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It’s so crazy that you called me a psycho: Why are we still using mental illness slurs?

In this post Zsuzsanna Chappell discusses some problematic aspects of mental illness slurs.

“Sweet but Psycho”, an upbeat pop song by Ava Max, topped the charts in 22 countries in 2019. Both the lyrics and the music video reinforce popular stereotypes of the madwoman as manipulative, sexually attractive, dangerous and ultimately violent. At the same time, “crazy golf” (a colloquial UK term for minigolf) is working hard to re-brand itself as “adventure golf”.

copyright Atlantic Records.

Both “psycho” and “crazy” can be used to describe people with mental illness, but the two words have very different connotations in everyday speech. “Psycho” is a negative term used to describe someone dangerous, – it could be applied as an insult to someone driving recklessly, for example, – whereas “crazy” is used much more broadly and often benignly. “Crazy golf” is meant to be fun, not violent.

In a recent article, philosopher Diaz-Legaspe defines slurs as pejorative, derogatory terms targeting identifiable, neutral groups, that are used as part of a relationship of dominance. Anyone can be part of these groups, regardless of moral character: hence they are neutral. “Psychos” are not villains, but slurs can make them look as if they were. Slurs are usually part of a dominance relationship. They express that one group has powers of marginalisation, discrimination or oppression over another group. Quite evocatively, philosopher Richard Stillman calls slurs ballistic speech. They are a kind of verbal weapon the strong can use against the weak. This describes quite well just how damaging and harmful slurs can be. They are emotionally hurtful. They can distance socially and maybe even physically.

Some terms – “psycho”, “loony”, “nutter”, “batty”, – are straightforward slurs. But there are a few other words, – most notably “crazy” and “mad”, – which originally denoted mental illness, but are now used much more broadly then this. “Crazy” golf is meant to be lots of fun and a “mad” idea is one that is very unusual, but may be brilliant exactly for this reason. In my view, these terms are not used as part of a dominance relationship of the sane over the mad, therefore it is reasonable to disagree whether they are still slurs at all. By removing these words too hastily, we may inadvertently impoverish our language without sufficient reason. In the case of “crazy” and “mad”, some of the most common dictionary references are to being in love. Mental illness is not the only thing that can rob us of our rationality.

An ad showing various small animals looking at a pile of peanuts through a shop window.

copyright Open Road Films

Here, context is key. Thus, companies like Google prohibit these words in a work context, as they are likely to come across as derogatory. They also recommend plenty of alternative, more professional words that can be used in their place, such as “complicated”, “strange” or “unexpected”. Of course, once we allow context to play a role, we will face uncomfortable borderline cases. One example is the animated children’s movie “Nut Job”. An unfortunate pun on the “Italian Job”, the film is about an unlikely squirrel hero leading the animals from the city park in a heist against a shop selling nuts. The question is: if the little furry creatures are lovable but “nuts”, does this use challenge or reinforce harmful stereotypes about the kind of over-the-top behaviour often associated with mental illness?

Apart from denoting fun and positive things, “crazy” is also a word that is associated with various stereotypes that make accusations of mental illness an insult in their own right. Thus an ex-partner easily becomes the “crazy” ex-girlfriend or the “psychopath” ex-boyfriend. Other harmful stereotypes that play on mental illness are the “manic pixie dream girl” trope and the “hot-crazy matrix”. As such stereotypes are harmful both to those they are applied to and those with mental illness, we need to stop using them.

Then there are the apparent counter-slurs: people calling themselves “a little bit ADHD” or claiming to “have a bipolar day”. The broader issue is that some of the terms we use to describe mental illness apply to moods, emotions and other mental states which are commonly experienced by everyone. Thus, many more people feel anxious, depressed, hyperactive, obsessed or manic than those who can be diagnosed with an equivalent psychiatric disorder. Censoring these words would severely restrict our ability to describe everyday emotions. At the same time, by not using the equivalent diagnostic terms (anxiety disorder, depressive disorder, ADHD, OCD, bipolar disorder) we can ensure that these are not trivialised and do not become slurs. Thus, it is more appropriate to describe oneself as very organised than jokily self-diagnose with OCD.

Ideally, the solution in the case of words such as “crazy” and “mad” would be for the discrimination against mental illness to disappear. This has happened in the case of cancer: cancer sufferers are no longer people to be shunned because of their illness. We can thus metaphorically say that corruption is a cancer of government without implying anything negative about those with actual cancer. Of course cancer has the advantage over mental illness of being more easily separated as an outside invader from those whose bodies it invades. This is much harder to do in the case of emotions, thoughts and behaviour. Activists are working towards turning “mad” into a reclaimed slur, turning the power relationship around and showing that madness is not something to be ashamed of. Maybe in the future some the indeterminate cases such as mad, crazy or even insane will become perfectly acceptable designations, similar to words such as gay or queer. Although some still see queer as a slur, which illustrates that there is often continued disagreement over the use of such words.

In the meanwhile, we can all stop using words that are clearly discriminatory, such as psycho.

I would like to thank Anneli Jefferson and Polaris Koi for their helpful comments on this blog post.

Works Mentioned

Diaz-Legaspe J (2020) What is a slur? Philosophical Studies 177:1399–1422. https://doi.org/10.1007/s11098-019-01259-3

Stillman RP (2021) Slurs as ballistic speech. Synthese. https://doi.org/10.1007/s11229-021-03095-7

My current research interest is in ethical issues related to mental illness and psychiatry. In the past I have written on democratic theory and deliberative democracy. Currently I am a Visiting Researcher at the Sowerby Project on Philosophy and Medicine, King’s College London.


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  1. What an intriguing post – thank you!

    I have one question regarding this claim about slurs and dominance: “Slurs are usually part of a dominance relationship. They express that one group has powers of marginalisation, discrimination or oppression over another group.” – This strikes me as right for many cases. But I wonder whether there is what I’d call an ‘inverted piggy-back phenomenon’, such that people also tendo weaponize slurs against people they feel are superior: children against parents would be a classic; but I could think of numerous situations. More specifically I wonder whether many of the slurs you identify might be used against academics etc. who might be as socially superior.

  2. I think it’s a bit complicated with words like “crazy” and “insane” (or their Swedish counterparts), in that there’s not always a ready substitute.

    So suppose, say, that the head of a company has a plan for how to radically restructure things, and it’s gonna be terrible for the people working there and have lots of negative consequences that he head seems to simply ignore. This is a situation in which we might naturally describe what the company head is doing as crazy or insane. And we use these words negatively, even though we don’t literally claim that the head of the company has a mental disorder.

    Now, I’ve seen people suggest that we should instead say that the plan was “wild” or “irrational”. However, “wild” isn’t obviously negative the same way as “crazy” or “insane” is in this context, which leaves us with “irrational” and similar. “Irrational” IS negative, and pretty accurate… but it’s also kind of dry. I might describe this plan as irrational if I use it in a philosophy paper to exemplify a certain type of practical irrationality, say, but it doesn’t quite carry the emotional flavour and condemnation that calling the plan “crazy” or “insane” does.

    So… despite being mad myself, and very much against people actually doing “hobby diagnosing” on others whose behaviour they don’t like (like when people say “I actually believe that to do such a thing, you must have some kind of disorder, maybe a narcissistic personality disorder, or maybe they’re actually delusional”), I’m fine with saying “WTF? That’s an INSANE plan!” in contexts like the one described. Because
    a) I don’t think there’s a good alternative option, and
    b) I think it’s clear in these instances that we don’t actually accuse this boss of having a literal mental disorder.

    I’m fine to agree to disagree (and I also agree there’s a grey area between “hobby diagnosing” and “clearly non-literal use”), but this is my take on it.

  3. Ray Briggs

    I have a “yes and” kind of question, concerning the framework of mental illness. I’m completely with you on “psycho”, and I share your reservations about “crazy” and “mad”, but I’m also not totally convinced of clinical diagnoses and a clinical framework as a viable alternative. A thing I love about “mad” is that it sounds poetic and powerful, whereas “mentally ill” conjures up images of passivity and brokenness. (I don’t think those images are *good* from an alethic or moral perspective; I just think they’re *there*.) I’m generally skeptical of having One Term to Rule Them All, but I think these reasons weigh in favor of having “crazy” and “mad” as options to build from.

    (Disclaimer: I am not diagnosable as having any mental illness, now that “gender identity disorder” is no longer in the DSM. So take my opinions with the appropriate amount of salt.)

    • I think there’s a place both for words like “mentally ill” or “mentally disordered” and for “mad” as ways to describe yourself, because different people have such different experiences in this area. I think I’m turning into more of a Mad Pride person myself nowadays, although this hasn’t always been the case (very long story I’m not gonna go through right now). But others might think that, say, “ill” just better captures their experience.

      • Ray Briggs

        “I think there’s a place both for words like “mentally ill” or “mentally disordered” and for “mad” as ways to describe yourself, because different people have such different experiences in this area.”

        This makes a lot of sense. It’s similar to how I understand trans terminology, where all of the things I might call myself are imperfect in different ways, some fit me better and some worse, and different things fit best for different people.

    • Zsuzsanna Chappell

      I agree with you completely about not having One Term to Rule Them All.

      I think mental illness is an illness in that there is exactly this feeling of passivity and brokenness about the experience. This does not mean that someone who experiences mental illness needs to take this on as an identity. People’s identities may also change over time: someone may identify as ill at some times and not at others. I completely agree that there is no term to rule them all. Mad seems to be a popular option. But being Mad as an identity, you could still experience the illness at times. I think there will have to be a plurality of terms to capture such a heterogenous experience.

  4. Zsuzsanna Chappell

    Thanks for this comment Martin! The literature on slurs is really growing fast and as it does, more of these issues are discussed.

    Of course slurs can be used towards more powerful people as well, but I don’t think they have the same pernicious impact. Of course you can try and draw attention to the fact that someone who is otherwise more powerful than you is in other ways inferior to you (e.g. “delusional”).

    I have not seen this specific issue discussed in a paper.

  5. I asked everybody that I knew, including psychiatrists and geneticists that have known me for a long time, and knew my bad behavior, what they thought. They went through very specific things that I had done over the years and said, “That’s psychopathic.” I asked them why they didn’t tell me and they said, “We did tell you. We’ve all been telling you.” I argued that they had called me “crazy,” and they all said, “No. We said you’re psychopathic.” I found out that I happened to have a series of genetic alleles, “warrior genes,” that had to do with serotonin and were thought to be at risk for aggression, violence, and low emotional and interpersonal empathy— if you’re raised in an abusive environment. But if you’re raised in a very positive environment, that can have the effect of offsetting the negative effects of some of the other genes.

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