Words taken from Rose et al (2007)

Despite how the nursery rhyme goes, words can hurt. They can also be used to reinforce mental health stigma, particularly in crime fiction.

Words are powerful – and “with great power comes great responsibility”. The longevity and influence of words can be epitomised in that one quotation, first used centuries ago and popularised by a comic book adaptation.

Words are the building blocks of the writer’s craft. They are our weapons and our tools. We can fuss for hours over the right choice of word to fit a sentence, a tone, a character. When it comes to fighting mental health stigma, we need to choose our weapons carefully.

The last time I wrote about this, I merely complained that writers should do better. This time, I’m going to do better.

The following words and phrases are all in common usage but have the potential to be harmful to people with mental health problems and reinforce stigma about them. I have here presented alternatives that will convey similar meaning but without the baggage.

NOTE: I have made some assumptions about the intention behind the use of these words. The alternatives will not fit every situation. If you have a question about options in context, please feel free to comment or contact me for suggestions.

The Anti-Stigma Thesaurus

asylum/loony bin noun
mental health unit, psychiatric hospital

bipolar adjective
capricious, changeable, fickle, flip-flopping, oscillating, unstable

commit suicide verb
complete suicide, die by suicide, kill him/herself, take one’s life
(For more guidance on writing about suicide, see Samaritans’ guidance. For a personal and professional perspective, see this note from Dr Alison Payne in the BMJ.)

crazy/insane/mad/mental/nuts adjective
1. general use
i. bizarre, eccentric, odd, outlandish, peculiar, strange, unbelievable, unusual, weird
ii. amazing, astonishing, awesome, incredible, outrageous, stunning, unbelievable
2. referring to mental health:
rephrasing is preferable – e.g. “person with mental health problems” or “he has a diagnosis of depression”
(See the “Time to Change” guide to language.)

demented adjective
absurd, nonsensical, ridiculous

OCD adjective
exacting, fastidious, finicky, meticulous, neat, tidy

psycho adjective
1. general use
violent, unpredictable, unstable, wild
2. crime fiction – referring to a murderer
cold-blooded, cruel, detached, remorseless

retard noun
fool, silly, twit
[EDIT: amended after feedback]

schizophrenic adjective
conflicting, contradictory, incongruous, inconsistent, indecisive

Do you have suggestions for other words to include in this list? Please leave your ideas in the comments.


  • Jason

    The Suicide Act (1961) decriminalised suicide so that those that attempted and failed would not be prosecuted. This does mean that people can no longer “commit” suicide as it is no longer against the law.

    I’m bipolar and I tend to describe it as yo-yo’ing.

  • Rosie, great post, as always. I know you will now be busy with Faih but when you are ready can I send you some questions about your books, writing and this website for GFT Press?There will be no rush at all.

  • Jude

    Thank you for the time, effort and thought you put into doing this.

    I have to disagree with you on the alternatives chosen for ‘retard’ though: I’d argue that every one of them is hurtful and damaging. I once saw a man call his daughter–who was perhaps two or three years old, and appeared neurotypical–a ‘moron’ over and over again, in the most casual, dismissive tone. She didn’t seem in the least upset or troubled by it, as though it was an everyday occurrence for her. It was utterly horrifying to me, and that was before I had children with additional support needs.

    Can I suggest ‘fool’ or ‘twit’ as insulting words which are more or less synonymous with ‘retard’? They seem likely to be less hurtful to people who have learning difficulties and/or mental health issues. (I’m open to correction: they may be more hurtful than I realise.)

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