Tuesday, March 13, 2012

Language, Stigma and Political Correctness: How We Talk about Mental illness

By Bob Carolla, NAMI Director of Media Relations

NAMI recently engaged in a dialogue with National Public Radio (NPR) over language, stigma and mental illness. It in turn led to discussion of what is meant by “political correctness.”

It started with NPR’s coverage of a pending Supreme Court case in which a man is appealing a conviction for falsely claiming to have received the Congressional Medal of Honor. In an interview with the man’s lawyer, NPR reporter Nina Totenberg asked whether his client, a habitual liar, was a “nutcase.”

NPR received many complaints. In consultation with NAMI, the NPR Ombudsman column on its website launched discussion  about language, stigma and mental illness.

NAMI pointed them to the U.S. Surgeon General’s Report on Mental Health, which frames stigma as a public health issue. We also acknowledged that assessing stigma can involve “balancing” several considerations. Particularly in entertainment media, NAMI’s “red flags” of stigma include:

  • Overall context
  • Inaccuracy
  • Stereotypes
  • Disparaging language
  • Devaluation (trivialization) of mental illness as a concern
  • Using mental illness as the butt of a joke
  • People with mental illness portrayed only as an antagonist or villain
  • Linkage of mental illness to violence
  • Offensive or insensitive symbols (e.g., straitjackets)

In the case of the NPR interview, “nutcase” waved at least three red flags. First, the context: it was used to describe a person (Description of a legal argument as “nutty” for example would not have been as great a concern).” Second, the word is often used to describe people disparagingly—with at least a suggestion that they live with mental illness. Finally, the word has an almost cartoonish impact that tends to trivialize mental illness, devaluing it as a social concern.

One of the best strategies in fighting stigma is to turn protest into dialogue. Dialogue does not necessarily lead to agreement, but it does heighten awareness and potentially connect to broader social concerns.

That’s exactly what happened in this case.

One NPR listener complained: “I’m sick to death of political correctness rules ... we use words like 'nutcase,' there's no reason to avoid them."

NPR’s Ombudsman replied: “Political correctness can surely get out of hand, but stop and think for a minute: It is highly likely that you or a family member or friend has at some point had some kind of mental illness.

“We often stigmatize it in ways that we no longer do with physical ailments, or race, or any of a number of human conditions. Calling someone a "nutcase" for something they can't help and others may share is out of bounds.”

The mention of “political correctness” led to a second discussion in the next NPR Ombudsman column.

And then a third.

One can empathize with people who sometimes feel that there’s too much “political correctness” today. But what does the phrase actually mean? Shouldn't we always try to do the right thing? Shouldn’t there be civic dialogue about language and attitudes? In many respects, invoking political correctness is only a way to duck an issue, rather than consider it.

What do you think? What do you consider most stigmatizing? Language, stereotypes, offensive symbols or something else?

Does the mental health community’s concern about stigma ever reach a point of too much political correctness?


Anonymous said...

What do you think? What do you consider most stigmatizing? Language, stereotypes, offensive symbols or something else. All of these continue the stigma of individuals having a mental health diagnois. Every chance that I get I will speak up and out for people with mental illness. Mental illness is my platform on Facebook as I have a mental health diagnosis and I try to enlighten,support and inform. I am not embarrassed by my illness neither would someone with diabetes, MS, high blood pressure, kidney disease, GI diseases and the thousands of other diseases. Like the article says you may know someone with a MH diagnois. Approximately 57.7million Americans experience a mental health disorder in a given year. One in 17 lives with a serious mental illness.

Mental Illness Policy Org said...

There is no stigma to having a mental illness. You can read my op-ed on that here: http://www.huffingtonpost.com/dj-jaffe/theres-no-stigma-to-havin_b_850024.html

Karen Estrada, M.S. (@milhealth) said...

Very good question and points. While, I feel mental illness is still much stigmatized ... I also feel that at times people do make statements without a real 'intent' to degrade someone. I also take issue with how people are portrayed in the media who have a mental illness(s). Very recent, the coverage of the Flight Attendant with Bipolar Disorder on (I think,) American Airlines.

Although I realize we do live in a 'constant reality TV show' environment, and events like this can be 'fascinating' (and in this case, extremely frightening), it did bother me seeing that all the passengers had whipped out their cell/smart phones to "document" the event. I'm not sure how much of this was really for 'documentation' and how much was for YouTube!

Another recent incident, the tragic killing of Afghan civilians by a US Soldier. I knew immediately (having two sons - 1 active duty military & 1 veteran), and because of my work with military members, families, and health care professionals...this was a situation where someone 'snapped' and certainly had psychological/organic issues. Yet, the media talked about the 'massacre', and 'slaughter', but it took several days for there to be any reference to Post Traumatic Stress Disorder, or Traumatic Brain Injury. I was most chagrined to hear the Secretary of Defense even mention the "Death Penalty" when this case is just beginning to be investigated. It is the responsibility of those of us who either work with mental health patients/education or who have a mental illness to educate the public whenever we have the opportunity, hopefully this will take the 'mystery' away from 'mental illnesses' and people will be able to understand what exactly it is and how it affects the individual who has it.

Justine said...

Worrying about "too much political correctness" is indicative, in my view, of how firmly entrenched the stereotypes are in our language, and by extension, our minds. People who make this complaint often seem to me to be exasperated with the difficulty of being considerate of the feelings of others.

Anonymous said...

I think the public fails to distinguish between general discourse and journalistic standards. I make that distinction when we discuss the idea of "pc" because there's a reason journalists are supposed to use accurate language - to present a fair and balanced report. It would never be relevant for a journalist to inquire about something being "just a nutjob." Ever. Inquiring about their MH status is different and would very much depend on the circumstances.

I suspect that much as with the LGBT community, some of the backlash comes from people losing access to their default insults. Someone told me I was being ableist when I used the term "stupid" even though I was not referring to a person. So there's a lot of education to be done on ... new ways to accurately insult people? Sigh.

Anonymous said...

Crazy is OK for a situation or bipolar or schizophrenic when they describe opposite extremes and not people or metal illness. But no to nutcase or psycho. Thank you NPR for taking us seriously.

Elizabeth said...

On What Not To Wear, they frequently referred to wardrobes as "schizophrenic", due to greatly different types of clothing, which is not only an insult, but not the correct definition of the term.

I actually met Clinton Kelly, a host of the show, and informed him of this error. He said he understood and apologized, and I haven't heard it from him since.

Lesson: SPEAK UP! If we don't, who will?

Elizabeth said...

@Mental Illness Policy Org
I read your article. Unfortunately, comments are now closed. But I wanted to respond.
I disagree with your post. I do agree that prejudice and discrimination against the mentally ill exists. But so does stigma. Try telling someone that you're schizophrenic, and see what their immediate reaction is. One instance I experienced is being told that I can't be schizophrenic because I'm not a murderer. I am schizophrenic though.
The definition is "A mark of disgrace associated with a particular circumstance, quality, or person". That very much still exists.
I also agree we should show how awful illnesses can be. But that in no way means we should stop Mental Health Awareness Day. How much hope would be lost in consumers if all we talked about were the worst cases? When I see successful people with mental illness, I have more hope for my own future. I would hate to deprive others of that.
I hope you get this, and I'm sad that for some reason comments are now closed on HuffPost.
(Sorry for two posts)

Delaney Ruston said...

I think Bob's point is spot on about the way in which our different word choices provide opportunities bring up the topic of mental health. I speak a fair bit publicly and I often say how we should all push ourselves to bring up mental health when we can. Let's face it weeks can go by and we will not have said anything...we will not have asked a friend known to have bipolar how there mood has been lately, or how is an ill relative coping with a different mental illness. And let's face it, our "inappropriate" word choices are so common because often we can't think of better words. So at least the upside is we can use these times to DIALOGUE. Thank you Bob!

Anonymous said...

What about the movie One Flew Over the Cuckoo's Nest? The name is slang for crazy. It says mental illness isn't real and treatment is bad, so it trivializes it. But it also is positive because consumers are the heros. Is it stigma? Is it OK because it creates dialogue on those issues?

Lonestarslp said...

I believe one of the biggest stigmas surrounds taking medication. The most recent example is the 60 minutes report featuring the Harvard researcher that claimed antidepressants worked no better than placebos.

Even on websites that supposedly respect the mentally ill, there are some factions that repeatedly urge us to talk to our doctor about giving up our medications because they are not necessary. Check out psychcentral.com.

If mental illness was just considered another type of illness, there would not be such an effort to de-medicalize it.