Righto, here’s my best shot at a TL; DR:

The technical, medical definition of a word isn’t its only meaning. Tonnes of other phrases in English are casual metaphors of medical things, like saying “I nearly had a heart attack” when you mean you were surprised. So it’s not “incorrect” to say “the weather is schizo” – because I know you don’t mean the weather has been diagnosed with schizophrenia, I know you mean it’s changeable. That’s just another meaning of the word.

meaning. Tonnes of other phrases in English are casual metaphors of medical things, like saying “I nearly had a heart attack” when you mean you were surprised. So it’s not “incorrect” to say “the weather is schizo” – because I know you don’t mean the weather has been diagnosed with schizophrenia, I know you mean it’s changeable. That’s just another meaning of the word. So, the only other reason for not using medical words is because it’s insensitive. Which would be a perfectly good reason, except that the best evidence we have at this point shows that that the medicalisation of mental health problems generates more negative, rather than positive, feelings for people with the mental health problems. I think that separating these words from normal, casual discourse medicalises them, and therefore, if your objective is to reduce stigma, you should’t be doing it.

On top of that, the very strict definitions that Hank seems to be sticking to often don’t even exist within the medical world. The DSM 5 is changeable and controversial, and absolutely not universally accepted.

Because of that, I don’t think you should be condemning people for using these words in the way they do. And I think it’s likely you’re causing harm if you do.

(I’ve been shadowbanned on reddit for posting a link to my own blog, so I’m sorry that I didn’t respond to any of the comments there. I had a load of responses put up, but it’s only when I logged out I saw they weren’t there. Lots of interesting stuff, though, so thanks to the few people who did comment.)

Yesterday, big-name youtuber Hank Green posted this video to SciShow, a popular Youtube channel (it’s got 131,469 views last look). The video is called “4 Psychological Terms That You’re Using Incorrectly”. In it, Hank describes four disorders (psychopathy, OCD, bipolar disorder, and schizophrenia), and how he feels their use in common discourse is insensitive and inaccurate, and minimises the actual disorders themselves. It’s the first video posted at the bottom of this page.

Hank is the brother of John Green, writer of The Fault in Our Stars. They’ve been vlogging since 2007, and their channel is one of the most popular on Youtube. I’ve been a fan and subscriber for nearly two years now. In stark contrast to other popular internet phenomena, Hank and John Green seem to be able to translate the enthusiasm of their fans into actual, real-world action. “Fans” is a slightly misleading term, though. The community of people who watch the Youtube videos, and do what Hank and John tell them to, are much closer to “followers”. This community has developed an identity in itself: “Nerdfighteria”, with individual nerdfighters effecting impressive change in terms of activism, charity, and protest movements. A quick visit to the Wikipedia page for Nerdfighteria should show the amazing amount of money, influence, and, honestly, power that this group has, with Hank and John Green at the lead.

I realise now that I’ve made them look a little sinister. I’m not saying that Nerdfighteria is negative: people enjoy the videos, and what the brothers say resonates with them. I would count myself, if a little hesitantly, among those nerdfighters. The videos themselves are genuinely enjoyable: they manage to combine the information-overload style of internet discourse (jumpcuts, rushed and excited tones, and charismatic nerdiness) with more weighty and important topics. Their take on these topics is also better than the usual PC, appropriately left-of-centre meek rubbish that you get from internet personalities trying to be popular. They approach questions with genuine wisdom, and are thoughtful and intelligent about how they answer them.

So, when I say that I have a problem with some of the things Hank said in the video posted below, I’m not trying to say he’s maliciously lead his cultish following astray: I’m saying he needs to be more careful about the tone he strikes.

Specifically, I think he needs to be more careful about the language used about psychological disorders. As far as I can tell, he’s been pushing the idea that we should be more sensitive and selective with our use of some medical terms for a while: I can find him going for a similar sentiment in this video (second video, also at the bottom). I disagree with this sentiment.

This kind of debate about language always has two key aspects to it, and I always have to separate these two out early on to avoid confusion. The first is the “technical” side, as in, am I “technically” right to use language in this way. Is that the correct definition of that word? Here, getting offended and feelings don’t matter. Here, looking something up in the dictionary can end the debate.

The second aspect is the “sensitivity” aspect. As in: sure, I’m technically correct to use this word, but it can offend or upset some people. Often, this aspect confuses things because by being sensitive about a certain word, you necessarily stifle discussion about that word. Nevertheless, being sensitive is a perfectly good reason to not use a word. Take a risqué comedian, for example. If that comedian has a bit about, say, 9/11, it’s completely possible that the bit is funny, and also interesting or insightful. I also wouldn’t think any less of the comedian, as long as he or she did the bit with common sense, irony, and humour. However, I wouldn’t bring someone I knew had lost a loved one in 9/11 to a show by that comedian. I wouldn’t show them that clip on youtube, I wouldn’t recount it to them, you get the idea.

With the medicalisation of language, I feel that Hank has gotten these two things confused. In the first video, he repeatedly insists that the common use of these words isn’t just “insensitive” but “incorrect” (it’s in the title of the video, for god’s sake.) There are a few problems, first of all, with saying that the use of any word is “incorrect”. It’s like saying someone’s name is “made-up”. Every word, at some stage, was not a word. Every word had to go through changes, mispronunciations, misuses, and so on, before it went into the ‘aul OED. It’s really really difficult to tell anyone that they’re using a word incorrectly, especially if the person they were talking to knows exactly what they mean.

And I think they probably do know what they mean. If someone says to me “he’s so OCD” I won’t think that the person in question has actually been diagnosed with obsessive compulsive disorder. No, I’ll probably think that, as Hank describes, they’re excessively neat and tidy, or something along those lines. The term OCD in common parlance is very different from the medical definition of OCD, but the term OCD in common parlance is a word in its own right, with connotations, layers of meaning, etc.

As a way of comparison, he gives examples at the beginning of the first video of physiological diseases, and how we would “never” use them as casual metaphors to describe non-medical things. (as in “you would never use cancer as a casual metaphor, why would you use mental health disorders?!”) I disagree. Of course you’ve heard someone say “I nearly had a heart attack” when they were shocked or surprised. You know that they didn’t actually nearly have a heart attack. You don’t feel that they’re belittling the condition of people who do have heart attacks. You don’t think, in the future, that a heart attack is just when someone gets really surprised. No. You think it’s a colourful and energetic, if a little clichéd, metaphor.

The other terms have similar problems. Schizophrenia, as a word, has almost nothing to do with the medical definition. The instances that Hank described it being used were clearly instances where it meant changeable, idiosyncratic, or unpredictable. In fact, I’d say if I asked the average person what schizophrenia meant, in a medical sense, they would describe split-personality disorder, rather than schizophrenia. However, when someone uses “schizo” to describe the weather, again, everyone knows exactly what they’re talking about. It seems here that people actually realise that there is more than one medical, and one casual definition, of schizophrenic, and they are completely different. Sure, people don’t know the medical definition, and they think it’s something else, but their normal, everyday definition isn’t necessarily wrong. Hank even goes so far as to explain why “schizophrenic” might, as a word, be very suited to describing something changeable when he explains its Greek roots translate as “split mind”. Maybe the disorder is incorrectly described by this word, then?

Psychopathy? I felt least comfortable with Hank’s discussion of this one. Psychopathy is not a recognised medical condition, and to say that it’s actually just “antisocial personality disorder” is grossly inaccurate. Everything about psychopathy is still hotly debated, including whether or not it exists, never mind a strict definition. Sociopathy, rather than being a more modern term for psychopathy, was at first a slightly different condition to psychopathy. Later, some argued that they were the same condition. Antisocial personality disorder is a cluster of symptoms that has a lot in common with psychopathy and sociopathy, but it is absolutely not the same. Different academics mean different things when they use these terms, and, in fact, the layperson’s idea of what a psychopath is (predatory, unfeeling, calculating, superficially charming) is very, very close to many of the current definitions. To equate all three, as Hank did, is downright untrue. Then, Hank goes on to incorrectly describe the DSM-IV-TR’s diagnostic criteria for antisocial personality disorder. The actual criteria are much, much more inclusive and broad than Hank makes it seem. At the very least, the fact that Sherlock was friends with Watson would not disqualify him from this diagnosis.

Talking about psychopathy, we get sightly into another issue, because antisocial personality disorder is in a class of disorders called “personality disorders”. The name should have you a little apprehensive. The question is, obviously, where does personality end and disorder begin? When does someone stop being just a tool, and become someone struggling with mental health issues? Here, we’ve leaked into the “sensitivity” side of the debate. More broadly, here, we should be finding out how we can best talk about mental health issues not in the most absolutely accurate way, but in a way that most helps patients.

A common theme you’ll hear among PC, well-meaning people talking about depression, is that it’s just a chemical problem, in the brain. It’s not the person’s fault, it’s not anything like “sadness” or “moodiness”, and addressing it as such is inaccurate and harmful. I was, for a while, one of those people. (Ben Goldacre describes what I’m about to talk about here in a much better way than I ever could) This is especially prevalent in Hank’s first video. More generally, it’s described as “medicalisation”, or a biogenetic causal theory. It is a well-meaning, perfectly logical way of thinking.

It’s dodgy, though, to draw a clear line between being moody and being depressed, as it is to draw a clear line between any of the things Hank talks about in the first video. (I’ve gone back to the “technical” aspect for a bit) The definition he gives at the beginning tries its best to differentiate them, saying that, for something to be a disorder, it has to be abnormal, and impact on the sufferer’s life negatively. However, I might be particularly moody, and I might not like being moody, but it probably won’t fall into the definition of clinical depression. Here, it’s affecting my life negatively, and it’s abnormal. I won’t be diagnosed with clinical depression, though, unless it is significant and noticeable. The point I’m getting at, here, is that the difference between being clinically depressed and moody is clearly the magnitude, not the nature, of the feeling.

If one is committed to these clear definitions for various conditions, then I’m afraid that those clear, immutable definitions don’t yet exist. The DSM 5 is the most current manual for diagnoses, and is widely renowned as nonsense. This same manual, you’ll have to remember, classified homosexuality as a disorder. (It’s not nonsense, by the way, because the people who write it are stupid, or anything like that, but because the problem they’re trying to solve is so incredibly difficult) So the problem is not just that clear-cut diagnosis is difficult, but that the conditions we want to diagnose these people into aren’t even constant.

There are a few other possible problems with drawing a clear line between everyday problems, and serious “medical conditions”. While Hank talks a lot about how sometimes certain discourse can belittle medical conditions, I certainly feel that Hank’s discourse could be construed to inflate them. Imaginably, someone suffering from one of these conditions could feel that they were being treated as more unstable, dangerous, or damaged than they really are, if they were told repeatedly something was medically, chemically, wrong with their brain. I’m not saying, here, that these conditions not serious, or that an individual’s experience of these conditions is anything less than horrible; I’m saying that our treatment of someone with a mental health condition could change if we use strictly medical terms to describe it.

Psychological conditions, I think, aren’t adequately described by the medical, clear-cut language that Hank uses. Most of these disorders are hugely contextual, changing from culture to culture, and even changing from doctor to doctor. That’s all well and good, so we can’t define them well, but what about being sensitive? Well, I’ve outlined why I think it’s equally possible that, by shrouding certain terms in an air of medical reverence we can cause just as much harm as we think we’re preventing. But that’s not the end of the debate. As it happens, we know the right answer here, as to whether or not we should medicalise mental health terms. You can test, relatively easily, the effect biological explanations have on people’s perception of mental health. (this is better explained the the Ben Goldacre article, by the way) A 2006 paper found 19 studies that looked into that question in particular, and found that 18 of them found beliefs in a biogenetic cause for mental health disorders were associated with more negative attitudes to sufferers. Having looked over the rest of the crash course psychology videos, it seems clear that Hank is firmly in the biogenetic camp, especially when comparing mental health conditions to physical diseases.

Again, I’m a huge fan of Hank and John Green. Their videos are great, interesting, and enjoyable. The movement that they’ve inspired does amazing things regularly. But, on this particular issue, Hank has got it wrong. And he is not just technically incorrect, but promoting a narrative that negatively affects the group he’s trying to protect. The fact that he has a large and energetic following makes this even more of a problem.