Wordwatch Towers

A plain language guide to punctuation, grammar and writing well.

Describing people with physical and mental conditions

with 23 comments

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Image by Jim Linwood via Flickr

This is an extract from the longer post ‘Am I allowed to say that? A no-nonsense guide to political correctness’.

People with a physical or mental condition

Describing people who have certain physical and mental conditions can be very tricky indeed. But there are two golden rules that will help you no end.

  • Firstly, don’t mention a person’s physical or mental condition unless it’s relevant to what you are writing or speaking about.
  • Secondly, if you are talking about an individual, don’t hesitate to ask them how they would prefer to be described. If they cannot speak for themselves, ask their parent, personal assistant, carer or the person closest to them. Don’t be shy about doing this. It shows respect for their feelings and preferences, and they will prefer being asked to later reading a description that they will interpret as patronising, insulting or inaccurate.

Here are a few more guidelines:

Avoid using general phrases to lump people together as a homogenous group defined solely by a particular condition. For example, terms such as ‘the deaf’, ‘the blind’, and ‘the disabled’ should be avoided. Anyone with a particular condition should not be defined as that condition. Never write, for example:

He’s an epileptic.

No he isn’t. He has epilepsy. Read more on this, including the views of the charity, Epilepsy Action.

Avoid phrases such as ‘victim of’, ‘suffering from’, or ‘afflicted with’.

Avoid calling disabled people ‘brave’ or ‘special’ – unless you would have described them in this way if they had not been disabled.

Being described as ‘brave’ or ‘special’ because you use a wheelchair, or are deaf or blind, is astonishingly patronising as well as a lazy cliché.

Be aware that ‘carer’ can be a tricky word – the term ‘personal assistant’ or ‘enabler’ is often now preferred. Also, some people object strongly to this label (and that of ‘enabler’ or ‘personal assistant’) when they are first a parent, husband, wife, friend, sister, brother, son or daughter.


Don’t describe people who use a wheelchair as ‘wheelchair-bound’ or ‘in a wheelchair’. Prefer ‘wheelchair user’, or use phrases such as ‘he uses a wheelchair’.

imagesCA4GX3CIIt is true that some disabled people don’t mind how they are described, and have no objection to words such as ‘handicapped’, for example. However, some disabled people object very strongly to such terms, and it’s advisable to avoid them completely.

See this excellent must-read discussion about various terms used to describe disabled people.

A while back, a columnist in the Sunday Mirror referred to a child with Hunter Syndrome as ‘handicapped’ and also used the phrase ‘handicapped kids’. I’d argue that it’s best not to follow such examples.

I used to think that ‘people with disabilities’ was a better phrase than ‘disabled people’ because it puts people first. However, I’ve since learnt that ‘disabled people’ is usually preferable, as disabled people can feel they are ‘disabled’ by an unsuitable physical environment and the negative attitude of society which holds them back, rather than their own physical condition. (This is to do with a concept referred to as the ‘social model of disability’.)

Don’t get too bogged down in all of this. All you need to know is that the phrase ‘disabled people’ is fine and should not cause offence. However, do note that there will always be disagreement about this issue (see the discussion relating to this under ‘Describing people with physical and mental conditions’). This underlines my advice above – to ask the person concerned how they would like to be described (if a description is needed at all).

Never use the word ‘invalid’ as this can suggests that someone is in-valid or without worth. It almost goes without saying that words such as ‘cripple’ – and others I won’t insult your intelligence by listing – should never be used.

It can be problematic to refer to someone who is not a wheelchair user as ‘able-bodied’. If you need to differentiate in this way, the term ‘non-disabled’ may be a better choice. This is because ‘able-bodied’ may imply that someone who uses a wheelchair is not able.

Deaf and not so dumb

Unbelievably, the phrase ‘deaf and dumb’ still appears in newspapers and magazines, and is still used by broadcasters. It makes me cringe every time I see or hear it. The phrase is both insulting and inaccurate. The terms ‘stone deaf’, ‘deaf-mute’ and ‘mute’ are also best consigned to the dustbin.

imagesAlways use ‘deaf’ or ‘hearing impaired’. ‘Hearing impaired’ can be a good bet if you are talking about a number of people, as levels of hearing can vary widely from person to person.

If a deaf or hearing impaired person does not speak, be aware that they may be a sign language user (not ‘deaf and dumb’, or a ‘deaf mute’).

As a slight complication, the word ‘deaf’ should sometimes take an upper-case ‘D’. You should write ‘Deaf’ when referring to the Deaf Community, or members of the Deaf Community. Members of the Deaf Community in the UK usually have British Sign Language (BSL) as their first language, or have adopted it as their main language. They share a culture and heritage, and BSL is at the heart of their community. In comparison, deaf people (with a lower-case ‘d’) live more in the ‘hearing world’, and depend far more on lip-reading. Again, do not be afraid to ask respectfully how someone would prefer to be described (if it’s necessary to refer to their deafness at all).

Don’t automatically assume that people who are deaf, hearing impaired or members of the Deaf Community can be described as ‘disabled’. People who are deaf or hearing impaired can deeply resent this description. I shall never forget the deaf teacher who demanded of her (hearing) sign language pupils: ‘Would you describe me as disabled?’. Be aware that this attitude may be shared by others with physical conditions which are commonly described as a ‘disability’.

This same woman was deeply angry about a lot of newspaper coverage of deaf or hearing impaired people. One story in particular, which described the ‘miraculous’ way in which a deaf woman was able to care for her new baby, struck her as being particularly ludicrous and patronising (she was herself a mother).

As a side issue, do bear in mind that British Sign Language is not a form of pidgin English (a patronising and insulting assumption that many people seem to make). It is an independent language, as sophisticated as spoken English, and with its own grammatical rules. NEVER refer to British Sign Language as ‘deaf and dumb language’.

Remember the golden rule – if in doubt about how to describe someone, ask them.

Blindingly obvious

Phrases such as ‘blind people’, people who are blind’ ‘partially sighted’ ‘sight impaired’ and ‘people with a visual impairment’ are all acceptable.

When referring to blind and visually impaired people generally, prefer the term ‘visually impaired’ as not everyone with a visual impairment is completely blind.

Learning disability? Or learning difficulty?

imagesCAQN4M2TTread extra carefully in this particular minefield.

I was told off by a very kind but very po-faced council employee that my use of the term ‘learning disability’ was no longer acceptable. ‘Learning difficulty’ was the phrase du jour and I should start to use it forthwith. The very next day I was listening to a radio phone-in. A mother rang in to say how deeply angry she was that officials in various professions had started to refer to her son as having ‘learning difficulties’. He had, she asserted, a learning disability; there were many things he would never learn to do, and many obstacles he would never overcome. Things were not ‘difficult’ for him: they were impossible.

‘Mentally handicapped’ is now an outdated term and in many quarters no longer acceptable. You will still see and hear it used, but that doesn’t necessarily make it OK. In 2006, I heard a BBC World Service newsreader refer to ‘mentally handicapped children’ and on the same day a radio play synopsis in the Radio Times described one of the characters as ‘mentally handicapped’. In both these cases, ‘learning difficulty’ or ‘learning disability’ would have been preferable.

Nonetheless, it’s very important to note that some people believe the terms ‘mentally handicapped’ and ‘severely mentally handicapped’ are not only acceptable, but actually preferable to other phrases such as ‘learning disability’. This debate was aired a while back in the Independent newspaper when columnist Dominic Lawson defended his right to refer to his daughter, who has Down’s syndrome, as ‘mentally handicapped’. He argued persuasively against ‘fashionable catch-all phrases such as “having learning disabilities”’ and posited that such language has the pernicious knock-on effect of denying the reality of some people’s lives. Some people believe this has led to a reduction in financial and social support for those who are severely affected by a mental and/or physical disability.

Nevertheless, I would argue that the term for someone with Down’s syndrome is just that. Upper-case ‘D’ lower-case ‘s’. Obviously, terms such as ‘mongol’ and ‘mongoloid’ should never be used. Don’t use phrases such as ‘Down’s baby’, prefer ‘a baby who has Down’s syndrome’. ‘Down syndrome’ is also used in the US.

Remember the golden rule – if in doubt about how to describe someone, ask the person concerned, or if this is impossible, those closest to them. And remember to always ask yourself if it’s necessary to mention the person’s condition at all.

If someone insists that they or someone they care for should be referred to as ‘mentally handicapped’, make this clear in your text. For example: ‘Mr Brown, who describes himself as mentally handicapped’.

By doing this, you are showing your respect for the wishes of the person concerned, as well as your awareness of and respect for the views of those readers who object strongly to such terms.

Mental health issues: Bonkers Bruno locked up

Frank Bruno

Frank Bruno

This 2003 Sun newspaper headline about the boxer Frank Bruno’s hospitalisation was changed in later editions following an outcry from mental health organisations and the public.

But words that convey a negative image of mental illness and distress still saturate our media and everyday language.

Bipolar as a term of abuse.

Don’t confuse mental health issues with learning difficulty/disability issues.

As a general rule, put the person first when writing. For example: ‘Michael has a mental illness’, ‘Anne has a mental health problem’, ‘They have mental health difficulties’, ‘George has experienced mental/emotional distress’. Avoid phrases such as ‘Mary is mentally ill’, or ‘Paul suffers from a mental illness’.

Avoid using any clinical terms for particular mental health conditions (especially those frequently bandied about such as ‘psychopathic’ and ‘psychotic’) unless you are absolutely sure you are using the correct one. A while back, the Sunday Mirror columnist mentioned above referred to a murderer as a ‘psychotic piece of scum’, a ‘freak’, the ‘devil’s child’ and ‘filth’. It’s that casual, non-clinical use of the word ‘psychotic’ there that bothers me. People diagnosed as psychotic should not be associated in this inaccurate and highly damaging way with a murderer who is also described as a ‘freak’, ‘filth’ and the ‘devil’s child’ (and may or may not have been diagnosed as psychotic).

imagesCACQKIWXDon’t use the word ‘schizophrenic’ to describe anyone or anything unless you are writing about someone who has the specific and diagnosed condition of schizophrenia. Casual references to ‘schizophrenic’ opinions, attitudes or behaviour should be avoided. This is because the word is frequently and inaccurately used to describe a type of ‘Jekyll and Hyde’ behaviour, and perpetuates a negative and fear-inducing image of people who live with this condition.

Never say someone is in a ‘mental home’: they are in hospital.

I would far rather be called a nutter…

There is no denying that the use of language in relation to people with mental health problems is very tricky indeed. Just look at this range of opinions published a while back on the charity Rethink’s website:

I would far rather be called a nutter, crazy, or a mentalist than a service user. It’s an absolutely ridiculous term, alongside ‘client’ which indicates some sort of business relationship…’

I actually went to see some mental health worker and when I said to her: “And then I went mad,” she actually told me off. I accept the fact that I am mad.’

Words are only words, we attach too much meaning to them. I refer to myself as mental, mad, crazy, loony – I don’t take offence at these words, they are only words. I’ve removed the power of such words in my life.’

I do not give a damn whether I am called a client/patient/service user or whatever. What matters to me … is that I receive the help I need when I need it…’

We have all heard the cry: “I do not care what I am called it is how I am treated that matters.” Well I do care, and I care very much because how and what I am called has at least as much to do with how I am treated…

All we can do when writing is be aware of this range of opinion, and do our best to ensure our prose is accurate and respectful, and does not fuel negative assumptions and attitudes to mental illness.

Update: February 2013

Rachel Whitehead, press officer at the charity Rethink Mental Illness, argues in The Independent that:

The language used in the media around this (taking medication for mental health problems) is very telling. There is a clear dividing line between those who simply ‘take’ medication, such as people with diabetes, and those who are ‘hooked’ on it – people with mental health problems. Antidepressants in particular are often written about in the context of someone trying desperately to ‘give them up’ as if they’re some kind of bad habit. Read the full article.

Defining autism

St Pancras Station, UK, by artist, Stephen Wiltshire, who is an autistic savant.

St Pancras Station, UK, by artist Stephen Wiltshire, who is an autistic savant.

According to the National Health Service here in the UK, autism is defined as a serious and lifelong developmental disability. On its own, autism is not a learning disability or a mental health problem.

People with autism usually have difficulties with:

  • social communication
  • social interaction
  • social imagination

However, some people with autism have an accompanying learning disability, learning difficulty or mental health problem.

Read more information here.

Autistic as a term of abuse.

Autism update: December 2012

Latest from the Diagnostic and Statistical Manual (DSM) of Mental Disorders, the American publication that is one of the most influential references for the profession around the world:

The term ‘Asperger’s disorder‘ will not appear in the DSM-5, the latest revision of the manual, and instead its symptoms will come under the newly added ‘autism spectrum disorder’, which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms.

Read more on this update in the Guardian.


From John Rentoul in The Independent’s Errors and Omissions column:

On Monday, in a report about possible explanations for the inexplicable, namely Adam Lanza’s murder of 26 people in Connecticut, we said: “His brother, Ryan, reportedly told police he thought his brother had a personality disorder, possibly Asperger’s, a form of autism.” Asperger’s syndrome is indeed a mild form of autism. It gives people difficulties with social interaction and can make them come across as odd. But it is not a personality disorder, and it is not associated with violence. We should avoid relaying, without clarification, erroneous speculation of that kind.

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– clear explanations of word classes, including nouns, adjectives and verbs; and
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23 Responses

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  1. Thank you for sharing your viewpoint Muhamid. As I acknowledged, this is a tricky area.

    The work is mine, based on many years’ experience. As you have demonstrated, not everyone will agree with everything I have written.


    09/01/2010 at 8:17 pm

  2. Hi, again, Muhamid — I would never presume to speak for anyone; that’s why this piece always advises asking the person concerned how they would like to be described. I am always open to new ways of thinking on this issue because it is such a tricky and controversial area. I tried to find the Associated Press guidelines on the web as I would like to read them and add a link here; do you have a link you could share?

    Here is a link to more information on ‘the social model of disability’ http://en.wikipedia.org/wiki/Social_model_of_disability

    And here is a quote from a longer piece on Wikipedia which is similar to my view that it is usually best to put the person first before the condition, but that more complex factors are at work when describing disabled people, or ‘a person with disabilities’ as you would prefer:

    People First Language
    The American Psychological Association style guide states that, when identifying a person with an impairment, the person’s name or pronoun should come first, and descriptions of the impairment/disability should be used so that the impairment is identified, but is not modifying the person. Improper examples are “a borderline,” “a blind person,” or “an autistic boy;” more acceptable terminology includes “a woman with Down syndrome” or “a man who has schizophrenia.” It also states that a person’s adaptive equipment should be described functionally as something that assists a person, not as something that limits a person, e.g. “a woman who uses a wheelchair” rather than “a woman in/confined to a wheelchair.”

    A similar kind of “people first” terminology is also used in the UK, but more often in the form ‘people with impairments’ (e.g. “people with visual impairments”). However, in the UK, the term “disabled people” is generally preferred to “people with disabilities.” It is argued under the social model that while someone’s impairment (e.g. having a spinal cord injury) is an individual property, “disability” is something created by external societal factors such as a lack of wheelchair access to their workplace.[6] This distinction between the individual property of impairment and the social property of disability is central to the social model. The term “disabled people” as a political construction is also widely used by international organisations of disabled people, such as Disabled Peoples’ International (DPI).
    Thank you very much for your thoughts, Muhamid, which I respect.


    10/01/2010 at 3:09 pm

  3. No, my source is not Wikipedia; I know from personal experience that it can be inaccurate, and I am wary of it. I just thought it provided some interesting background to our discussion. The American Psych. Assoc. agrees with us both about putting people first! However, the piece also points out that international organisations (such as the DPI – http://v1.dpi.org/lang-en/) have adopted the term ‘disabled person’ as a political construction:

    A similar kind of “people first” terminology is also used in the UK, but more often in the form ‘people with impairments’ (e.g. “people with visual impairments”). However, in the UK, the term “disabled people” is generally preferred to “people with disabilities.” It is argued under the social model that while someone’s impairment (e.g. having a spinal cord injury) is an individual property, “disability” is something created by external societal factors such as a lack of wheelchair access to their workplace.[6] This distinction between the individual property of impairment and the social property of disability is central to the social model. The term “disabled people” as a political construction is also widely used by international organisations of disabled people, such as Disabled Peoples’ International (DPI).


    10/01/2010 at 3:33 pm

  4. This is a really great post and one that I think I will link to from our blog as a good guide for everyone. Language changes really quickly, but I think Deborah has hit the nail on the head with the logic- you should think about the person first.

    The language we use might change, but the principles behind it remain the same.

    Incidentally, as far as I’m aware, it’s Down’s syndrome in the UK and Down syndrome. I’d say Down’s is more gramatically correct, but Down seems to be accepted usage in the US.


    11/01/2010 at 10:27 am

    • Hello, there — thank you for visiting and for considering a link from your website. This is such a complex area, and so thank you for your appreciative comments which I value. I would welcome any suggestions for amendments, additions etc. which may improve the contents.


      11/01/2010 at 1:53 pm

  5. Three cheers for the sensitive way DB seems to have handled this very emotive subject. Perhaps if society put the person first a little bit more seriously it would be of little consequence how the language evolved.

    Lizi B

    11/01/2010 at 4:08 pm

  6. I think I agree with Lizi, if she means that actual social practices carry far more weight than mere words.

    For what it’s worth, my understanding is “Down’s” is commonly used and accepted in Canada. That doesn’t necessarily make it right, of course, but that’s the reality (again, to my understanding). And Canada is (in broad strokes) a rather liberal nation with much top-down concern for political sensitivity.

    Michael Farrell

    11/01/2010 at 4:21 pm

    • Thanks again for contributing to this discussion, Michael.


      11/01/2010 at 4:32 pm

  7. Thanks, Lizi B — you are right; it is the way that we actually treat people that is important. The language we use is part of the mix and I do believe that in some cases it is necessary to change our language to help effect a change in the way we treat people.


    11/01/2010 at 4:29 pm

  8. One of our members, who has a learning disability was awarded an MBE recently (honours from the queen for those non-Brits out there).

    He was really proud, but then really angry that the papers reported it as “Mentally handicapped man overcomes adversity to get MBE”. Obviously the language mattered to him. He did a blog post on it, which you can read if you’re interested

    The good news is the press sat up and took notice after they read what he had to say.


    11/01/2010 at 5:32 pm

    • Many thanks for sharing that. As Donald says in his excellent piece (link above):

      The words we use make a big difference to how people view us, and how we view ourselves.

      I strongly recommend reading Donald’s post in full.


      11/01/2010 at 5:43 pm

  9. Thanks, Enable. Well done and good on him.

    Is his objection the term “mentally handicapped” as opposed to “learning disability”? Or the prominence of his disability in the press? Aside from word choice, I get why the papers would focus on his disability: it’s what makes his MBE unusual, no? The newspapers, which must sell print to survive, are constantly looking for a hook or an angle to draw attention.

    The Press & Journal article that he cites has one use of “mental handicap” (albeit in the lead–the large-font, all-caps headline uses “learning disabilities”) and eight uses of “disability” or a cognate overall.

    I looked at his blog. On the one hand, he’s upset (I think) about the word choice or the focus on his being disabled. On the other hand, he discusses his disability as something he proudly overcame. Aside from word choice, that’s why the press focused on his MBE, as well.

    Michael Farrell

    11/01/2010 at 5:53 pm

    • Hi Michael

      I think it is the term “mentally handicapped” that he objects to. He is quite astute, and I think he understands that his disability is part of what made it a story.

      You’re right about the other uses of “disability”, but it’s “mental handicap” in the headline. I reckon what’s happened is that the journalist has checked it out, but the sub-editor has written the headline.

      I think it just knocked the wind out of Donald’s sails a bit when he saw it on bold type on the front page of his local paper.


      12/01/2010 at 10:16 am

      • Hi, there — Many thanks for this. I too looked at the paper; the headline knocked the wind out of my sails too. I hesitate to speak for Donald as he speaks so eloquently for himself, but I agree with your analysis of his viewpoint. (And I agree with his viewpoint). Thanks again.


        12/01/2010 at 10:22 am

      • Thanks, Enable! It’s been enlightening.

        Michael Farrell

        12/01/2010 at 4:04 pm

  10. I have been prattling on a bit much on this topic, so I’ll give it a rest. The topic has been interesting and enjoyable and has given me food for thought – I daresay added sensitivity. I have one ending salvo:

    As the bromide says, actions speak louder than words. I thought of this when, over the weekend, news broke about racially insensitive (if not racist) comments in 2008 by long-time US senator Harry Reid regarding Obama. Here’s an arch liberal (Reid), with a career premised on liberal tolerance and bridge-building, saying intolerant things in private – i.e., behaving intolerantly. All his public words, over a long career, were trashed by the image that he’s a closeted racist.

    In a similar vein, but reaching an opposite conclusion, I’ve used the word “niggardly” to mean miserly or stingy for many, many years – sometimes prompting a strong reaction, even among educated whites. It has an utterly unrelated etymology to the odious N-word (use of which is a separate, evolving topic). (“Niggard” to refer to a miser is in the Wycliffe Bible and Canterbury Tales in the late 1300s; the first published use of the N-word was in 1574.)

    I always knew the basic etymology of “niggard” and felt it’s silly railroading or kowtowing not to use a perfectly proper, bias-free term. But with age comes a smidgeon of added wisdom. I now won’t use it, not because it’s racist – it isn’t – but just because so many people *think* it’s related to the N-word. I wish that weren’t so but it’s a lost cause.

    We will see where the “disabled” debate ends up years from now. It’s usually ineffective to try to mandate language use from above – usage catches on or not primarily by majority will (see the French Academy with its finger in the dike, while “corrupted” French floods over it). But politically sensitive words might be a modest exception to the general rule.

    Michael Farrell

    12/01/2010 at 5:20 am

    • Not ‘prattling on’ at all. I’d like to thank you very much for all your positive, constructive and interesting comments on this one, not least of which is the insightful piece above. Many thanks for all the time and thought you have put into these contributions.


      12/01/2010 at 7:16 am

  11. A truly educating post.
    I honestly feel things like these should be taught at school level to widen the scope of education and to make more sensitive people.

    sunil balani

    19/01/2010 at 5:46 am

    • Hello, there — thank you very much for taking the time to comment and for your kind and supportive words. Yes, your suggestion about encouraging sensitivity and awareness in schools is an excellent one and makes good sense. Thanks again.


      19/01/2010 at 7:21 am

  12. Pleasure is all mine. Reading your posts really increased my knowledge and i deeply identify with the thought of making better citizens rather than just making successful individuals.
    Have written some posts on these issues ,take a look if time permits…

    sunil balani

    19/01/2010 at 11:42 am

    • Thanks, Sunil, I certainly will take a look. Many thanks for the link.


      19/01/2010 at 11:44 am

  13. President Barack Obama’s tart-tongued chief of staff, Rahm Emanuel, has apologized for using the word “retarded” to describe liberal activists whose tactics on health care he questioned.

    Emanuel made the apology last week in a phone call to Tim Shriver, CEO of the Special Olympics, the White House said Tuesday.

    The apology followed a Wall Street Journal account of a private White House meeting involving liberal groups and administration officials. In it, Emanuel reportedly grew exasperated at plans by some groups to run ads against Democratic lawmakers who were balking at Obama’s health overhaul.

    “The White House remains committed to addressing the concerns and needs of Americans living with disabilities and recognizes that derogatory remarks demean us all,” a White House statement said.

    You can read more in the LA Times.

    Michael Farrell

    03/02/2010 at 5:55 am

    • Excellent stuff! Thanks for sharing that, Michael. I was really pleased and interested to hear it.


      03/02/2010 at 6:16 am

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