Thomas Ungar is an associate professor of psychiatry at the University of Toronto and the psychiatrist-in-chief at St. Michael’s Hospital.
As a psychiatrist and anti-stigma researcher, I’m supposed to be outraged when someone calls a person with mental illness “crazy” or a “nutcase.” But secretly? I’m not that upset.
Now before you think I’m off my rocker, let me assure you I value my career and prefer people don’t use that type of language. I don’t recommend it, as it can be hurtful to the one in five Canadians affected by mental illness, and to their families. But truthfully, it’s no biggie.
I can understand why people let fly politically incorrect language when trying to understand the sometimes bizarre symptoms of mental illness. Even people we expect to know better in positions of influence or responsibility can do this.
Remember last summer when Ontario Premier Doug Ford called someone a “nutcase?" This was in response to a very rare and not run-of-the-mill case – a patient who was deemed not criminally responsible because of mental illness for killing someone with a meat cleaver absconded while on a pass from a prominent mental hospital.
The truth is most of the public was outraged and felt exactly the way the Premier did. But yelling and shaking our fists only alienates the majority of the public who reside outside of our virtue-signalling, assumingly enlightened, liberal academic and echo-chamber Twitterspheres.
Now before my beloved anti-stigma mental-health activists start beating their drums, let me explain. When people let loose and use language we don’t approve of, they are just being human and authentic. If we can’t tolerate that, we’re not going to get very far.
Expecting people to speak and behave correctly, as they should, is a very naive, limited and superficial approach. In my chosen field of medicine, we do this all the time. We give scientific, evidence-based advice and expect people to follow it.
Then we are surprised, disappointed or blame others when things don’t work out the way we expect them to in the messy real world. After all, with all the exercise and dietary advice out there, we should all be super fit, shouldn’t we?
Fortunately, human-centred design – the practice of finding solutions to problems by considering the human perspective – offers a way forward by daring to ask what people really think, and why? It starts with the lens of seeking to understand culture, and the deeply rooted causes and drivers of behaviours, and then proposes design solutions that expect, predict and factor in our human limitations, warts and all.
My colleague and I took this approach in describing what we called the hidden logic of mental-health stigma. What this means is that otherwise good, kind and caring people often don’t think mental illness is as real or legitimate as a physical condition.
They incorrectly think it’s in your mind, not in your body. You can’t see or touch mental illness the way you can see a skin rash or a cast on a broken arm. Is it really a surprise that people have trouble accepting it as valid? They might even let loose a few colourful descriptors – nutcase, wack job, loony bin.
This is why we are shifting efforts beyond surface language- and attitude-shaming to strategies that try to transform the way people understand mental illness. This includes showing people brain scans of persons when they are unwell, compared with when they are in recovery; the before-and-after good-news story to make it real and show that there’s hope. For most of us, seeing is believing.
We’re also shifting efforts to uncover the hardcore “structural stigma” macroeconomic resource allocations and policy requirements for mental-health services. Spoiler alert, the misallocations and absence of policy-performance measures easily explain the lack of access. Want to know what the wait time is to see a psychiatrist? I can’t tell you, because it’s not measured or reported.
We have made real strides at reducing mental-health stigma and discrimination with impressive social-media campaigns, education and coming-out-of-the-mental-health-closet testimonials of people we admire (some are even celebrities). But despite awareness efforts to improve attitudes and language, there is still a lot to be done.
So, do I condone “nutcase” name-calling? No. (What is a nutcase anyhow? Is it some travelling sales person’s sample bag filled with almonds? Walnuts? Filberts?) Do I wish people were less hurtful and more sensitive in their language? Absolutely. But will I spend my years protesting natural human behaviour? Nope.
Instead, I’ll try to understand what is behind the nutcase, wack job and loony metaphors and analogies to strategically design deep solutions to hack human nature and change their explanatory models of illness and resulting language.
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