In the deep shade, at the farther end of the room, a figure ran backwards and forwards. What it was, whether beast or human being, one could not at first sight tell; it groveled, seemingly, on all fours; it snatched and growled like some strange wild animal; but it was covered with clothing, and a quantity of dark, grizzled hair, wild as a mane, hid its head and facet
In 1847, Jane Eyre’s description of the madwoman in Rochester’s attic was consistent with the popular conception of mental illness. Since then, the treatment and perceptions of mental illness have changed dramatically, posing challenges to writers of both nonfiction and fiction.
Language. One out of every seven people will be affected at some point by a form of mental illness, ranging from mild depression to a chronic condition. One out of four families will be affected. Now that the condition is out of the closet (or, in Rochester’s case, the attic), people are more likely to object to such references as the funny farm or the men in white coats.
The National Alliance for the Mentally Ill lists these terms as offensive: crazy, nuts, wacko, maniac, sicko, psycho, lunatic, demented, loony.
Most writers don’t apply these terms to people with mental illness. The problem comes when these words are used to transfer the contempt these terms imply to an object of derision. For example, a sportswriter might call a coach off his rocker for sending in the third-string quarterback. Less objectionable would be foolish or ill-advised.
A particular oddity is the word sick: The sentence “That woman was really sick; her fever was high, and she had difficulty breathing” describes symptoms of physical illness. The word evokes at least neutrality if not compassion. But the sentence “That woman was really sick; her actions were incomprehensible” implies mental illness and becomes a negative pronouncement. A safe test is to substitute mentally ill for sick without changing the connotation.
Some other nuances of language concerning mental illness:
Person/people with mental illness is the preferred terminology. It places the emphasis on personhood rather than illness. Unfortunately, the term is cumbersome.
Strictly within the public mental health system, the term consumer of mental health services, or consumer for short, is recognized nationwide. It is not widely recognized within the private mental health sector, and becomes blended with other ideas of consumerism in general settings.
Never label someone with mental illness as a mental patient unless they are in the hospital. Anyone outside the hospital is a person. And hospital is most likely the correct term. Mental institution is less used now, while insane asylum and lunatic asylum carry undesirable connotations.
Although there is still a national support group for people with manic depressive and depressive disorders, the term manic depressive is no longer used as a diagnosis. The correct term is bipolar disorder.
People frequently connect schizophrenia with split personalities (as in Sybil or Three Faces of Eve). Although multiple personalities do exist, this condition is a separate diagnosis from schizophrenia and is less common.
Insanity is a legal term, not a medic al one. It involves a court’s finding that somebody is not guilty by reason of insanity. Similarly, although psychiatric evidence will be heard, it is a court that determines if a person is competent or incompetent.
Mental illness and mental retardation are separate conditions. One does not imply the other.
The Diagnostic and Statistic Manual of Mental Disorders (American Psychiatric Association), commonly referred to as DSM-III-R, is the “dictionary” of diagnoses used by most professionals. It’s difficult for a layperson to use, but useful for checking on terms.
Characterizations. As in all good writing, the key is to flesh out characters rather than falling back on stereotypes. In Tender Is the Night, for instance, F. Scott Fitzgerald portrays Nicole as a whole person, one of whose attributes is mental illness. It’s not the first. thing we learn about her. Author Donald Hall has said, “It is not necessary that we know instantly what he is, for it is the process of learning about him that interests us.” The writer who doesn’t know anything more about a character than his or her diagnosis is in trouble.