Battling demons? When it comes to mental illness, language matters

by Dominic Sisti, PhD & Andrea Segal, MS of the Department of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania

Published Aug. 26, 2014, 5:30 a.m. ET

We've seen it written dozens of times in the past week: Robin Williams was battling demons. What does this mean, anyway?

For some reason, we tend to use mystical metaphors to describe the suffering of those with a mental illness, particularly depression. These images play off of anachronistic views about the nature of mental disorders. It was once thought that persons with mental illnesses were in fact possessed by demons and should be exiled on the ship of fools, exorcised, burned at the stake or boarded in dungeon-like institutions. This way of thinking permeates contemporary views of mental illness, as both the words we use to describe depression and our awful mental health care system betrays. Patients themselves have internalized the mystical ethos of mental illness. They too regularly describe their illness in terms of a futile battle with the demons of depression, addiction, or other diseases of the brain.

Supernatural metaphors obfuscate the objective reality of mental disorder and perpetuate the belief that mental illness is merely a sickness of the soul, or an existential, abstract battle between the forces of good and evil. Such a view about mental illness is both foolish and dangerous.

Individuals with major depressive disorder or bipolar disorder are not battling demons any more than a person with stage 4 lung cancer is possessed by the devil. Persons with severe depression are sick, oftentimes very much so. They are suffering from an actual illness for which there exists a range of medical treatment options not simply to prevent suicide, but to enable them to recover their sense of purpose and return to living a normal life.

The more we load the language of depression with mystical terminology, the more difficult we make it for afflicted individuals to accept their illness as real and then seek actual, evidence-based medical treatment.

Journalists, in particular, must do a better job and resist the temptation to color their reporting with bad metaphors. They should unequivocally describe suicide as the outcome of a serious medical disorder and not so quickly talk about the metaphoric defeat of the deceased by a legion of supernatural forces.

Dominic Sisti is Assistant Professor of Medical Ethics and Psychiatry in the Perelman School of Medicine at the University of Pennsylvania. He directs a research and education program on ethics in mental health care. Andrea Segal is a research associate in the Department of Medical Ethics & Health Policy.