opinion, is always linked to one’s inner self. I must emphasize, however, that one has, not is, a mental illness. I am not my disease. I am not a manic-depressive; I have manic depression. I am an individual who has bipolar disorder. If there is such a thing as mental health culture or sensibility, I demand to be considered first a human being in that culture.

There are many words that describe (the behavior of ) persons with mental illnesses. The majority of the general population is most familiar with the casual, idiomatic, slang terms that refer to mental illness and the people who have been diagnosed with it. There is another, less commonly known language - the psychiatric lingo. Instead of someone being called ‘crazy,’ those in the mental health system use specific terms, as in "the individual was exhibiting psychotic behavior." That may be a fact, although the definition of psychosis has broadened to include a whole range of behaviors. On the other hand, if a mental health worker decides a patient is "acting inappropriately," I tend to believe this statement is a matter of judgment. It would be better to state the specific behavior rather than labeling the individual as having a lack of appropriateness. One would have to understand the patient’s motivations, taking into account the illness, the effects of the medications, the (hospital) environment, and so on. Acronyms describing groups, such as SPMI (serious and persistent mentally ill) or MICA (mentally ill chemical abusing) reveal an ignorance of the human element. Simply adding the word ‘individuals’ to the end of the acronym makes a big difference in humanizing a disease.

The vernacular, the terminology, this language of the psychiatric and therapeutic communities does not come close to what society as a whole has used to label and, in effect, demean the individual with mental illness.

There are far too many casual, flippant terms and images that show little regard for persons with mental illnesses. Stigma devastates, discredits, derides and disables. Being labeled solely on the basis of a diagnosis is at the rotten core of what hurts people’s feelings and diminishes their self-esteem. I used to think that if I didn’t mind, it didn’t matter. Now, I believe the social and personal implications of my mental illness have not and never will be a matter of mind over matter. I learned the implications of the term ‘empowerment’ years after my mental health diagnosis. Like so many other things in life, empowerment evolves and changes individuals and communities with time, effort, and a personal and social commitment to strength and wellness.

Persons with mental illness have developed their own language over the years, terms and phrases that, to a large degree, the psychiatric community has adopted as well. The term mental health consumer was a choice of self-identification. Unfortunately, some people inside and outside the mental health community have objected to this term, citing that the word consumer is not an appropriate term for those with mental illness. The debate over the use of a word or words is common. It brings to mind the controversy of homosexual men and lesbians self-identifying with the term gay. The original meaning of the word was cheery or merry. Many people resented the fact that this group had co-opted a word to describe a lifestyle, a sexual orientation, a way of being. In the TV movie Doing Time on Maple Drive, the son has just revealed that he is gay. His father replies that he does not accept that word, since the word gay was once a "perfectly fine word."

A person can use a word to disclose or describe oneself, but the availability of the word in the culture can be an opportunity for someone else to discredit and deride, if only by the tone of voice. Used in a derogatory sense, a word or phrase can devalue a population by those outside it. Oddly enough, the meaning of the word gay has changed yet again, to its most recent, slang meaning as ‘lame,’ which is yet another slang word originally used to describe the condition of persons unable to fully use their arms or legs.

Although it had its roots in the civil, women’s, students’ and gay and lesbian rights movements of the 50's, 60's and 70's, political correctness ("PC") as its own movement came of age in the 1980's due to the pervasiveness of the media. Certain people, groups and populations were sensitized to the common terminology that described them. Slang, in particular, devalued and offended many groups. Some disabled individuals (the prefix dis- means without or not, implying a lack of some sort) were soon called differently-abled, a less emotion-laden term. The terms visually impaired and hearing impaired in some cases replaced the words blind and deaf, respectively. Mental retardation became more commonly referred to as a developmental disability. Perhaps the new terms were taken on in an effort to reduce over generalization, insensitivity and thoughtlessness.

Internet technology has introduced new ways of using words. A search of the keywords insane, crazy, or psychotic very rarely provides information related to mental illness. Rather, the search gives links to websites by and for persons who have adopted the words to describe themselves or the contents of their web pages. These web site operators appear proud to identify with these words, most commonly used to refer to mentally ill behavior.

This could open the discussion of "who ‘owns’ the language of a specific group (like the mental health population?). At the point of diagnosis with a mental illness, an individual may be self-conscious, or worse, horrified to realize that he or she is "crazy." And with good reason, the standard definition of the word is anything but the light-hearted, "goofy" meaning the slang use would lead us to believe. Webster’s Dictionary defines crazy as "characterized by weakness or feebleness; broken, weakened or disordered in intellect, shattered, demented, deranged." Still, some people may learn to use to word self-referentially, with the firm belief that it is an easy way to describe oneself. Sometimes, friends can jokingly tell them they’re crazy, and it may be okay. But if someone without a mental illness calls one or more mental health consumers crazy, then it’s offensive. Why? I have heard gay men call each other faggots in a kidding manner. Using a loaded and stigmatizing word within a circle of friends as a form of friendly sarcasm seems to dilute the mean-spiritedness of the word that society has used to demean a population.

To own the language is to freely call oneself whatever one wishes. However, using words to describe others presents complications. The word crazy does not always refer to a person who is experiencing delusions or hallucinations. For example, some may call the person who climbs a skyscraper (or who owns more than six cats) crazy. There are a multitude of ways to use the word to describe a person, a feeling, a situation. It seems to be a matter of context and tone.

A study of synonyms of mental illness in the thesaurus reveals the complicated levels and nuances of language and shows how pervasive stigmatizing language can be. A thesaurus’ entry under insanity can provide a chilling landscape of words and phrases that alienate a person with a diagnosis of mental illness (delirium, hysteria, idiocy, lunacy, absurdity, craziness, dementia, derangement, foolishness, frenzy, incoherence, madness, neurosis, paranoia, psychosis, rage, senselessness, stupidity). The dictionary definition reads: "Unsoundness or derangement of mind: a mental condition from the existence of delusions, or the incapacity to distinguish between right and wrong" (Webster’s Revised Unabridged Dictionary, 1998). What was a psychiatric disorder comes to be equated with the quality of the individual who suffers from it. A label. A mark. Stigma.

Many words define mental illness in what it’s not (the prefix un- means ‘not’): unwell, unbalanced, unstable, unhinged, of unsound mind. I will readily admit my behavior while mentally ill could have been described in these ways, but not my self. To paraphrase an old saying, the spirit was willing, but the mind was weak. I had symptoms of mental illness: an illness of the mind. Although my behavior shocked and confused others and myself, I am convinced my behavior resulted from thoughts, from a brain out of control, from a chemical imbalance. I was overcome by impulses that I sometimes acted out, and almost always regretted. For me, sanity was never a matter of will.

Many idioms of mental illness point to a lack, a loss of some kind (not dealing with a full deck; out of one’s mind; to lose one’s mind, one’s reason, one’s faculties, one’s wits, one’s head, one’s marbles). What does it mean to lose one’s marbles? When you think about it, have you ever heard of someone who has an ‘abundance of marbles?’ Using this and other phrases to describe a person who is mentally ill only devalues the individual by taking away something many people never have to make the claim to possess. In describing a situation or feeling, the use of metaphor can often be effective, but using it to describe an ill person and/or their behavior is nothing less than stigma.

Some synonyms and metaphors for mental illness simply seem, well, not nice (to have a screw loose, go mad, go crazy, go bonkers, flip one’s wig, to flip out, loony, cracked, berserk, stark raving mad). I have seen the bumper sticker "Mean people suck," but I refrain from that opinion, knowing it just perpetuates yet another level of nastiness. When we discuss mental illness, we must recognize that it is an illness, not something to loosely describe in common, often vulgar terms. Education is the key to understanding people and the behaviors they can exhibit. Do you blame a person for having epilepsy? Would you blame a person for chemical imbalances in their brain? At face value, you might say ‘no.’ When some people witness someone having a seizure or someone who says or does things you perceive as unusual, bizarre, even frightening, they may choose not to get involved. That’s a choice. Yet, another choice is to act out of compassion in your heart, which in the long run, can heal ourselves and the people with whom we share this journey called life on planet Earth.

Responding to stigma is not simply a matter of being sensitive. I believe we, as mental health consumers, have more accurately become sensitized to stigmatizing gestures and words. Although it has been said that "sticks and stones will break my bones, but names will never hurt me," I can’t help but believe, from my own experience, that anyone who has been called a ‘name’ or otherwise labeled, can feel rejected. This is not how we want to be called, and, from the feelings it evokes, not the way we want to be treated.

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