Breaking Culture In Our Language Around Mental Health

What we say matters

Posted Nov 14, 2019

@JimLin via Twenty20
Source: @JimLin via Twenty20

Recently, a client was explaining to me that she was concerned about someone who worked for her, because she had been visited by the police with regard to his mental health. It seems that a concerned family member had contacted them in fear that he was going to try to commit suicide.

My client was completely taken by surprise when they showed up and clearly still shaken when she was telling the story to me. She shared that when she discussed it with the co-worker who had recommended this man for the job, they both realized the missed signs, because they simply weren’t paying attention. She told her co-worker that despite the missed signs, she was comforted by the fact that she advocated for her employee by supplying the police officers with the names of a few hospitals that she knew were skilled in handling mental health concerns.

The co-worker expressed how badly he felt that he didn’t know there were issues going on and she replied, “That’s okay, you didn’t know he was losing his marbles.” She laughed a little when she said that to me and shared that she and her co-worker both chuckled a little when she said it. I find that this kind of conversation is not uncommon among people who disregard mental illness and people like my client who saw herself as an advocate.

Mental health concerns are beginning to be open discussions as they touch the majority of our society. Many of us are starting to take a deeper look and it’s about time.

According to an article published by

  • In the United States, almost half of adults (46.4 percent) will experience a mental illness during their lifetime.
  • 5 percent of adults (18 or older) experience a mental illness in any one year, equivalent to 43.8 million people.
  • Of adults in the United States with any mental disorder in a one-year period, 14.4 percent have one disorder, 5.8 percent have two disorders and 6 percent have three or more.
  • Half of all mental disorders begin by age 14 and three-quarters by age 24.
  • In the United States, only 41 percent of the people who had a mental disorder in the past year received professional health care or other services.

Another article by National Alliance on Mental Illness (NAMI) provides the following stats:

Annual prevalence among U.S. adults, by condition:

  • Major Depressive Episode: 7.2% (17.7 million people)
  • Anxiety Disorders: 19.1% (estimated 48 million people)
  • Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)
  • 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
  • Suicide is the 2nd leading cause of death among people aged 10-34 
  • The average delay between onset of mental illness symptoms and treatment is 11 years.

This is all pretty serious stuff that we as a society are being asked to come to grips with and pay attention to in our homes and in the workplace. There is still a great deal of stigma about this and culture provides a host of reasons to deny, avoid, ignore and make fun of mental health needs.

As is the case with my client, even those of us who are onboard with the seriousness and prevalence of it get trapped in the culture of the language that is so commonly used around it. Expressions like “He’s lost his marbles", "She’s crazy", "He’s flipped his lid", “They’ve lost it" and "She’s out of her mind or psycho" are commonplace in our conversations about our friends, relatives, co-workers and employees.

Language like this creates conflict and only serves to send people into hiding and feeling broken. As information continues to be shared and real conversations begin to take place, we can break culture and do something about the way in which we advocate for others.

Real talk allows for clarity and understanding. In the case of my client, she could have told her co-worker that it was more common than not that he would be unaware that his colleague was struggling and having suicidal thoughts. That is what was actually happening. In other words, he was not “losing his marbles.”

Substituting the real words for the colloquialism most likely would prevent the laughter and open up an opportunity for some honest conversation, maybe even about their own mental health. We need to do our own personal inventory on what words, sayings, phrases and colloquialisms we have internalized around mental illness and watch for them when they come into our thoughts or out of our mouths. Some of these are so embedded in the culture that they can often be uttered before we have the chance to stop ourselves. Time to start crossing these off of our list.

Challenging others to rethink and rephrase when we hear this language can save someone’s dignity. I asked my client to think about that phrase "lose his marbles" and consider whether she would have said that to her employee’s face. She said that she would not and so I asked her to consider why it was okay to speak about him in that way behind his back.

"Everyone says things like that, it’s just an expression" was her response. She’s not wrong except that language like that does a lot of harm. And while we’re at it, so does “be strong", "this a weakness", "snap out of it" and "don’t bring shame to the family" to name a few.

Language is such an important part of any culture and we need it to create community, understanding and frankly to exist, but language is flexible. We can add to it and we can take away from it and when it comes to mental health, it’s time for each of us to examine the power of the language we use when we speak about this crucial topic.

Let’s break culture together on this one.