"Psychosis" as a term of abuse

On Twitter, I have been discussing the use of mental health terms in political speech with the journalist Beatrice Bray.  In recent weeks, Guardian cartoonists Martin Rowson and Steve Bell have both used the term ‘psychotic’ to describe political figures in negative terms.  Beatrice says this is wrong and that is marginalises people who are actually clinically diagnosed with psychosis.

On the one hand, I think this is a case of ‘useful’ political correctness.  First, I’ve said before that a respect for names and labels, of people, groups or cities, is one of my tenets of useful and persusive speech.  Free speech campaigners always reserve the right to offend… but when we do, we are usually referring to the right to offend the people we are talking about!  What Beatrice is complaining of in this case, is that other people – those with an actual mental illness – are the ones being hurt in the cross-fire.  And I have sympathy with her contention that the ‘hurt’ caused is a very real social marginalisation, rather than just ‘hurt feelings’.

On the other hand, I cannot shake a feeling at the back of my mind, a sense that Rowson and Bell and others who use mental health terminology, are in fact using the words as metaphors.

Often, the term employed as a metaphor is not always used properly.  ‘Spastic‘ was often used to convey mental deficiencies when in fact it refers medically to a motor/physical illness; and schizophrenia means delusional and disorganised, not split-personality.

However, I think Rowson and Bell are at least getting their metaphors straight.  They seek to describe the Conservatives’ policies as being dangerously out-of-touch with reality.  They reach into our vocabularies for a word that describes such trait… and often, the word ‘psychotic’ fits the bill.  We all know that David Cameron does not actually have a clinical mental illness… but the term seems the perfect metaphor for his political tactics (as least to a liberal lefty).

So, while many will consider the word extreme, they nevertheless know that it is an accurate metaphor for the concepts under discussion.  Does that necessarily translate into harm against people with a clinical psychosis?  Thoughts and opinions welcomed.

9 thoughts on “"Psychosis" as a term of abuse

  1. Well, defending freedom of speech , I think, means defending the other guy’s right to offend me and I’ll go to my grave doing that but the mis-use and abuse of psychiatric diagnostic terms is problematic to me as a person with a Paranoid Personality Disorder diagnosis not because the terms themselves hurt me in a name calling way – as they don’t . No, the mis-use and abuse of these pseudo-scientific psychiatric terms , whether used as metaphors or not, offends people like me because it normalises and perpetuates the power relations behind the terms.

    What Rowson and Bell are actually doing is running out of moral arguments to lampoon their powerful targets with and very deliberately resorting to psychiatric language and the tacit complicity of the audience to ridicule , disempower and silence their targets with unchallengeable authority.

    So I’m not offended by name calling , I’m pissed that left leaning luminaries like Rowson and Bell think that psychiatric terms that are still routinely used with the backing of state power to render other human beings powerless, rights-less and choiceless and misrepresent and harm through related prejudice are so innocently hilarious when deliberately used offensively against hate targets..

    This creative pair and the mainstream media obviously get the point when it comes to other simlarly loaded terms like ‘nigger’ as they have polices for those terms set clearly within the context of civil rights.

  2. I agree – I think it accurately reflects the point they are trying to get across – in that policies are “out of touch with reality” which is a correct definition of psychotic.

    Personally I believe that challenging such statements as being discriminating – can create more stigma and discrimination. I have suffered from psychosis before – I was psychotic – my thoughts were out of touch with reality. I don’t have a problem with that and I don’t have a problem with the term being used in the way described in this blog post either.

  3. In this instance, I can agree that the use of the word may be simply metaphorical, and in that sense I have no particular problem with its use – though having said that, even with the caveat of metaphor, there remains nevertheless clear criticism in the use of the word.

    The thing is, many people use the word ‘psychotic’ erroneously to describe violent or offensive or “weird” behaviour, rather than in metaphorical terms. So those who are well aware of the minutiae of mental illness, or members of the intelligencia, using it figuratively may be OK, but is it in the other (I would wager the majority of) cases? And where is the demarcation between the two?

  4. As a psychiatrist I have to say that overall I agree with Beatrice Bray although this is a rather grey area and I can see the use of the word psychotic as a metaphor may be seen as useful.

    It does mean being out of touch with reality but the reason for someone being out of touch with reality i.e. illness is relevant and in my view is inherent in the meaning. It is a technical, although quite broad, term and when used carelessly and inappropriately by someone without the relevant technical expertise , and therefore not understanding the full meaning of the word, as a term of abuse increases the stigma associated with mental illness. For this reason , now I think about it, I realise that when I am explaining to a patient that he/ she is sufffering from schizophrenia I tend to avoid the use of the word psychotic. The same argument applies to the word schizophrenia which has an even more specific meaning and is frequently used to mean two opposing ways of thinking in the media by people who should know better.

    I think the whole debate comes down to how we feel about people hijacking words with an agreed meaning and using them in a less precise way. I think the answer is “not good” especially when there is a risk of increasing stigma and or causing offence.

  5. While the use of “psychotic” as a metaphor is somewhat problematic, people are not going to stop using psychiatric terminology even if we convince people that that specific word should be avoided.

    They would revert to using “crazy” or “insane” instead of “psychotic” (which they do 99% of the time as it is, “psychotic” is very rare as a term of abuse compared to those.)

    I am not sure that this is any better: true, “psychotic” is an actual technical term which people get diagnosed with, while “insane” no longer is, but that’s not a big difference.

    Also, where does it end? Should we stop calling someone who is really active “manic”? Should we stop referring to economic “depressions”? Should we stop using the word “panic” except in the case of actual, clinically meaningful panic attacks?

    Ultimately I do not see this getting us very far.

  6. “We all know that David Cameron does not actually have a clinical mental illness…”

    Must have missed that broadcast. Or is just a prejudice. What’s a “clinical mental illness” when it’s at home anyway?

  7. I think the reason ‘psychotic’ is of particular issue and hence not about to become an issue of psychiatric terms becoming a complete no go area for common use is that it’s something that happens to a very vulnerable minority and not something that happens regularly to a general population. ‘Crazy’ and ‘insane’ doesn’t bother me though I have suffered a short bout of psychosis myself: “Insanity in individuals is something rare – but in groups, parties, nations and epochs, it is the rule.” _ Nietzsche

    Current usage as well as etymology is important; words and their usages will gain and lose favour as is natural with most living languages. There is however some real bite to the way the word ‘psychotic’ gets mis- characterized and the permanence, ignorance or violence with which the word is wrongly associated. In truth ‘psychotic’ has a very limited qualitative value and should really only be associated with the periods when someone is actually ‘out of touch with reality'(which is actually a really weakly worded definition). These negative associations do appear to increase the impression that people with mental health issues are a threat. I’m sure over a day I could pull some papers, even meta-analysis to support this, however, I doubt anyone could argue that heuristic models are not involved in agitating discrimination and prejudice.

    I would also argue that for political use it isn’t a good analogy either as after the psychosis is over (which for the majority of sufferers fortunate enough to spontaneously recover or recover with treatment or go into remission) they accept that their previously held beliefs were wrong and try to repair any misdoings — not something common of your average politician.

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