Why You Shouldn't Use Mental Illness As A Metaphor

And speaking of the dilution of language, I’m going to talk a little about how the language of mental illness gets co-opted regularly.

Sometimes this is done completely innocently, as metaphor. “The weather’s really bipolar today.” “I’m kinda OCD about this, sorry.” “I’m so depressed about the Blackhawks losing!”

Sometimes it’s a little less innocent, as “humor” that implicitly degrades its target: “She’s, like, totally fucking schizo.” “Clinically Depressed Rob Pattinson Cavorts With Models in New Dior Ad.” (Jezebel has historically been pretty bad about using mental illness as a punchline.)

My usual objection to using mental illness terms in this way is that mentally ill people (who comprise a fourth of American adults) are likely to find them marginalizing and hurtful. It makes us feel like the potentially-fatal conditions we struggle with are just a joke to you. It’s not a nice feeling, and if you are a person who generally cares about your friends’ feelings, you should probably be aware of this.

But the dilution of mental illness terms might have another, more insidious effect, and that is changing our mental schemas of what mental illness looks like such that it’s less and less serious, and treating it accordingly.

As an example, I was recently posting on Facebook about the infuriating phenomenon in which someone discloses a phobia or trigger that they have to warn their friends, and then their friends proceed to try to deliberately trigger them. I literally watched it happen, and then I watched the friend post a new status about how people do this, and someone tried to do it again.

So my friends and I were discussing this and one of them mentioned that a possible factor (aside from the obvious douchebaggery) is the fact that many people now use “phobia” very colloquially, as in, “thing that makes me have a sort of uncomfortable but totally harmless reaction that would probably be amusing for you to see,” as when my little brother wants me to taste something totally gross (but safe and edible) or when my mom is like “ewwww look at all this dust that’s built up on your windowsill!”

I think my friend may be right. These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re “sooooo OCD” because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.

Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?

Likewise, if your friends are constantly telling you they’re “depressed” because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, “Come on, get over it! You’ll feel better if you go out with us.”

And so the meanings of words change.

But just because the people around you use mental illness terms in that diluted way doesn’t mean you should accept it. If you want to be an ally to those who struggle with mental illness, you should treat disclosures of mental illness seriously every time unless you’re absolutely certain that that’s not what the person is telling you. Feel free to ask for clarification.

I already shared this story as a comment on another post, but I’ll share it again because it’s applicable here. I once ran into an acquaintance and we chatted for a bit. I asked him what he’d been up to, and he said, “Just, you know, getting sober. I’m an alcoholic.” And I said, “Congratulations, good for you!” And he responded, “Oh, I’m not actually an alcoholic, I just meant that I’ve been drinking less. Haha, I forgot that you’re a psych major.”

The latter comment annoyed me because of its implication that I took his seeming disclosure of alcoholism seriously because I majored in psychology. That’s not why. I took it seriously because it sounded serious, because I want to support people who struggle with mental illnesses, and because I know what a big step it would’ve been for me to tell someone I didn’t know that well that I had started treatment for depression, back when I had it.

But other than my brief chagrin, there weren’t really any drawbacks or negative consequences for me in this situation. I faced no repercussions for taking him seriously. I undoubtedly came out of the situation looking like a decent person who cares about people, and he probably felt a little silly for flinging the term “alcoholic” around, but also reassured that if he ever did get diagnosed with a mental illness, I would take him seriously.

Although it may feel that way sometimes, you do not have a limited number of Real Mental Illness Points that you need to save up for responding to people who have a Real Mental Illness, and that you shouldn’t waste on those who are just using those terms metaphorically. The worst thing that happens if someone tells you that they have a phobia and you decide to refrain from trying to trigger that phobia is…exactly nothing. The worst thing that happens if someone tells you they’ve been feeling depressed lately and you say, “I’m so sorry to hear that, is there anything I can do to help?” is that they say, “Oh, don’t worry, it’s not like, depression or anything. I’ll feel better soon.”

That’s it!

And your taking them at their word sends a message to them that you believe that these words should be reserved for describing the illnesses they indicate, rather than being used as convenient metaphors. You’re helping to set a norm about how these words should be used.

Meanwhile, if you’re someone who uses mental illness terms to describe states of mind that you do not feel are mental illnesses, I’d encourage you to take advantage of the richness of the English language (or whichever language you speak, which I’m sure is also rich) and not do that. (Russian, for example, has some beautiful words for sadness. There’s the general sadness, or grust’; there’s a stronger version, toska; there’s a type of sadness that’s accompanied by an unwillingness or inability to do anything to improve one’s state of mind, unyniye; there’s a type of sadness that isn’t really directed at anything in particular and lies somewhere between grust’ and toska in severity, pechyal’; and there’s a type of sadness that includes grief, but also sadness at the loss of a treasured possession or an important opportunity, skor’b. And that’s a few. And don’t get me started on the Portugese word saudade.)

Note that I’m not including here folks who have diagnosed themselves with mental illnesses because they’re unable (or currently unwilling) to seek help from a professional. If you feel that you have the mental illness known as depression, then that word, I believe, is yours to use.

My point is only that sometimes misusing language has actual harms, and while language does evolve and change over time, we need words to describe mental illnesses. We can’t fight something that we can’t name, and we need to be able to fight depression and OCD without people thinking that we’re fighting feeling sorta down when your team loses or wanting to have all your books organized just so.


Related: Small Things You Can Do To Improve Mental Health In Your Community

Why You Shouldn't Use Mental Illness As A Metaphor

32 thoughts on “Why You Shouldn't Use Mental Illness As A Metaphor

  1. 1

    […] Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD. […]

  2. 2

    […] However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.) […]

  3. 4

    I was diagnosed with Bi-Polar when I was young. Long story short, with therapy, meds and a lot of behavior modification I am appropriate and manage my symptoms 99.5% of the time. But woe to the world during the .5% when I am not. I tend to have really inappropriate responses to things even when I am managing my symptoms, so I explain my diagnosis, what it means, what people should do if I am inappropriate, how to respond, and why sometimes I will get SUPER angry for no reason and walk out of the room. I have learned over the years that these warnings help me explain to my co-workers/friends some of my more eccentric behavior. A couple of years ago I was working at a company and very stressed. Because I was very stressed, I stopped doing a lot of the things that I need to do in order to function…sleep, eat, keep a routine, watch out for the signs that my cycling has started, etc. I had a melt-down, and it was ugly. I am a big, loud person and can be incredibly scary when raging. I quit my job, yelled at my boss and generally scared the shit out of everyone around me. After some time, a few Xanax and a lot of meditation I was able to go talk to my boss about what had happened. I started the conversation with “I apologize for my outburst, I have been so stressed and overworked that I haven’t been taking care of my mental health, I should know better after this many years of living with bi-polar.” Mind you, I have a whole song and dance explain my mental health that I tell co-workers, as well as talking very openly and often about how my mania/rage and depression has fucked my life over more than once. When I said “bi-polar” to my boss in this meeting, her response was “oh, I didn’t think you meant REAL bi-polar”. it was so crushing to me, that I worked in a place where disability is the focus, and I was open about my mental illness and my co-workers still didn’t understand that it was “real”. thank you for this blog, and for this conversation.

  4. 6

    I remember George Carlin’s bit on the evolution of the term “Shell Shock” into “Post Traumatic Stress Disorder” and how the term being so clinically diluted probably contributed to society’s practical indifference to the plight of our walking wounded vets (now we often just use shorthand whittling it to PTSD). I thought of that routine a lot after 9/11 when I was obviously traumatized, but I never felt that I was actually suffering a real disorder. Some friends of mine did, in all kindness, try and coax me into seeking perhaps some professional counseling, but while this too is a form of self-diagnosis, I didn’t feel compelled to do so, as I wasn’t suffering at work (though I hated my boss) and I wasn’t more than reasonably afraid of going out and being part of the city and my network of friends and family afterwards. I think I had a couple of bad dreams, but who wouldn’t? It also felt somehow disrespectful to the people I knew, co-workers and friends who lost loved ones or were present for more of the devastating elements of the day, suffering greatly,

    How we use words isn’t something we should just take for granted as they have greater impact on how we treat people and institutions than one might realize. Not to say we police everything we say to such scrutiny that communication nearly becomes impossible, but it does behoove us to take the time out and think about how our language usage impacts those around us.

    1. 6.1

      the flipside to that can be that people develop very narrow definitions of what the “real” thing is and treat everything else as flippant use. So you get comments denying someone’s PTSD because they’re not a soldier, or denying that someone is depressed because yesterday they were laughing at people’s jokes, or calling people who need wheelchairs only sometimes lazy or scam artists.

  5. 7

    I had a talk with a friend about the word ‘schizophrenia’ a while back. He wasn’t sure that it was still used by psychiatrists owing to the fact that it’s been used as a word meaning ‘strange, unusual etc.’ by the general public for so long, and was curious if there was a newer, more proper term. Showed him the entry in the DSM and yes, schizophrenia describes fairly distinctive symptoms.

    This is an area where the prevalence of people (mis) using psychology terms seems to create the illusion of a public that is knowledgeable and concerned, when it’s really just more ignorance.

  6. 8

    Thank you for this post. I have to admit that in the past I had used words like “OCD” and “bipolar” in a flippant/joking manner. I stopped once I realized that this minimizes the experiences of those who actually live with those disorders. Even today though, I still sometimes use “depressed” as shorthand for “this news/incident gives me a sad.” I am diagnosed with major depressive disorder too, so I should really know better. Thank you for talking about this and getting me to reexamine the language I use. 🙂

  7. 10

    I saw this exemplified on a Minecraft video the other day. Someone made a comment that some lack of symmetry or lack of tidiness was tripping their OCD. Someone replied saying they were really OCD and didn’t appreciate the flippant use of the term. The original commenter replied back that they were also OCD and had meant their comment in total seriousness but then argued that language changes and everyone should just roll with it.

      1. Yeah I replied to them with basically what you’ve said here: that diluting the term makes it harder for people who actually deal with these things to be taken seriously because people just think being OCD means you’re a bit of a neatnik and they responded with more “meh, what’re ya gonna do, it’s futile to try to stop it.” And I said well sure, if nobody speaks up. But if people are willing to say “hey that’s not cool” then maybe they think about it. Didn’t get a response back, so hopefully I at least made them think.

  8. 11

    I wonder if there’s a bit of “well why can’t I say it?” going on here, because I have been in more than one mental health therapy group and it’s quite common to resist the symptoms of mental illnesses by making jokes about them. I know I do it often, saying things like “and then I had a three alarm jackpot screaming panic attack!”

    and I’m making light of a completely harrowing hour where I spent the whole time experiencing physical panic symptoms, trying unsuccessfully to get out of an anxiety loop, and at the time, It’s a horrible lonely place to be in that I wouldn’t wish on anyone.

    But it’s my life, and my life is not a tragic pean to helplessness. So i will make fun of a six month long depressive episode where I experienced psychosis at the very worst points of it, since I came out alive at the end of it and all.

  9. 12

    This is an area where I’ve been trying to improve on. One of the more difficult issues for me has been trying to find alternate words to describe some of the culturally-conditioned behaviours and beliefs of people without lapsing into psychiatric jargon.

    There are lots of Americans who have grown up swaddled in the alternative narrative of Fox News and Fundamentalist Christian homeschooling. Is “delusional” the proper term for someone who has been educated with lies? Would “Paranoid” be a good term for the Alex Jones style conspiracy theorists, who believe the government is out to get them, personally?

    Unfortunately, the thesaurus fails me here, alternating less appropriate mental illness terms, (deranged, senile, neurotic, or worse).

    I don’t think the english language has evolved to the point where the distinctions between mental illness and socially unacceptable behaviour are there, let alone the general perception of both classes as undesirable, and used as insults.

    1. 12.1

      We do have words for people like that: obtuse, privileged, unaware/lacking in self awareness, ignorant, intentionally ignorant. We have words to describe people who refuse to acknowledge the experiences of other people, who won’t sympathize with the existence of others whose live are somehow different. We just have to recognize that such people are capable of change, and that they choose to stigmatize others, and then we have to use the appropriate language when responding to them as well. We should most certainly not use the same connotation they use in order to silence prejudiced jerks since that only maintains existing stigma.

    2. 12.2

      I have schizo-affective disorder which has included hallucinations and delusions, so I thought I’d weigh in that I think ‘delusional’ just isn’t an accurate label for the negative behaviors you describe. This isn’t so much because it uses a term that’s applied to me as a negative label for someone’s political platform, but just since I don’t think their thought process is really ‘delusional.’

      Delusions sort of happen, involuntarily, and kind of come out of nowhere. Your average Fox News viewer goes out of their way to reinforce their political views as often as possible, probably because they can’t be maintained without regular doses of propaganda. There’s a lot of willful behavior going on whereas an actually delusional person isn’t refusing to say, use a different source for their news for a few days or to actually look up some real economic or social statistics or accurate science about reproduction or evolution or climate change. There’s a sort of *willful refusal* to look at real information on the part of some people, not that their brains are malfunctioning but that they are refusing to use them.

      Something on the word paranoid though, I find that it’s one that I worry could get used as a gaslighting term – imagine how the behavior of a person might be different regarding safety if they’d been stalked by a violent ex and think how someone might label the precautions taken ‘paranoid’ just since they’d never faced the same risk of harm, or that a young Black man who runs from the police instead of stopping is displaying a ‘paranoia’ about police.

      1. Thanks smrnda. Those are very good points, and I’ll definitely take those to heart.

        I generally only use the term “Paranoid” in reference to distinguish the conspiracy theories which continually expand regardless of evidence (i.e. Antivaxxers), as opposed to those which are constrained by the evidence (i.e. Watergate) . This is mostly because of the tendency for some conspiracy theorists to accuse those who oppose their position as being in on the conspiracy.

        That said, I’ll continue to seek alternative descriptions that don’t invoke mental illness

        1. I also feel conflicted about ‘paranoid,’ because I feel that certain people (anti-vaxxers) are showing signs of real paranoia, particularly given their immunity to evidence, whereas certain people get labeled ‘paranoid’ when their behavior is really pretty rational – if you have any discussion about rape (which I get into frequently) a sizable contingent of men will label pretty much all women ‘paranoid,’ but absurd views with some political clout get taken seriously. it’s kind of a privilege game; thinking Obama is building secret FEMA death camps to kill white male heterosexual Christians is seen (in some quarters) as a reasonable assessment, but a woman showing some reluctance to allow a man she doesn’t know well to ‘walk her home’ is paranoid, or a Black teenager who runs from cops is ‘paranoid.’

          Of course, assessments of mental health don’t take place in a vacuum. But yeah, it’s tough to know the right words sometimes.

  10. 13

    Great points. I confess I’ve often been bad about this myself. I’m trying to do better.
    A few years ago, I was out with a group, and a friend made a comment about having a major phobia about bugs. Some asshat took that as his cue to go catch a bug and place in on my friend’s shoulder. It took us quite awhile to get my friend calmed back down again. The silver lining is Bug Guy nearly had his head ripped off (not quite literally), and I believe he’ll think twice before doing something like that again. As important as it is to not be That Guy, it’s perhaps equally important for us to not put up with That Guy’s shit.
    I would say it’s a little trickier with things like depression, which have a common-usage definition separate from (and in this case pre-dating) their clinical definition. So if someone says they’re depressed to mean “I has a sad,” they’re not technically incorrect. Not saying this as an excuse for being insensitive, but I’m not sure how you get around it.

    1. 13.1

      Yes, this. I agree with the substance of the post (and of course find myself often falling into using mental-illness terms for non-psychiatric ass-hattery), but AFAIK the word “depressed” never has been a primarily clinical term (unlike “bi-polar”, “schizoid”, etc.). It may indicate a phase longer and deeper than whatever is “usual”, but it’s not invoking the disorder as a metaphor. And I speak as someone with an Official Diagnosis of mild-to-moderate depression.

  11. 14

    Counterpoint. I’ve been diagnosed with things (one I’m not really comfortable being specific about with random folks online, but also depression). I support diluting the ‘official’ terminology, because it’s a great way to remind myself that I am more than my condition. I’m not offended when people use the terminology in off handed ways because, dear god, I wish society would treat this stuff less seriously. I’m disgusted and sick of saying “Oh, by the way, I have ” and having everyone suddenly behave differently. Because I am more than my condition, and having everyone suddenly behave differently when they become aware of it? It’s really goddamn insulting. Diluting the language means we’re going in the direction; treating these diagnoses as things, rather than the be all and end all of the people with them.

  12. 15

    I think another commenter mentioned this, but I should say I am Disabled (received disability for ten years, have had a diagnosed disability for about 15 years, received medicare for eight years now, etc) and for the time frame I am 31 and a half years old. Documents to prove some or all of this can be found here, with names edited out: http://imgur.com/a/54IaN#5 My health conditions, two primary disabilities are DESNOS coupled with Chronic PTSD, but I also suffer and have suffered from Major Depression, ADHD, petit mal/absence seizures. I’ve probably seen about 20 unique psychiatrists over my lifetime, heavily drugged, ~4-6 months on mental wards, etc. Also, my perspective on this, as someone who is transgender, autistic, disabled, stubbornly perceived to be PoC in offline/meatspace from birth due to the strong Spanish on my mother’s side of the family, lower class, etc, is simply this: I will make fun of my own conditions frequently, even gibbing myself badly, just to make light of serious trauma I’ve been through so I can cope; seeing the world as a ‘bad joke’ that’s happening to me or being played on me, is much easier for me to deal with than being super SIrius about everything. That having been said, there’s a difference between doing that and being ableist, and it’s a subtle difference that can escape people. As well, if I joke about certain things that have nothing to do with my conditions or past misdx’ED conditions-and I’ve had re’DX’ed schizophrenia/schizoaffect, re’DX’ed to DESNOS and Chronic PTSD- then I do feel guilty of ableism where I am indeed guilty of it. I am careful to only joke in the context of my own suffering and remind people that I joke to cope, and not to belittle other disabled people. What I’ve found is, if I can’t see my life as a living nightmare that is a bad joke, then I’ll always see it as a living nightmare that is Way Too Serious (TM), and the minute I start taking myself too seriously, and all the obscene amounts of trauma life has thrown my way, is the minute I kill myself, so I simply must view reality as this horribly traumatic, awful, unintelligent joke…or something..to cope with it all. I’ve even caught myself joking in ableist terms with ableist assholes making fun of me using the very same ableist terms, just as a way to condescend them intellectually; they usually realize it but it takes them a bit to catch on usually, and it makes them feel priceless horrible. I usually end such jokes with a schold that they weren’t to laugh at my ableist joke after they made an ableist comment to spawn it, and go elsewhere.

    I find ableism is often so mainstream it makes buzzwords out of serious mental illness within the mainstream culture, such that I’ve found myself listening to very privileged people talking in serious tones about how Traumatizing this or that menial but supremely difficult thing they just did, was to them, when the reality is that it was supremely difficult, they should feel the proper reward for their effort, but not lay claim to ableist language. I’ve had this happen so many times in my presence it’s teeth gritting every time. Of course I can fall prey to doing it to; such is the pressure of the wider culture.

    What I’ve found, in the end, for my rule of thumb is that I needle myself to test people: if they try to say I’m being ableist for trying to make a joke out of my suffering to cope, then I know I’m dealing with a cruel asshole and a privileged clueless person, trying to pretend to be anything but those terms and failing badly. I’ve often found lots of people fit into this category: they’ll sound totally convincing, like they get what mental illness is, but then when I start joking about my own mental illness, even when they don’t have any actual diagnosed disability and a form of mental illness different from my own, they’ll try to hold me account to being ‘ableist’ or stupidly pretend like somehow I’m just making it all up because they naively believe survivors would never joke about what they’ve been through. I’ve seen that happen time and again too, and it’s really funny when it happens, because the person doing it isn’t aware they’ve just exposed themselves as either frauds to me, or clueless about reams of privilege that they have that I don’t have. It gets me everytime: makes me smile =)

    1. 15.1

      It might also be over exposure to pain porn. I’m often completely amazed at the appetite for consuming someone’s horrible experiences. I often run into people who seem to want me to talk about nothing but how hard it is to be living with PTSD, and don’t seem to realize how objectifying it is to demand that I remain a tragic figure emanating pain 24/7. There’s more to me than that.

  13. 17

    Would you consider not using “war” or “killing” likewise?

    “I made a killing on the stock market”
    “Stop it, you’re killing me!’
    “There is a war being waged against intellectuals”
    “I am getting killed with these taxes”
    “The war on poverty is not working”

    Also, what do you think about the word “mad”?

    1. 17.1

      I’m not sure I see any evidence that war is taken less seriously BECAUSE OF such usage. It’s taken less seriously for other reasons, to be sure.

      Further, mental illness terms are specialized language devised to refer to very specific things. “War” and “kill” are not.

      I don’t oppose all metaphor. I’m a creative writer after all.

  14. Oob

    I’m totally with you on people tossing around “I’m totally OCD” as coopting a medical term, and a more general problem does exist.

    One example I’m not sure works as well is usage of the word “depressed”. I could be wrong here, but hasn’t that word been used colloquially long before it gained a medical meaning? I was under the impression that “depressed” was actually coopted BY the medical field for that condition, not the other way around.

    To that end, I am not sure saying “that’s depressing” or “I’m a little depressed right now” should be taken the same way as “Oh I’m totally OCD”. I think that using the term depressed in that way is entirely legitimate, and a word we do need to describe a non-medical sadness that lasts based on actual life circumstances.

    The problem is conflating the two definitions, as you go on to point out. Someone says “I have depression” (a phrasing that I only hear in the medical sense) and what someone else hears is “I’m depressed”. Those are two totally different things with very little if any overlap, and shouldn’t be mixed up. However, asking that people stop using the word “depressed” as it has always been used is a bit of an extreme measure. It is far easier to expand than change a mind, so maybe we should be using a more clinical sounding term. “Clinically depressed” has been making great strides in clearing up that confusion, at least around my neck of the woods, but maybe we can do one better and come up with a phrase that removes the word “depress” entirely from the medical term.

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