Recently, a husband in a counseling session turned and asked me to tell his wife that she was crazy. In declining to do so I asked if he could tell me what he was feeling when he made his request. He responded by saying that he felt exasperated. Indeed , sometimes we hurl words like nuts or crazy when we are frustrated and don’t know what else to do. When we feel powerless, name-calling is sometimes the only thing we can think of to do. That’s because cutting remarks, about the other person, although unkind,  makes them appear smaller and makes us feel better .

Apart from the session, it got me to thinking about how his comment , in addition to being hurtful, is a sign that, despite all that we have learned and despite all the progress that we have made, that we still have a long way to go to get beyond the fear and stigma attached to mental health issues.

Part of the prejudice stems from ignorance and a gross misunderstanding of psychological disorders.  This confusion has been and continues to be perpetuated, in part, by the common usage of antiquated and misleading terms such as “crazy” and “nuts”. Today, let’s explore the linguistic origins these hurtful anachronisms and consider some better alternatives to use when discussing mental health issues.

To begin, looking at the etymology of the words is helpful. Our understanding of the origins of the usage of those terms crazy and nuts to refer the mentally ill is imprecise but is still illustrative.

The word crazy come from the 16th century and meant  something that was full of cracks, i.e. not whole or structurally solid.  It usually referred to someone who was ill.  Gradually, the meaning of the term was narrowed to apply to people who were insane.

The slang use of the word nuts was derived from the common old English usage which referred to the head as a nut. Thus, it was common to describe an insane person as being “off one’s nut” or a “nutter”.  It is not a stretch to see how the words nut and cracked became associated with mental illness. These metaphors reveal an implicit assumption mental illness was due to the loss of the structural integrity of the head i.e. that it was cracked and had lost its structural integrity.

The usage of cracked nuts over time was shortened to simply, nuts. (Ironically, to be nuts also was used in a positive way, as it is today  to mean be pleasured by or in love, as in to be nuts about something.)

It needs to be understood that mental illness was understood differently centuries ago. The subtleties of mood disorders were not understood and mental illness was seen narrowly as insanity or what we would refer to now as psychosis. According to 16 century thinking, a person was either sane or insane. The problem with these metaphors is the either or dichotomy which they assume, i.e. that either a person’s mind is intact or is fractured. Our modern understanding of psychology originally grew out of the 19th century health/sickness medical model which was binary, i.e. either the absence of a bacterium if one is well or presence of a bacterium if one is sick.

In fact, our modern understanding of the brain has shown that a person’s mental health is determined by the interaction of different parts of the brain. What distinguishes mental illness from health is not absolute. The two are not separate but are joined and and lie on a continuum. Mental health is conceptualized as thoughts and behavior which are rational and controlled by the person’s cortex. Mental illness is seen as irrational  thoughts and behaviors driven by the instinctive, non-rational , anxiety ridden parts of the brain called the limbic system and amygdale.

Seen this way, it is understood that mental health and mental illness is not an absolute distinction and it is usually a matter of degree. Mentally healthy people are not perfectly rational and those folks with clinical diagnoses are not completely irrational. As it is with most things in life, it is all a matter of degree.  Mental health and mental illness is, then, clinically defined as a relative condition. Mental illness is understood on the basis of functional impairment wherein limbic/amygdala based impulses over-ride the rational control of the cortex and, thus, result in dysfunctional outcomes.

With this understanding the distinction between rational and irrational provides us with a better and more useful way to conceptualize and to talk about mental health issues rather than the colloquialisms of crazy or nuts. Using terms such as irrational or limbic based to refer to bizarre behaviors is more descriptive and less pejorative and less insulting than employing the commonly used slang phrases.

Finally, updating and changing the words we use when talking about mental health issues is not simply an intellectual exercise.  Being more careful and precise about the words we use when we are engaged in conflicted conversations can reap immediate and practical benefits. Using descriptive words rather name-calling is simply a more effective way to communicate because it is less inflammatory and less provocative. As such, using non-pejorative words will result in more constructive and more productive discussions.

Sometimes we get the impression that advanced medical science is a distant thing that is useful only for doctors. It is helpful to realize that advances in medical research can benefit you and me in our everyday lives and make getting along a little bit easier and a lot more understanding and considerate of one another.

Rev. Michael Heath, LMHC, Fellow AAPC                 10 3 2019

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