Why I’ll Never Stop Calling My Psychiatric Patients “Crazy”
It’s not because I want to insult them
Denise is hallucinating again, hearing voices that call her a failure to God and insist she is going to hell because of the abortion she had at sixteen. An unidentifiable man’s voice calls her name over and over and she hears “cymbals smashing together” nonstop.
Denise is a bipolar patient of mine who is having a psychotic episode and experiencing auditory hallucinations and delusions of paranoia, convinced her ninety-seven year old neighbor is breaking into her house and stealing medications out of her pillbox.
She has visions of dead family members wrapped in snakes and is worried that aliens are communicating with her through her microwave. She hasn’t slept for more than three hours in a week, and her appetite is non-existent. Most of all, she is worried she is going irreversibly crazy.
Crazy has a clinical definition, sort of. Labile mood, poor judgement, poor insight. Aggressive behavior, disorientation, hostile affect. Auditory hallucinations, delusions of persecution, threatening behavior. I can think these things and document these things, but I cannot say these things to Denise while she is in the midst of a psychotic episode. What I say to her is, No. You are not Crazy. You are not Crazy because you came in to see me and ask for your medicine and ask for help and Crazy people don’t do that.
What I can do for distressed individuals is paltry compared to the constellation of services they really need, but the reassurance that one’s fabric of reality has not come undone, that they remain tethered to a knowable earth and their mind remains intact is one of the more significant. Next comes medication and finally hospitalization.
I won’t stop using “crazy” because crazy is our common language. We know what it means if someone is acting crazy, being crazy, or going crazy. We know people who are unquestionably crazy — the man having a vivid conversation with himself who lives in the bushes in front of the 7–11. We also know the relief of hearing from a medical professional that you are not Crazy. That I see you and I have hope for you because you haven’t gone over the edge. Crazy people don’t know they are crazy, because they have no reality to compare themselves to anymore. On my drive to the grocery store today, I saw a man tying a teddy bear with a handwritten sign that said “Active CIA Recruit” to a telephone pole. That man doesn’t think he’s Crazy.
Shorthand language tends to be quick and dirty. There isn’t always time to explain, so we use the undeniable and unfriendly terms that are universally understood. “Where’s the mental,” a police officer arriving to my clinic asked me after I called 911 on a homicidal man.
Junkie. Psycho. Loonie Tune. Similarly to crazy, these words are used in haste, but not always hate. They indicate urgency and acuity. To be a junkie or a psycho infers that one is currently behaving as a junkie or a psycho. To be Crazy, whether for a moment or an episode, communicates to me above all that things are Not Well, that my Assistance is Needed Right Away. Leaving me a message at my clinic saying that you have Gone Crazy is very different than Having a Hard Time or Feeling Bad.
According to clinical literature, we aren’t supposed to use “crazy” because it’s blaming. It infers that all people with mental illness are “crazy” and behave in unpredictable, violent, or irrational ways. Robert Spencer, in a piece on the NAMI blog, comments that crazy is used without thought or consideration, but I disagree.
Crazy is sacred. Crazy is a message but not the whole language. It’s a symptom but not the whole illness. If you’ve been there, you know it’s possible to return, and if you’ve returned you know the fear that will always be with you of the hell that may befall you again.
Let this fear remind you of just what kind of resilience is needed to recover a broken mind. Let this uneasiness remind you that you have come back from Crazy and lived to tell the tale.
