RETHINKING THE LANGUAGE OF MENTAL DISORDERS: From nuts and crazy to irrational and dysregulated.
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 thinking about his comment. In addition to being hurtful, it is a sign that, despite all that we have learned and despite all the progress that we have made, 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 of these hurtful anachronisms and consider some better alternatives to use when discussing mental health issues.
How did the words crazy and nuts come to mean emotionally disordered ?
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 to the mentally ill is imprecise, but it is still illustrative.
The word crazy comes from the 16th century and meant something full of cracks, i.e., not whole or structurally solid. It commonly referred to someone who was ill. Gradually, the meaning of the term was narrowed to apply to people who exhibited emotional problems.
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 that 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.
It needs to be understood that mental illness was understood differently centuries ago. The subtleties of mood disorders were not understood. According to 16th-century thinking, a person was either sane or insane. The problem with these metaphors is the either-or dichotomy that 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 the presence of a bacterium if one is sick. Study Reveals Shifting Language in Mental Health Over 79 Years – Neuroscience News
How neuroscience has changed the language of mental disorders.
In fact, our modern understanding of the brain has shown that the interaction of different parts of the brain determines a person’s mental health. What distinguishes mental disorders from mental health is not absolute or disjunctive. The two are not separate but are joined and lie on a continuum.
Mental health is conceptualized as thoughts and behavior that are rational and controlled by the person’s medial prefrontal cortex (MPFC). Mental illness is seen as irrational thoughts and behaviors driven by the instinctive, non-rational, anxiety-ridden parts of the brain’s limbic/amygdalae/autonomic nervous system..
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.
Emotionally healthy people can be triggered into irrational feelings and reactions. The distinguishing feature that separates healthy from disordered is the frequency and degree of irrational eruptions.
Mental disorders are understood on the basis of functional impairment wherein limbic/amygdala-based impulses override the rational control of the cortex and, thus, result in dysfunctional outcomes.MENTAL HEALTH | Pastoral Counseling Syracuse NY
Understanding psychological disorders on a continuum removes the stigma.
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, 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 with the words we use when engaged in conflictual conversations can reap immediate and practical benefits.
Using descriptive words rather than 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.
Beyond consideration, descriptive language removes the stigma and thus a barrier to seeking help.
Rev. Michael Heath, LMHC, Fellow AAPC 9 9 2025
Photo by Rev. Michael Heath
