There has been no shortage of insults during the first nine months of the Trump presidency—both those directed at members of the administration, and those dished out by the commander-in-chief and his staff. But one specific insult recently caught the attention of two psychiatrists, who blogged about it on the BMJ website.
In July, in a now-infamous phone call to reporter Ryan Lizza, then-Communications Director Anthony Scaramucci referred to then-Chief of Staff Reince Priebus as a “paranoid schizophrenic”—using the name of a legitimate mental health condition as an insult directed at someone who, as far as we know, has no such diagnosis. And while this was a highly publicized event, it’s just one example of a larger problem, says Arash Javanbakht, MD, director of the Stress, Trauma, and Anxiety Research and Clinical Program at Wayne State University and one of the article’s authors.
It's a problem that's evident even without leaving the world of politics. On one side of the aisle, Trump himself has called people "crazy" and "psycho" in recent months. On the other side, psychiatrists have debated whether it's appropriate to question the President's own mental health. At least one psychiatrist says terms like dementia and narcissism are being thrown around without evidence, and are unfair to people who are truly ill.
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Javanbakht, and his co-author Aislinn Williams, MD, weren’t the only people to take issue with what Scaramucci said in July, or the way it was reported in the media. In their post, they reference a Teen Vogue op-ed that also points out “the profound problems” with how news organizations reported the phone call, with most never mentioning “how unacceptable and stigmatizing such a phrase is.”
About 1% of the world population actually has schizophrenia, Javanbakht and Williams note, and the disease affects several million Americans and their families and friends. “They are worthy of respect and should be met with support, but many of our profession’s top journals and the news media at large, remained silent in the face of this onslaught.”
Javanbakht spoke with Health about his blog, and about the larger problem of mental-health illnesses being used in such derogatory ways. “Anytime a medical diagnosis is used as an insult, it is basically an insult to an entire group of people that are not responsible for their condition,” he says. “You wouldn’t insult someone by saying they have diabetes, so why would you insult them by saying the have schizophrenia?”
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Using mental illnesses as insults can be directly harmful to people living with these conditions, and they can also spread inaccurate perceptions of what they really are, says Steven Meyers, PhD, professor of psychology at Roosevelt University.
For example, people may use the word schizophrenic to describe how someone can alternate between two different states, while the actual symptoms of schizophrenia involve poor reality perception, hallucinations, and confused thinking.
“Accurate information about the symptoms of a disorder can lead people towards diagnosis and treatment,” say Meyers, “while misinformation is more likely to promote stigma or cause us to dismiss or marginalize people.”
Javanbakht and Williams note that in recent years, it’s become socially unacceptable to make fun of people with illnesses like cancer, and that a public-relations campaign started by Special Olympics in 2008 has even had success reducing use of the “R-word.”
“As psychiatrists, we need to speak up alongside our patients and help people understand that using mental illness as a pejorative is equally hurtful and unacceptable,” they wrote.
“I’m a neurobiological researcher, and to me there’s no difference between a disease of the brain or a disease of the gut or any other area of the body,” Javanbakht says. “We need to help people see diseases like anxiety, depression, schizophrenia, and bipolar disorder the same way they see diabetes, high blood pressure, or Crohn’s disease.”
That starts with education, he says. “We know that 30% of the general population deals with some form of anxiety and 20% deal with depression, so chances are you have a family member or friend dealing with a mental health condition,” he says. “If we can talk openly and learn about those conditions, we’ll be able to develop empathy and see them for what they really are.”
Meyers says there’s no widespread agreement about what is an offensive use of a mental health term, and that it always depends on context. “Saying that someone has a ‘crazy’ idea isn’t the same as labeling a person as a paranoid schizophrenic,” he says. But when in doubt, he says, people should think about how their casual use of certain terms could impact others—and if they hear those terms being used incorrectly, they should call it out.
“Derogatory words that were commonly used one or two generations ago in conversation don't appear as often because they have been challenged by friends, family members, professional communities, and the media,” he says. “Slang and joking will continue to occur, but the goal is incremental progress stemming from greater awareness and the elimination of the most insulting or serious misuses of these terms.”