As someone who deals with depression, anxiety, multiple eating disorders, and post-traumatic stress disorder (PTSD), Erin M. is no stranger to the word crazy. Others have often directed the word at her in hurtful and derogatory ways—a common experience among many people living with mental illnesses.
“One [experience] that stands out was after a suicide attempt in graduate school,” says Erin, who has been interacting with the mental health system since she was a teenager and is now in her early 30s. When Erin returned to school after her attempt, she and a classmate had an argument. Erin tells SELF that, in front of a hallway full of students, her classmate said, "Well, at least I'm not the one who is crazy!"
“It cut me deeply,” Erin says.
As a psychiatrist, I’ve had a long-standing internal debate about whether I should be using the word crazy at all. This debate dates back to when I first saw judgmental headlines circulating about Britney Spears in 2007 and others about Amanda Bynes a few years later. Their public struggles with mental health earned them both a horrifying amount of vitriol. My uncertainty about using the word has only become stronger now that people often use it to describe the perpetrators of mass shootings and blame their heinous acts on mental illness. I’ve actually stopped myself midword, trying to come up with a synonym. But is that really even necessary?
I’m far from the only one asking these questions about how I use language that can carry some hefty baggage. I see conversations about this kind of thing on Twitter all the time, especially when it comes to words like crazy that have become so ingrained in conversation but also have some potentially tricky connections with mental health. As we reexamine our language and try to be thoughtful and not ableist with our word choices, crazy is one of the words we should be discussing.
To help figure out where exactly I stand when it comes to crazy, I talked to people with mental illnesses and mental health experts. One of my most interesting discoveries? No one I talked to felt like we should all just stop using the word crazy entirely.
“[Banning the word] discourages dialogue and public discourse among people who want to learn,” Gabe Howard, who is the author of Mental Illness Is an Asshole and has bipolar disorder, tells SELF. “They fear using the wrong words, being unintentionally offensive, or getting scolded.”
Instead, everyone I interviewed felt as though the conversation should be about when and how we use the word crazy.
“Rather than stop using the word, I think we should make a conscious effort to note that difference,” Alan P., who has bipolar disorder, tells SELF.
When the word “crazy” is harmful and stigmatizing
Figuring out when it does and doesn’t feel okay to use the word crazy requires a lot of thought and nuance. But the more I talked to people about this, the clearer it became that there are a few times when throwing around the word crazy can pretty obviously be hurtful, so let’s start there. Here are the examples that came up most in my conversations:
Across the board, the people I spoke with felt that the most damage comes from this usage.
“The problem with the word is it implies something other than a person living with a very complicated, profound health condition,” Christine Moutier, M.D., chief medical officer for the American Foundation for Suicide Prevention, tells SELF. “It implies a characterological issue or personality flaw rather than a brain illness.”
This becomes an even stronger argument when you think about the word’s etymology. Crazy comes from the root word craze, which, according to Merriam-Webster, was first used in the 14th century to mean “break” or “shatter.” Around 1812, people began using craze to describe “an exaggerated and often transient enthusiasm,” per Merriam-Webster. The word’s association with mental illness is believed to have originated later, in 1867, when crazy was first known to be used to describe someone acting deranged. None of these are definitions we should be associating with complicated health conditions, much less the people who have them.
The same goes for using crazy to describe negative behaviors that you are attributing to mental illness, whether or not they’re actually symptoms of that illness. Erin notes that people who know she has mental illnesses will sometimes call her behavior “crazy,” which she says feels demeaning. “Any action [or] reaction that someone doesn't like is pathologized as part of my mental illness, and I am seen as unstable or overreacting or manipulative or simply just a bad person,” she says.
Using crazy in this way can be so stigmatizing that it can prevent people from seeking help for or disclosing their mental illness, so they have a lack of both social and medical support. I’ve heard many stories about people being scared to reach out for help out of fear that they’ll be labeled “crazy,” sometimes not getting the treatment they need until they’re eventually hospitalized.
Crazy can be especially troublesome when we use it as a catchall for negative behavior.
“Describing someone who is bad at their job—they are incompetent, not crazy,” Jessica Gimeno, who has spoken about her own bipolar II diagnosis in a TEDx talk and on her blog, Fashionably Ill ® Blog, tells SELF. “Someone who is racist—they are racist, not crazy. Or sometimes people use the word crazy to label people they have issues with, from a political figure they oppose to an ex.”
We’re seeing this a lot in the news lately, especially with how many people are quick to label perpetrators of mass violence “crazy.” It’s a harmful connection to reinforce. “The majority of us with mental illness don’t have violent tendencies, and one can be violent without having a mental illness,” Jane M.,* a medical student who has bipolar disorder and has been psychiatrically hospitalized, tells SELF.
All of these uses of crazy perpetuate stigma around mental illness. For better or for worse, the two have become linked in many people’s minds.
As a psychiatrist, it’s especially important for me to explore this topic with other clinicians. We all share a responsibility to help patients feel safe and cared for, and the way we talk plays a big role in that.
The issue here isn’t so much that medical professionals (like psychiatrists) are straight-up telling patients they (or their thoughts or behaviors) are crazy. It’s more about the inadvertent damage the word can do when patients hear it tossed around by professionals in a health care setting.
For example, while on clinical rotations in medical school, Jane says she heard other physicians dismiss patient complaints and psychiatric symptoms as “crazy.” “That was actually hurtful because it made me think about how providers may have talked about me when I presented at the hospital as a patient,” she says.
It’s not hard to imagine the impact comments like that could have on any patient who overhears them. The good news is the psychiatrists I talked to agree with Jane that crazy should be excluded from medical vernacular, meaning, we should never describe psychiatric symptoms as “crazy.” Hopefully, that attitude is widespread.
In fact, some agree that using the word at all might make patients feel unsafe, even when not referring to a person. Context is everything where “crazy” is concerned, which can cause a lot of issues. A patient could overhear a doctor using the word and think they’re talking about another patient even if they’re not, for instance. Or a person who hears a doctor toss the word around, even when not using it about people, might worry the doctor could just as easily use the word when referring to patients.
“If a doctor flippantly uses the word, the patient may presume that doctor is judgmental,” Jack Turban, M.D., a resident physician in psychiatry at Massachusetts General Hospital and McLean Hospital, tells SELF, adding that this could result in someone not being as upfront about their mental health as they otherwise would be.
When the word “crazy” is less fraught
It’s become pretty normal to use the word crazy to describe a lot of things and situations in our day-to-day lives, whether they’re tests, events, or feats of nature. This kind of use actually dates back to 1887, Merriam-Webster explains. Even for a lot of people with mental illnesses and mental health experts, using crazy this way isn’t really an issue.
“The word by itself feels like nothing,” says Howard. “It's a great word. I'm crazy about my wife—I love her that much! The new roller coaster that is the tallest, fastest, longest in the world is absolutely crazy. And, honestly, you'd have to be crazy to pass up the Black Friday savings every year. Crazy has [uses] that aren't offensive.”
Gimeno agrees. She offers up the example, “Simone Biles shows ‘crazy speed.' We know that's not an insult,” she says.
Some people with mental illnesses even want to reclaim the word. Reclaiming a word—as in, taking a word that has been used against you or a group you belong to and using it instead on your own terms—can be empowering for many.
Some of the people with mental illnesses who I interviewed talked about using the word to joke about themselves or cope with their experiences. For example, Jane uses the word because she hopes if she chooses to call herself crazy, it will sting less when others do. “If I use it myself, then it can’t hurt me,” Jane says. For her, it’s basically like using dark humor and sarcasm to deal with her bipolar disorder.
Similarly, Erin uses crazy to acknowledge her awareness of the fact that sometimes her actions, reactions, emotions, and behaviors are a result of her mental health. “I want other people to know that this is hard,” she says.
Even though these two women have found reclaiming the word to be helpful, Dr. Turban points out that this is not always the case. “The difficult thing about ‘reclaiming’ a word is that some people will be on board with reclaiming it, while others will find the reclaiming in itself offensive,” he says. “It can be a fraught process that may leave many hurt and offended.”
If you personally want to reclaim crazy to describe yourself as a person with mental illness, great. Just understand that it doesn’t give you blanket permission to use the word against others.
Where I landed on the use of “crazy”
When thinking about how I should talk moving forward, I keep coming back to something Dr. Moutier learned from her experiences working in suicide prevention. “We need to leave judgment up to the people with lived experiences,” she says.
So, after all of these conversations with people who have mental illnesses and have had others wield the word like a weapon, I’m even more committed to not using the word crazy when referring to a person with mental illness, a person who’s been violent, and anyone in or around a health care setting. I’ll also encourage my peers and students to do the same by calling it out in the moment. It’s possible that my patients might say it about themselves, but that’s their right—not mine.
I’m also not going to call any negative behaviors like driving dangerously or yelling “crazy.” Instead, I’ll follow Erin’s advice: try to figure out a better, more descriptive word, and use that instead. “We can choose to be creative, thoughtful, and original in the words we use instead of continuing to use words that can cause harm,” Erin says. It’ll be a nice little brain workout for me with the huge payoff of making the way I talk less stigmatizing.
At the end of the day, there aren’t universal rules about whether and how we should use the word crazy. Some people very well might want to eradicate it from their vocabulary completely (even if only to make it easier not to slip up and use it when they shouldn’t). But, for me, it’s comforting to learn that using crazy under specific circumstances doesn’t always have to be stigmatizing or hurtful, which is why I’m not going to ban myself from using the word entirely. I feel okay saying someone did a “crazy” backflip or did “crazy-well” on a test as a compliment. I also know I can sing “Crazy in Love” and not worry that the lyrics are harmful, which is a great bonus.
As Alan says, “[Crazy] should always be used mindfully like a curse word. We don't go about using the F-word just anywhere, do we?”
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