Keeping the Label ‘Insane’ Out of Our Public Discourse

The 2020 U.S. presidential election is finally over, and next month President-elect Joe Biden will become our national leader. As we look back on Donald Trump’s term as president and the social upheaval that has taken place during this time, I hope that we have learned important lessons about choosing our words with careful thought and showing respect for our fellow Americans—including people with mental illness.

As we psychiatrists know well, language matters. The truth of this surrounds us daily. Preferred pronouns appear in the signature blocks of many people’s email. Applying a designation to the term “racism” has become fundamental to intelligent discourse on this subject, such as differentiating among “individual racism,” “structural racism,” and “institutional racism.” We have been working in psychiatry to use “person first” language: rather than referring to a “ schizophrenic patient,” we say “a patient with schizophrenia” and never refer to a patient by his or her illness—“a schizophrenic.” We have substituted “substance use disorder” for “substance abuse.” We educate the public not to refer to an individual who has a serious mental illness as a “lunatic” or “a crazy.” We have changed the names of hospitals and agencies by using nondemeaning language, such as changing the name of the “department of mental retardation” to the “department of developmental disabilities” and public psychiatric hospitals from “state hospitals” to “psychiatric centers.”

The column you are about to read is not a political statement or a commentary on the president’s mental status, as I have no firsthand knowledge of it. Rather, it is a plea for the media to help us decrease prejudice and discrimination toward people with mental illness by considering the language reporters and headline editors use. The media are describing President Trump’s mental status and presenting President Trump as a person whose behaviors qualify him to be a person with a severe mental illness. My concern is not how this kind of coverage impacts the president, but how it impacts all those who have a severe mental illness. Their struggles are enough without being tainted by referents to the president.

President Trump has used defamatory language quite loosely and often. He peppers his comments with words like “stupid,” “dumb,” and “idiot.” APA can do little to impact the language this president, or any president, chooses to use. However, APA has been making a vigorous effort to educate those who report on our political leaders to consider the language they use. Stating or implying that a public figure, the president in this case, has a mental illness runs the risk of instilling prejudice toward and discrimination against people who have a mental illness and thus exacerbating stigma.

How has the media used “insane” to describe the president and his actions?

• In the March issue of Vanity Fair, Bess Levin wrote an article titled “The 12 most insane moments from Trump’s national emergency presser. … ”

• Salon carried this headline in its April 18 issue: “Trump is insane: And it’s time for leading Democrats to say that out loud.” Subhead line: “Rational Americans already understand that our president is mentally ill. Will Democrats ever speak truth to power?”

• Lake County (Ill.) News Sun published this headline in its April 20 issue: “Trump is proving himself a power-hungry insane asylum candidate.” (I don’t believe we still have “insane asylums.”)

• On July 30, Tim White reported on WRPI News, “[Rhode Island Governor] Raimondo on Trump’s tweet to delay election: ‘He’s insane.’ ”

• An article by Jack Holmes published August 7 in Esquire was titled “Trump’s rant about how Joe Biden will kill God was insane but clarifying.”

• A story in the September 4 Washington Post by Dana Milbank was titled “Documenting Trump’s insane comments. …”

• The Guardian published a letter to the editor on September 29 that said “I wonder if Trump is insane enough. …”

• Describing Trump’s brief sojourn outside the hospital on October 4, The Guardian ran this headline the next day, “ ‘This is insanity’: Walter Reed physician amongst critics of Donald Trump’s drive-by visit.”

• Tim Miller’s piece in the October 7 Bulwark was titled “Art of the crazy: Trump’s insane Twitter negotiations.”

• An article titled “Make it Stop” by Michael A. Cohen in the October 11 Boston Globe read, “ ‘Astonishing,’ ‘remarkable,’ ‘appalling,’ and ‘insane’ have been my go-to words over the past four years [to explain the Trump era].”

• Jack Holmes, again in Esquire, was the author of an October 16 article titled “At the NBC Town Hall, the President Demonstrated That He Is Completely Insane.”

These citations are but a few examples. If we expanded our scope to social media, we’d probably find thousands of references to President Trump as “insane.” The “I” word has been used so frequently of late that even those aligned with President Trump are using it. Former White House press secretary Sean Spicer was quoted twice in “Fox Business” on October 14 as saying, “The idea that ‘CNN is in the pocket’ of President Trump is ‘insane.’ ” and “Give me a break that CNN is in the pocket of the president. That’s insane.”

I could make similar lists of examples of the president being labeled “crazy.” For example, the day after the first presidential debate on September 29, in an article by David Mastio, deputy editor of USA Today’s editorial page, and Jill Lawrence, commentary editor of USA Today, Mastio reacted to Trump’s remarks about a COVID-19 vaccine in this way: “He really is crazy.”

Criticisms can be made effectively without resorting to labeling people or their actions and statements as “insane.” A stellar example is an editorial titled “Dying in a Leadership Vacuum” in the New England Journal of Medicine signed by all the editors. These authors described our national leaders as “consistently inadequate,” stating they have “taken a crisis and turned it into a tragedy,” “undercut trust in science and in government,” and “recklessly squandered lives and money.” They called our leaders “dangerously incompetent.” These are powerful statements without any use of mental illness attributions. They speak much louder than calling our national leaders “insane.”

Another example is Michael A. Cohen’s “45 reasons not to reelect the 45th president”, which makes no mention of insanity or any psychiatric terminology. When Trump said at the second presidential debate last month “I think I have great relationships with all people. I am the least racist person in this room,” no one needed to label him “insane”; the statement spoke for itself.

APA provides guidance to reporters on its website on how to write about mental illness and the appropriate language to use. Now is the time for all of us to advocate for not using designations that can be referenced to mental illness as a way to disparage a president, any public figure, or anyone for that matter. When the media use language that invokes mental illness, those with serious psychiatric disorders suffer far more than does a president who is called “insane.” ■