The Casual Stigma Test

We’ve had a lot of very public casual stigma recently. Firstly those hideous fancy dress costumes of “mental patients”, then Miley Cyrus casually dismissing Sinead O’Connor’s heartfelt advice as the result of her mental illness.

Thankfully, the vast majority of folks seem to get why this kind of thing is deeply offensive to people with mental health issues and why it sets us back decades on the road to a parity of esteem with other health problems.

 Unfortunately, some people didn’t get why we were insulted. They either didn’t care or worse, found it funny. To them, I suggest that in future when they’re considering whether something about mental health is in good taste, fair, or accurate, use this rule:

 Replace the mental health word with a word to do with being physically ill or to do with another minority group.

Let’s take those “mental patient” costumes for example. Some thought they were “just a bit of fun”. But if you just replace the word “mental” with something that’s been in the public consciousness as unacceptable to attack for a while, all suddenly becomes clear.

“Gay person costume”


“Black person costume”

Not so fun anymore is it? Because we realise that it’s deeply offensive to those groups. And anyway – when has the fact that some people find something fun make it morally okay?

Others said that the costumes were fine because everyone knew that real mental health patients weren’t like that. But that’s the point.  We don’t have costumes of mincing, camp gay people or sugar cane-farming, harmonica playing black people, because those groups find it horrifically insulting to be seen in those denigrating stereotypical ways – they spend their lives fighting against it.

How about the Miley Cyrus debacle? If you’ve not already heard (I needed some education here) Miley Cyrus is a young American singer who stated recently that she’d used one of Sinead O’Connor’s old videos as an inspiration for one of her own. O’Connor sent her an open letter thanking her, but also warning her about being abused by the music industry, based on her own decades of experience and suffering. Cyrus responded by sending a tweet mocking O’Connor’s past struggles with bipolar disorder as if they somehow encompassed everything about her and devalued her advice.

Yet no public outcry or apology. But what if Cyrus had been mocking O’Connor’s past struggles with a physical illness?

“No way I’m listening to your advice – you had cancer”

“Get away from me – you’ve got HIV”

We wouldn’t have been surprised to see her dropped by her record company amid an outpouring of anger. But because it’s just mental illness, nothing happened.

Though mental illness is obviously different to physical illness in many ways, two things that aren’t different are the amount people are to blame for getting it and what it says about their character. So if you’re ever going to cast judgement on someone in those ways, just take a second to check if it passes the test:

“How could they be so selfish and commit suicide?”

“How could a nice guy like him get schizophrenia?”


“How could he be so selfish and die of a stroke?”

“How could a nice guy like him get diabetes?”

My final point is about descriptors. The content of this article in The Telegraph, about homicides in schizophrenia, is very interesting – but I only want to concentrate on its use of the words “psychotics” and “schizophrenics” to describe people with psychotic illnesses.

This easily fails the test of replacing the word with one from another type of minority:


“The disabled”


People are more than their mental illness. They should not be defined by it or reduced to it. The degree to which people with mental illness want to identify with it is varied – some are happy to see it as part of themselves – but none are only their illness. This was realised decades ago in other fields and the fact we still have to point it out about mental health says somethiing profound about how far behind we are in terms of equality.

Until casually stigmatising mental illness is as unacceptable as casually stigmatising any other minority or disempowered group, we have some work to do. If something fails the casual stigma test, point it out.

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

8 Responses to The Casual Stigma Test

  1. roblupton says:

    Very powerful weapon against stigma. Thanks!!

  2. I just wish the wider public could be exposed to literature such as this. I fear as wonderful as this post is that the majority of readers are already strongly opposed to casual stigma. Let’s hope people get sharing this link and that it attractions the attention of those who might need their perspective nudged.

  3. Interesting – I sometimes wonder whether the difference is that people with cancer, diabetes, COPD etc are seen as “victims” of their disease process whereas patients with mental health problems tend to be viewed as “weak” i.e. they aren’t strong enough to deal with “life” – in a fashion, patients with mental health issues appear to be the last patients in the playground who it is OK to pick on.

  4. Pingback: Emotional problem or mental illness | counselorssoapbox

  5. Paul says:

    You will be pleased to hear that O’Connor was recently told she had been wrongly diagnosed and had never had bipolar disorder.

  6. Pingback: Thorpe Park: Royal College of Psychiatrists’ open letter | Dr Suzanne Conboy-Hill: real world, virtual world, tech, & health

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