Sticks and Stones: Using Language to Heal, Not Hurt


You remember the old playground taunt: sticks and stones will break my bones, but words will never hurt me. Until they do.

When Harold A. Maio was released from a psychiatric hospital in the late 1970s, he hid for several years, feeling ashamed of who he was. He internalized the descriptors that are still all too common in our everyday lexicon. Pick up a newspaper (or read one online) after the latest tragic incident in which mental illness is believed to play a part (whether that is definitively known or not). You will see words like “madman, “crazy,” “lunatic.”

When I first started reviewing research about mental health problems, I came across the terms “chronic male” and “chronic female.” What does that even mean? It referred, in fact, not to the person’s gender identity but to someone else’s judgment that this person would never recover. They were and always would be “a depressive” or “a schizophrenic.” “Language contributes to false acceptance,” notes Melody Riefer, MSW, Senior Program Manager at Advocates for Human Potential, Inc.

But Maio didn’t accept his label or prognosis. His study of languages taught him that words matter. When he told a conference presenter that the speaker’s words contradicted his message, Maio ended up with a job. For some two decades he was a mental health editor at the Boston University Center for Psychiatric Rehabilitation, and he was my first teacher in what has come to be called “person-first language.”

I was editing a newsletter about homelessness and mental illness when Maio called and took me to task. It’s not “the homeless,” he instructed. You wouldn’t think of writing “the Blacks” or “the Jews,” he pointed out. And I’m not the only one he has schooled over the years. Everyone from individuals to federal agencies have heard from him.

Clearly, he made an indelible impression, even if some of his criticism stung, so I called him recently to continue our conversation from long ago. Now retired, Maio remains vigilant about the words we use, though he admitted it can be difficult to choose correctly. “We do not easily surrender the language to which we are accustomed,” he told me.

Though it may not be easy, it is simple, Maio believes. He offers three key points:

  1. Talk about issues, not diagnosis, by putting the person first. You dehumanize people and reduce them to caricatures when you lead with what is essentially a medical diagnosis and perhaps not a precise one at that. I remember years ago when my parents returned from visiting my grandparents at their retirement community in Florida. My father noted that folks referred to their neighbors as “the heart attack” down the block or “the hip replacement” around the corner. Seems pretty silly seen in that context.
  1. Lead with the positive. The “least restrictive environment” is still restrictive, Maio points out. I recently heard a news report about a school for “troubled girls.” We read and, yes, sometimes we write, about people who “suffer from,” are “stricken by,” are a “victim of,” are “afflicted with.” Even when we say someone has “overcome” their illness, we are leading with a deficit rather than a strengths perspective. See examples of more appropriate language from the Centers for Disease Control and Prevention and The National Inclusion Project.
  1. Be specific. In addition to being negative and denigrating, a term like “the chronically mentally ill” is too abstract, Maio believes. He advises:
    1. Avoid “mental illness.” Whenever you can, use a specific diagnosis.
    2. Avoid “mental illness” in the singular. Use the plural, “mental illnesses,” as there are many.
    3. Avoid “mental” illness. Whenever possible, use “illness” instead.

You may think we are doing all of this to reduce stigma, but Maio takes exception to that term, as well. Stigma, he believes is an innuendo that victimizes. He notes we do not associate stigma with having a broken leg. Use “prejudice” or “discrimination,” beliefs and behaviors that can be addressed or redressed, a sentiment embraced by the federal Substance Abuse and Mental Health Services Administration.

I was interested to learn that not everyone agrees with the need for, or advisability of, person-first language. In her post for thinkinclusive.us, Emily Ladau writes about identity-first language. “In the ideology of identity-first, ‘disabled’ is a perfectly acceptable way for a person to identify,” Ladau writes, calling herself a disabled person. To do otherwise, she argues, implies that you have to dissociate yourself from your disability to be considered a whole person. Likewise, in his essay on autismmythbusters.com, Jim Sinclair believes that saying “person with autism” suggests, falsely, that autism can be separated from the person, or that autism isn’t even consistent with being a person.

I think what this discussion of language shows is not only that words matter, but that we must treat each and every person with the dignity and respect we would like shown to us. We may have learned about “sticks and stones” on the playground, but somewhere along the way, we also learned the golden rule.

Susan Milstrey Wells is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

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richard regan

I prefer the platinum rule. Treat other people the way they want to be treated (or at least be aware of what that is). Assumes differences. Walk in another person’s shoes. Remember their point of view makes sense in their world


Richard, you are so right. Each of us is different and should be treated as the unique person we are. Thank you for your comment.


Thank you for this article. I believe most people are not aware of the undercover messages attached to what they overtly say, and would have never used those terms if they knew their comments would be perceived as destructive or dismissive. Mostly, it’s lack of familiarity with the day-to-day reality of anyone who would be negatively influenced by their choice of words. Helping the general public learn to be aware and sensitized is key to everyone’s development.

maureen poirier rn

excellent writing, thank you. as one with ‘mental illness’ this is helpful to me, I have experienced a great amount of bullying in the VA.


This is a GREAT post and I appreciate the key points shared here, Susan, as well as the reminder to treat others with dignity and respect. Thank you!


Thank you, Yesenia, and to all who have taken the time to read and comment on this post. I sense it’s helped begin, or perhaps continue, an important conversation. What a thoughtful, engaged group we have!