The misuse of mental illness-related terms
- yourlistener249
- Jun 18
- 5 min read
Welcome to the March 2025 edition of the Your Listener Counselling newsletter! This month, we are correcting some common misconceptions about the meaning of certain mental illness-related words. These misconceptions appear to arise from casual conversational usage as well as sensationalism in popular culture and the media; you may have heard some people refer to every unlikeable ex-partner as a "narcissist", an apparently uncontrollable person in a frenzy as "schizophrenic", or as anyone who commits a crime as a "psychopath". In exploring this issue, we are not policing language nor being pedantic or "politically correct"; whether we realise it or not, how we comprehend the world and subsequently interact with it is influenced by our language usage, so part of being a more precise thinker, in aid of living constructively, is using language precisely.
The importance derives from the purpose of language in any case: to refer to specific ideas or phenomena so that others arrive at a mutual understanding. If we use such terms imprecisely, they become less effective and we can not use them in the confidence that they will be understood as intended. Through this, we also risk incorrectly labelling and stigmatising others. Also important is that often these terms refer to mental illnesses to signify the need for interventions such as psychotherapy. For a condition to constitute a mental illness, it must meet a strict set of criteria, which in time have been researched and codified in diagnostic manuals such as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Mental illnesses are characterised by problems in how an individual thinks, feels, behaves, and otherwise experiences the world, to such an extent that they struggle to function as normal. To distinguish these from less severe experiences is not to deny that clinically well individuals can suffer distress and deserve help. In addition, to truthfully acknowledge that an individual has a problem is not to blame the individual for that problem, deny their humanity, or minimise their right to accept treatment only with consent and have it delivered in a humane manner. Rather, it is to emphasise that in order to identify appropriate solutions to problems, we must hold precise ideas about what the problems actually are. This explained, let us define these words precisely.
Narcissist: a "narcissist" is an individual who has an exaggerated desire to be noticed and admired, with an accompanying sense of being important, entitled, and lacking in flaws. They will tend to their own interests and needs without regard for those of others, often lying or exaggerating about themselves or others to create a positive impression of themselves, and exploiting others for their own gain. They may satisfy these desires by exerting control over others through manipulation and psychological or physical abuse, while denying the severity or even the truth of their actions. These tendencies are often born of underlying insecurity combined with a lack of empathy. Narcissism can take milder forms through to the more severe diagnosis of narcissistic personality disorder. Narcissism is not simply a preoccupation with one's physical appearance (vanity), occasional difficulty understanding others' perspectives (egocentrism), or exaggerated self-confidence (arrogance).
Sociopath: "sociopath" is not a formal psychological term. The recognised phenomenon which most closely matches it is a diagnosis of anti-social personality disorder (A.S.P.D.). An individual with A.S.P.D. persistently violates social norms and causes distress or harm to others, sometimes with enjoyment, and born of a lack of impulse control and empathy, even if they are conscious of what is expected of them.
Psychopath: "psychopathy" is not a formal diagnosis, but rather a set of traits. A psychopath is an individual who pervasively deceives and manipulates others in to trusting them in order to exploit them. They usually do so by appearing to experience and understand normal emotions, and presenting as (perhaps exaggeratedly) personable. While these tendencies may at times resemble narcissistic ones (such as by lying to bolster their impression) and inevitably involve upsetting or harming others, psychopathy is not underlaid by a need for attention nor impulsivity; rather, a psychopath is considered, planful, and lacks empathy.
Obsessive-compulsive: an "obsessive-compulsive" individual is not simply overly-fixated. Obsessive-compulsive disorder is a type of anxiety characterised by two corresponding components: obsessions, which are repetitive thoughts which are difficult to ignore, and compulsions, which are strong desires to engage in repetitive behaviours. For these to be obsessions and compulsions respectively, they must interfere with executive functioning — that is, they must be so intense that they make it difficult or impossible for the individual to engage in other tasks while they are occurring. The obsessions and compulsions may manifest as exaggerations of ideas and activities which are normal in their milder forms (such as a repetitive worry that one is going to become ill from infection, leading to repeated hand-washing), or those which are atypical (such as a repetitive worry that having an odd number of objects on a desk will cause misfortune, leading to repetitive re-arranging so that an even number are present).
Schizophrenia: the term "schizophrenia" is often used casually to refer to someone who has "multiple personalities", which is incorrect, or appears severely disturbed psychologically, which is not inevitably true. Schizophrenia is a severe mental illness characterised by disorganised thinking, feeling, and behaving that often makes it difficult for an individual to live. This disorganisation may be present in a number of different symptoms, most commonly: hallucinations (seeing, hearing, feeling, smelling, or tasting sensations where no direct physical causes exist); delusions (strongly held beliefs which are not true); disorganised thinking and speech (for example, involving not answering questions in a relevant fashion, or engaging in dialogues in which the ideas are not clearly related); emotional responses to events which are culturally atypical; and an inability to sustain certain experiences (such as pleasure or focus). The severity of these symptoms varies; some individuals may have no awareness of them, while others may be completely aware that they are unwell.
Psychosis/psychotic: like schizophrenia, "psychotic" or "psycho" are often used to casually describe an individual who appears severely disturbed psychologically, however this is not the meaning. Psychosis is an experience in which an individual can not discern between reality and imagination. This often manifests as hallucinations and/or delusions. Psychosis often is a symptom of another illness, however it can derive from sources such as drug usage.
Trauma: use of the term "trauma" has broadened, and while awareness is important, we still must understand the utility of the concept. In psychology, trauma is a consequence of experiencing an event or series of events in which the stress overwhelms the individual's ability to cope with it. It manifests as symptoms such as constantly thinking of the events, nightmares, difficulty focussing or conducting normal activity, loss of interest in normal activity, mood disturbances, and functioning as if the event or events are still taking place (such as with hyper-alertness). In more severe cases, it may cause the individual to hold distorted ideas about themselves (such as that they are to blame for all negative events in their life) or the world (such as that nobody can be trusted). It may or may not constitute a diagnosis of an illness such as post-traumatic stress disorder.
Whether someone has a mental illness or not, they deserve access to quality and safe help to learn the skills to solve or cope with the problems they experience. While counsellors do not provide medical diagnoses, a key principle in my counselling practice is to educate my clients about the nature of problems to help them think about them in a precise fashion. Thinking precisely about the problems helps them to define what solutions may help — and this specificity increases the likelihood that we will actually take action.