Your typical ‘crazy’ person or ‘nutbag’

Your typical ‘crazy’ person or ‘nutbag’

In the mental health community, we generally discourage, and for a good reason, the use of the word crazy. So, what happens, then, when you run into someone truly off the wall, bats, wacky, or friggin nuts? In my opinion, sometimes, when we whitewash and carve out the meaning from the language, we lose something. In the case I am describing, we lose a few things. Let’s take a look at that.

What do we lose when we sanitize language and eliminate words like crazy and other colorful modifiers to explain away someone’s demeanor in an interaction or a grand over the top ornate and unnecessary display? We lose a few things. First, we lose magnitude—the sheer grandeur and size or volume of the craziness. Since we already said crazy isn’t a word we can use, I better not use it here. So, we lose the magnitude of the bat shit over the top extreme nature of what this hypothetical person is doing.

Why is it wrong to lose this aspect of description? On a clinical level, it can disrupt treatment and even, in some circumstances, put clinicians at risk. For example, I have read EHR clinical notes that are so devoid of meaning and description I wasn’t sure what to picture for a client I was reading about and under my care. The letters were so dull and obtuse that the person could have been anywhere on the affective spectrum, just short of hypomanic and subclinically depressed that I couldn’t get a read on their wellbeing.

Now, when picking up the reigns of this hypothetical case and thinking about the next session, this form of carving out description leaves me in quite the lurch when thinking about how to plan the next steps in care. Even worse, this missing aspect of the language leaves me dangerously vulnerable and ruinously unprepared if their mental status shifts were just a little bit more to an extreme state. A state which might require a different approach than what the thread was guiding me towards in the EHR notes.

So, scaling aside. What else is impacted by this loss of language? I would hazard to say, an authentic piece of the life of human disposition. While I think of my life as a series of chapters out of the theatre of the absurd, I can certainly understand why other people might want to lead a different, more subdued, and predictable life. When I think of disposition or presentation, we cannot deny that thought processes have qualities to them that take on the critical capturable aspects of personality, which must not be dislodged from writing on and language detailing its texture and nature. Meaning, when we cut out, slice off, and remove markedly identifiable pieces of a person’s personality. What makes them different, so to speak, from others who would walk in their shoes. Not only does the clinical picture suffer a loss if this was in an EHR note but also day to day conversation. We lose a fundamentally large part of a person’s narrative—the amount of their narrative different than the next person’s and the person after that.

I will not delve into aspects of the removable description or can go without saying through the loss of language in mental health. My point was it is impactful, and these examples should hopefully attest to that. So, what is the point then? My more significant concern is identity and how conversations about mental health in very ‘PC’ terms seems to cut out a piece of how people respond, react, and behave under normal real-life conditions. We have taken such a narrow-focused and manufactured approach to mental health that it is not only disrupting treatment but creeping into our identities as people and how we think and talk about each other.

I seem to remember a day when different was both a good thing and a bad thing. Today, ‘other’ seems to lead to a diagnosis and behaviors people need to avoid. Very problematic. We need to encourage diversity, support difference, and understand when something is clinically deviant from the norm in a harmful, disruptive manner or something beautiful, sexy, and richly different. It should be enshrined in a museum.

J. Peters

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association. Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia. "I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others." "In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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