The Lexicon of Madness


Anthony Marsella, Ph.D. – TRANSCEND Media Service

My purpose in writing this commentary is to call attention to the perils of language use and abuse that characterize the “mental” health professions and the public. As the introduction of the DSM V approaches, it is essential we understand the many underlying issues that exist at this time regarding the terms professionals and the public use when referring to “mental” health problems, especially with regard to their denotative and connotative meanings.  I have tried to present these issues in this commentary with a full awareness of the complexities involved as we cross professional boundaries, traditions, and histories, but also with an awareness a conversation is needed.  Perhaps it will occur.

ADJECTIVE                                      CONDITION

Psychiatric                                        Illnesses

Mental                                                  Disorders

Emotional                                         Diseases

Behavioral                                        Dysfunctions       

Bio-Behavioral                              Deviancies

Psychological                                 Distress

Psycho-Social                                 Breakdowns

Neuropsychiatric                        Pathologies

Neurotic, Psychotic                   Abnormalities



In the first column, we have a listing of popular “adjectives” associated with possible origins, sources, and/or manifestations of various types, patterns, and natures of human distress, etc.  In the second column, we have a list of “conditions.”  Virtually every combination of terms in each column has been used in our society in the classroom, clinic, media, and/or family dialogue.  Each combination has been used to refer to that broad category of “mental disorders,” now included in the Diagnostic and Statistical Manuals (DSM).

The Problems of Meaning and Implication

 Although the different adjective and condition combinations carry different denotative and connotative meanings and implications (e.g., legal, medical, moral, social), this has not prevented their widespread use and abuse.  Because of this, the terms on both sides come to lose their specificity and referent points.  Further, when joined for purposes of research, care, or legal action, a combination can be challenged regarding its specific meaning.  That is to say, what does it mean when we use the term “emotional disorder,” or “mental disease?”

Whether in a court, professional clinic, or family conversation, the excesses in the meaning of this “lexicon” of terms creates abuses and serious problems for all sides involved in the situation (i.e., person, family, professional, institutions). It is not that the terms cannot be defined, but rather that the definitions blur into one another both professionally and in the vernacular. The situation is untenable.  The existing terms of reference constitute a problem across boundaries.  And speaking of boundaries, I cannot help but call attention to the non-English translations of these terms since each has different denotative and connotative meanings in the other languages.

The Problem of Diagnosis

I do not have a solution for this situation.  The effort after specificity present in the DSM, with its range of etiological, symptomatological, and chronological descriptors represents an attempt to bring clarity to this problem. It is admirable.  But even here, it is clear that a broad array of cause, manifestation, and time criteria have not addressed the more serious problem of “diagnosis” and the abuses of terms.

It is essential we recognize that the issues of validity and reliability continue to be a source of problems for a diagnostic term.  While we can probably agree on specific parameters (e.g., frequency, severity, duration, situational settings) of a behavior (e.g., anxiety), there is a problem in assigning it to a diagnostic category.  It is at this point that problems begin and grow. The problem is further amplified when the same diagnosis can be caused, manifested, treated, and prevented in a number of ways.

The issue of diagnosis is rooted within the traditions and histories of the different “mental” health professions that serve the public.  While the medical tradition can speak readily of physical diseases in which diagnosis guides and determines understanding and treatment, there is much more ambiguity and when speaking of “mental” disorders where individual and ethnocultural differences exercise a profound effect. And, as is widely known, diagnosis within the mental health professions does not mean we understand cause, treatment, or even display or experience.

No Escape Into Good Intentions

Perhaps it is time to address these issues beyond turning to the usual solutions: (1) a new and expanded DSM, (2) increased focus on reductionism, (3) development of new medications, (4) efforts after de-stigmatization [i.e., “depression is a mental disease”].  I say the latter because I believe the term depression has many different causes, co-morbidities, experiences, symptoms, pathologies, and treatment responses. I do not deny good intentions, but I do question whether these intentions only add to the problems by continuing a tradition of thought that is in need of change.

As a final note, I wish to call attention to the obvious fact that as we locate these many problems within the human psyche (brain, body, mind), we too often forget the problems of dysfunctional societies and cultures.  When do we begin to “diagnose,” in the best sense of the word, the very living conditions, environmental milieus, and cultural contexts that not only foster disorders, but sustain them through abuses of human rights, excesses in poverty, racism, crowding, pollution, values, and cultures that are at best “living hells” for their members?  When do we begin to question the “pathogenic” impact of popular cultures rooted in unbridled consumerism, commodification, materialism greed, and exploitation?  Let us not miss the opportunity to consider our society as a locus of problems as we move toward yet more labels of madness for the mind. And here I must call attention to the risks of medicalizing social problems.  “Sick” societies may describe some situations, but this does not mean the treatment or prevention must medical.  Indeed, it is clear that political and economic interventions are needed.

In any case, perhaps these brief comments will encourage discussion of this critical problem that resides in the words we use, the assumptions behind them, and the possibilities for advancing our knowledge and practices with regard to a major challenge.


Anthony Marsella, Ph.D., a  member of the TRANSCEND Network, is a past president of Psychologists for Social Responsibility, emeritus professor of psychology at the University of Hawaii, and past director of the World Health Organization Psychiatric Research Center in Honolulu. He is known nationally and internationally as a pioneer figure in the study of culture and psychopathology who challenged the ethnocentrism and racial biases of many assumptions, theories, and practices in psychology and psychiatry. In more recent years, he has been writing and lecturing on peace and social justice. He has published 15 edited books, and more than 250 articles, chapters, book reviews, and popular pieces. He can be reached at


This article originally appeared on Transcend Media Service (TMS) on 22 Oct 2012.

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