My unpopular opinion: It’s okay to say “mentally ill.”

Man sitting at table with a sign in front of it saying "It's okay to say someone is 'mentally ill.' Change my mind."

When I was in college, I had a roommate who found a great many things weird. She used “weird” to describe things more than any other word. In an effort to get her to help her open her mind, I would respond that it isn’t weird, just different. After a while of this, she started describing things and people as “different” with the same tone of derision as she used with “weird.” Maybe even more so.

I was reminded of that experience today when I saw this tweet from NAMI California.

Tweet with image including the text “Say this…They live with a mental illness. Not this. They’re mentally ill/unstable.”

Yes, the stigma of mental illness is very real. It can make it hard for people to get help when they need it. It can make life harder for those who are already seeking help. Stigma increases suffering. Reducing stigma is a good thing.

Limits to language changes

That said, there are limits to how far we can mince words.

Reduced return on investment

For instance, I remember when calling someone mentally ill was preferred phrasing, as opposed to words like “crazy” and “nuts.” Perhaps we can agree this is a big difference.

We put energy toward whether we say someone is “living with mental illness” rather than someone is “mentally ill.” Or we can address other issues affecting people with mental illness.

Inadequate meaning

In my reading, I found a someone’s blog talking about “having mental health experiences.” Everyone has some sort of mental health experience. To use words to try to avoid stigma, we can dilute the language to a point where it is absent of meaning.

Playing into stigma

By continuing to mince words, we are fighting for the table scraps of respect. It’s beggarly to continue to change our wording to try to please people into a basic level of respect. By asserting that we should not say someone is mentally ill, we are validating that there is something wrong with mental illness.

I am a woman. Am I only a woman? No. Do I call myself something other than a women to appease people who would disrespect me because I am a women? No.

There is a reason that other communities embrace words of derision rather than continually changing ways of describing themselves. Likewise, we can stand in the strength of mental illness in ourselves and our loved ones.

Some will never change

As with my college roommate, some people will not change their attitudes. We have to recognize this and move on to where we can have the biggest effect.

Mental illnesses are medical illnesses

In NAMI Family Support Groups, which I am a member and facilitator, we have “Principles of Support.” Number two is “We recognize that mental illnesses are medical illnesses that may have environmental triggers.”

Medical illnesses are what we are talking about. Yet, we treat people with mental illness differently than people with cancer or heart disease. People who have lost loved ones to suicide blame themselves, when it is the severity of illness that took their loved one.

This is the heart of stigma, that mental illnesses are not medical illnesses. People with mental illness are not ill. They are lazy, irresponsible, weak. This is where attitudes change.

What serious mental illness can look like

Some people get to “live with a mental illness.” Some cannot get out of bed. Some are trapped in their delusions and hallucinations. Some end up homeless. Some succumb to their illnesses.

I have closely witnessed someone with serious mental illness deteriorate over decades. I have seen them go from a happy, loving, functional, contributing member of society to someone who is completely overwhelmed by their illness. They are living on the street, sleeping under the stars. They is mentally ill. There is no form of tinkering with words that changes that elemental experience.

I am not the only one. This is why groups like “Where’s NAMI?” exist. Many of us with family members with untreated illness, living on the street, are frustrated by NAMI’s focus on words when actions are urgently needed.

Let’s refocus

There are so many important needs in the care of people with serious mental illness. There is no amount of overcoming stigma that overcomes lack of care.

Psychiatric bed and staff shortages

We need to refocus on those with serious mental illness, starting with the Psychiatric Bed Crisis in the U.S. The number of psychiatric beds available have reduced drastically since their peak in 1955.

Even with more beds, there isn’t enough staff. There is a growing psychiatrist shortage and mental health nursing shortage. We need long-term strategies to retain the people we have working in psychiatry and encourage more people to start.

Better laws and applications

We need better laws for involuntary commitment and more consistent application of existing laws.

In California, for instance, we have the Lanterman-Petris-Short (LPS) Act. It defines the conditions for involuntary commitment as 1) danger to one’s self, 2) danger to others, and 3) grave disability. It defines grave disability as inability to provide one’s self with food, clothing, or shelter.

Civil liberties are a critical issue, so these laws should be used sparingly. Yet, grave disability is almost never applied as cause for involuntary commitment. The last time my mother was committed, they only asked her about the first two criteria under the LPS. They were going to leave after she said she wasn’t a danger to herself or others. I had to argue with the police about her needing help. They brought in a sergeant, who had her committed when they found she had thrown out all of her food.

So many people remain on the street even when their mental illness compels them there. People have a choice how they want to live how they want. When the delusions and hallucinations of their illnesses decide for them, that is where we have a obligation as a community to care for them.

The right, hard decisions

We can change the way we talk about mental illness and feel good making acceptance of help easier for people. When it comes to affecting significant changes, we have to decide what kind of society we are going to be and then make the right, hard decisions.

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