Midlife No. 2 available to pre-order

Two years ago, before COVID-19 vaccines were widely available and when we were still mostly keeping to our homes, my old student journalism pals got the band back together, and over just four months, 27 of us wrote and self-published the essay collection Midlife.

The project gave us a unique, lovely way to catch up with friends, some of whom we hadn’t seen in two decades. Reading my friends’ witty, incisive, and poignant essays reminded me just how amazing these folks are and how lucky I’d been to have met them and worked with them when I did.

We made the book as a gift to one another but figured that others might enjoy the writing as well, so we sold it online and through a couple of bookstores. After selling out our first print run almost immediately, we reprinted it and even briefly ended up on the bestseller list in Edmonton, where we had all met.

Wanting to keep the creativity, collaboration, and social connection going, we embarked on creating a new collection of essays a few months after launching Midlife. But by that time, the world was opening up, some of us had to return to the office (and to the commute), kids were back at their after-school activities, and life got super busy again.

After writing and editing in fits and starts, and supported by a heap of patience, perseverance, and coordination from the collection’s editors, Sarah Chan and Jhenifer Pabillano, we’re pleased to announce that Midlife No. 2 is available to pre-order. On midlifebook.ca, you’ll be able to preview the book’s introduction and see the list of contributors and essays, as well as get a closer look at the cover illustration, another Raymond Biesinger original.

A purple book embossed with a silver foil M representing "Midlife." The M is an elaborate line illustration of a building with different rooms and people engaged in activities like shopping and gardening. The text next to the book says "Pre-order now. Release date November 24, 2023" Continue readingMidlife No. 2 available to pre-order”

Hands—and book announcement

Four-frame cartoon. Frame 1: Bespectacled editor sits at her desk and types on her computer. Frame 2: She raises her hands toward her face and stares at them. Frame 3: We see her point of view, showing her two spherical hands hovering over her keyboard. Frame 4: She says, "How the hell am I typing?"

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Time flies when you’re living in a slow-motion apocalypse! I can hardly believe it, but I posted my first cartoon about editing and publishing ten years ago.

To celebrate a decade of esoteric absurdity, I’ve compiled my archive into a print book.

Cover of the book "An Editorial Cartoon" by Iva Cheung. The image shows a black-and-white cartoon on a white background, featuring Bespectacled editor and Curly-haired editor sitting at a table with their laptops and chatting over coffee. Continue reading “Hands—and book announcement”

Plain language and health literacy series

WordRake invited me to contribute four articles about plain language and health literacy to their Guest Author Series, and the final article was posted today. Here are links to all four posts in case you’re interested:

I want to thank WordRake for the opportunity! In addition to their editing software, WordRake offers a wealth of resources about writing in plain language from experts with a variety of professional backgrounds.

Angry Jelly Donut

Last fall I participated in the annual #Inktober challenge—drawing a picture in ink each day of October, based on a list of prompts. Although a lot of participants use the official Inktober prompt list, I opted to follow Janelle Shane’s AI-generated #Botober prompt list, and one of those prompts was for an “angry jelly doughnut.”

After I posted my attempt on Twitter, Steve Kleinedler (@SKleinedler)
replied, “This needs to be a children’s book, and the angry jelly donut needs to be pissed off all the way thru to the end. No transformation.” I said, “I smell a Kleinedler–Cheung collaboration,” and within days, I had a manuscript from Steve in my direct messages.

It took me a while to find the time to work on this hilariously absurd project, but I finally got it done, and you can download the accessible PDF of Angry Jelly Donut*, the children’s book, for free.

Cover of the book *Angry Jelly Donut*, story by Steve Kleinedler and illustrations by Iva Cheung. The image shows a golden-brown jelly donut with a spot of red jelly oozing out a hole in its side. The top is sprinkled with powdered sugar. The donut has an angry facial expression and is sitting on a green armchair in a room with blue walls and beige flooring.

If you’re interested in getting a hard copy, you can find an 8×8 hardcover or (adorable) 6.5×6.5 paperback wherever IngramSparks books are sold, including Bookshop.org (paperback; hardcover), Chapters-Indigo (paperback; hardcover), and Amazon (paperback; hardcover). If you’d rather get it from your local indie bookstore or library instead, be sure to let them know they can order the book via Ingram Content Group.

Want to show your allegiance to Team Angry Jelly Donut or Team Happy Vanilla Cupcake? Order a shirt from TeePublic!

Steve and I are donating $1 from each hard copy and shirt sold to charity, with half going to Indspire, which supports education of Indigenous children and youth, and half going to the Trevor Project, which offers suicide prevention and crisis intervention programs for LGBTQ youth.

I don’t really consider myself an artist, but I had an awful lot of fun creating the illustrations, and I hope they bring you a bit of delight, too.

Enjoy our ridiculous little book!

*Yes, I’ve retained Steve’s spelling of “donut.” He’s the lexicographer—take it up with him.

UPDATE, December 16, 2022: Steve and I made our 2022 donations to Indspire and the Trevor Project. We sold 122 books and 95 merch items in 2022, so each charity got the equivalent of US$108.50. Thank you to everyone who supported this silly project! We will continue to donate as we make sales, so if you know anyone who’d enjoy an Angry Jelly Donut book or shirt or mug or tote bag, be sure to visit your favourite online book retailer or the Angry Jelly Donut TeePublic store!

Introducing Midlife

Photo of a book with a green cover and gold foiling of a maze in the shape of the letter M. Next to the book is the text "Midlife: Available now as an ebook and limited edition hardcover"

Look, a rare written post!

I wanted to tell you about the launch of Midlife, a collection of personal essays by a group of friends who met twenty years ago at the University of Alberta’s student newspaper, The Gateway. 

Editor-publishers Sarah Chan and Jhenifer Pabillano brought the old crew together in January, and over the past four months 27 of us contributed to what turned out to be a warm, thoughtful, poignant, funny anthology in a beautiful package. The project was a wonderful way to reconnect when so many of us were feeling disconnected, and I feel privileged to have been a part of it.

We wrote this book as a gift to one another, but we thought other people might like to read it, too. I’m painfully averse to self-promotion, but I encourage you to get to know my brilliant friends through their writing!

You can order the book as a limited-edition hardcover or ebook at midlifebook.ca. (We sold out of our first print run in a day! You can order books from our second—and final—print run right now. You’ll get the physical book in early June and can read the ebook, included in the price, in the meantime.)

For every book sold, $1 goes to the Edmonton Community Foundation. The book will also be available through the Edmonton Public Library, and the publishers are working on getting it into other libraries as well.

Keep up with the project through social media (@midlifebook on Twitter, Instagram, and Facebook) or by signing up for our newsletter at midlifebook.ca. If you love the maze illustration on the cover as much as I do, you can learn more about how the idea for it came about from illustrator Raymond Biesinger in the first issue of the Midlife newsletter. 

Upcoming events

  • Thursday, April 22, 5:30 to 7:00 PM Eastern Time—You can win an ebook copy of the book as a door prize at the Freelancers Happy Hour.
  • Thursday, April 22, 8:00 to 9:00 PM Mountain Time (10:00 to 11:00 PM Eastern Time)The Midlife public launch will be a livestream on YouTube featuring publishers Sarah and Jhen interviewing Midlife contributors Leanne Brown (NYT bestselling cookbook author), Jag Dhadli (consummate Oilers fan), and Don Iveson (mayor of Edmonton). Ask a question for a chance to win a copy of the hardcover!
  • Saturday, April 24, all day—I’ll be doing a Twitter takeover of the @midlifebook account. Look out for other contributors’ Twitter takeovers over the next month, too.


CONTENT NOTE: Potty-mouth.

Two-frame cartoon. First frame, bespectacled editor, in this case an author, is on her knees on the floor, her head in her hands. She says to curly-haired editor, who's at her desk, "I'M SO SORRY THE REFERENCES ARE SUCH A MESS! I completely ran out of fucks by the time I got to the back matter!" Second frame: Curly-haired editor goes to comfort bespectacled editor, saying, "It'll be OK. I'll lend you some of mine."

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I’ve spent a disproportionate amount of my billable time fact checking and editing references. Depending on the project schedule, I often wouldn’t mind that kind of work, which could be kind of meditative—I’d put on my favourite music and get ’er done. But under time pressure, the task could be frustrating, especially if I knew that basically nobody would be reading the back matter. And why, I wondered, was reference formatting so hard for authors to get right? Continue reading “Spent”

Michelle Clough—Editing and writing in the video game industry (Editors BC meeting)

Michelle Clough has worked in the game industry for seven years as a freelance writer, editor, narrative designer, localization specialist, and narrative quality-assurance (QA) playtester. At the April Editors BC meeting, she gave a wide-ranging introduction to the complex and competitive world of writing and editing for video game studios.

Clough contrasted AAA games—big-budget projects produced by major studios with massive creative and marketing teams and characterized by realistic presentation and a cinematic story—with independent games produced by smaller teams, which may be more artistic and experimental or cater to niche audiences. AAA games usually have a lot of dialogue and action that can require hundreds of thousands of words to tell a story, but indie projects can still involve quite a bit of writing.

Writing and editing in different game genres

Some “wordy” game genres require more writing than others:

  • role-playing games: This genre comes out of the Lord of the Rings tradition. The player takes the place of a hero in an immersive story, where the worlds are often incredibly detailed.
  • interaction fiction: Players use text commands to control characters and interact with their environment.
  • visual novels: Games of this genre became popular in Japan, and they are heavy on graphical elements and relatively light on gameplay. Players move the story forward by clicking on various game elements to make narrative choices.
  • point-and-click adventures: Players click to pick up objects and interact with them, sometimes to solve particular puzzles or problems. This older genre is enjoying a renaissance.
  • walking simulators: A genre where players use clues from diaries, audio recordings, and other artifacts to piece together a story.

Other game genres, like sports games and first-person-shooter games, may not necessarily have a story but must have clear instructions for the player.

Some games have a linear narrative, like movies and books, where events happen in a set order as the player progresses. The player’s skill dictates whether they fail and have to try again or succeed and progress to the next level.

In contrast, many games have nonlinear, branching narratives, where the story can change based on the player’s actions and choices. “Open world” or “sandbox” games are even less defined, allowing players the space to explore and engage at their whim. These games often have a central story triggered by arriving at certain locations within the game’s universe but also has side quests and secrets players can unlock.

In games with nonlinear narratives, the player is the driving force of the story. Editors are used to promoting the maxim “show, don’t tell,” but in video games, it’s “do, don’t show”: the players take the action and may be creating the story as they progress.

As you can imagine, this type of game can pose a writing an editing challenge. Continuity and causality are major considerations, and writers and editors have to keep all of the “what if” scenarios in mind as they write. Clough likens the task to “editing a novel where people could read it in any order and it still had to make sense.”

Writing for the story and beyond

Clough emphasized that writing for the video game industry isn’t limited to the story itself.

Even games with no story or dialogue will have text for game information, player instructions, menu options, and tutorials. This text must be clear. Some games feature cutscenes—mini movies that play at certain stages of the game to explain the story. Some extremely detailed worlds, particularly in science fiction and fantasy games, will have codexes that explain the world’s history and culture. Games will also have “flavour text”—bits of text on items in the game that don’t figure in the mechanics of the game but lend realism to the item. All of this in-game text has to be written.

Games that use environmental storytelling, advancing the story and building the mood through the setting, may not have text in the game itself, but the scenes must be described in detail to the development team. Teams also rely on a ton of internal documentation—such as character biographies, game design documents, level layouts, and world bibles—to ensure continuity and consistency between different parts of the game.

Marketing copy also has to be written, and for high-stakes AAA games with aggressive marketing campaigns, the copy has to be professional and persuasive.

Writing- and editing-related roles on teams

Writers and editors can bring their skills to various roles on game-development teams. Besides being game writers—producing the actual stories or words used in a game—people with a knack for story and narrative can also be narrative designers, who are kind of like movie producers: they champion the story and communicate to others on the team about how the story should advance, through art, mechanics, and sound. Narrative designers combine writing, editing, and design and are often in a management role, overseeing game writers.

Development teams also call on narrative QA testers to playtest the game with a focus on the story, looking for bugs, logical inconsistencies, and narrative discontinuities.

Editors may work on localization, which usually involves editing text in games developed in other languages and translated to English. Sometimes the translations are done by machine or by people who don’t speak English as a first language, so the results can be awkward or non-idiomatic. Localization editors also flag and adapt cultural references and jokes or puns that may not work with the local audience.

Challenges of game writing and editing

  • Pacing and length: Players are usually eager to get back to gameplay, so game text and dialogue need to be short. Mobile games, in particular, may restrict text to a certain number of characters.
  • Player agency: Writers and editors have to consider all of the possible choices a player can make. If the different trajectories have a shared ending, the tone should match and the story should make sense.
  • Coding: Writers and editors have to understand code, particularly how variables in the programming affect causality and story structure.
  • Workload and timelines: Project timelines are usually tight, and scenes can cost a lot of money and time to develop, because they involve so many people. There’s not a lot of room for iterations of editing. Some developers also put a low priority on the story. Clough said “It’s not uncommon to be hired as a writer near the end. The gameplay will be done, and they’ll say, ‘Now come up with a story for it.’” A lot of people believe that anybody can write and don’t value the skill as much as they should.
  • No standardization: Game writers and editors never know what they’ll be using to work on the text. Sometimes they’re writing in Word or Google Docs, sometimes the scenes are in Excel files, and other times they’re working directly with the code.
  • Gender bias: Some vocal segments of the gaming community have developed a reputation for being hostile to women. And although things are improving, only 21% of game developers are women, although women make up half of all game players.

Despite the challenges, Clough enjoys her work because it involves a high level of creative and critical thinking. Because games are one of the newest art forms, the industry is evolving quickly and offers a huge variety of work.

Finding work as a game writer or editor

There aren’t many permanent positions available at game studios, because much of the industry still isn’t convinced it needs writers and editors. But Clough and others like her began building their careers by subcontracting, learning about coding, and approaching smaller indie developers. She suggested that a good way to break in to the industry is from the business and marketing side—editing and proofreading ad copy, for example.

Clough also regularly attends and speaks at game conferences. She suggested attending not just the developer conferences but also fan conferences, where developers often show off games in their early stages and can be approached about writing or editing.




Games that may appeal to writers and editors

Platforms to create and write games

Steven Pinker—The thinking person’s approach to writing in the 21st century (Beyond the Red Pencil, 2015)

Experimental psycholinguist and author Steven Pinker gave the opening keynote at Beyond the Red Pencil, the Northwest Independent Editors Guild’s fifth biennial conference. His talk covered the same territory as his book The Sense of Style (which I reviewed earlier), but I still very much enjoyed hearing him speak in person.

Why is so much writing so bad, he asked, and how can we make it better?

One common theory is that bad writing is a deliberate choice by bureaucrats who use gibberish to evade responsibility or by pseudo-intellectuals who want to hide the fact that they have nothing to say. But good people can write bad prose, said Pinker. Another theory suggests that digital media are ruining the language, because we can all recall that in the 1980s, Pinker quipped, “teenagers spoke in coherent paragraphs.”

A better theory is that whereas speaking comes naturally to us, writing doesn’t. “Writing is and always has been hard,” said Pinker. “Readers are unknown, invisible, inscrutable—and exist only in our imagination.”

What can we do to improve writing, then? Some would suggest reading books like The Elements of Style, but among some good advice—such as using definite, concrete language and omitting needless words—is advice that is obsolete or downright baffling. “The problem with traditional style advice,” said Pinker, is that it’s an arbitrary list of do’s and don’ts based on the tastes and peeves of the authors.”

Instead, we should base our writing advice on the science and scholarship of modern grammatical theory, evidence-based dictionaries, cognitive science, and usage. Pinker made a case for classic style, which uses “prose as a window onto the world.” Reader and writer are equals, and the goal of the writer is to help the reader see objective realities. “The focus is on the thing being shown, not the activity of studying it,” said Pinker. The latter is a feature of self-conscious style that contributes to the verbosity and turgidity of academic and bureaucratic writing.

“Classic prose is about the world, not about the conceptual tools with which we understand the world,” said Pinker, who suggested avoiding metaconcepts and nominalizations. But he urges caution on the common advice to avoid the passive voice—especially since the advice itself often uses passive voice while condemning it. “The passive could not have survived in the English language for 1500 years if it did not serve a purpose,” said Pinker. English sentences rely on word order to convey both grammatical information and content. We expect material early in the sentence to name the topic (what the reader is looking at) and later in the sentence to show the focal point (what the reader should notice). “Prose that violates these principles feels choppy and incoherent.”

So “avoid the passive” is bad advice. But why is it so common in bad writing? “Good writers narrate a story, advanced by protagonists who make things happen,” said Pinker, whereas “bad writers work backwards from their own knowledge.

Too much knowledge can be a curse: “When you know something, it’s hard to imagine what it is like for someone else not to know it.” It’s this curse of knowledge that leads to opaque writing. The traditional advice to solve this problem is to assume a reader is looking over your shoulder at what you write. “The problem with the traditional solution is that we’re not very good at guessing what’s in people’s heads just by trying hard,” said Pinker. A better approach is to show your draft to a representative reader, or “show a draft to yourself after some time has passed and it’s no longer familiar.” Rewrite several times with the single goal of making prose more accessible to the reader.

Another battleground in writing are rules of usage, but Pinker said that the “prescriptivist versus descriptivist” paradigm is a false dichotomy. Rules of usage aren’t logical truths and are not officially regulated by dictionaries, he said. They are tacit, evolving conventions. “Many supposed rules of usage violate the grammatical logic of English, are routinely flouted by the best writers, and have always been flouted by the best writers. Obeying bogus rules can make prose worse.”

How does the writer or editor distinguish real usage from those bogus rules? “Look them up!” said Pinker. “Modern dictionaries and usage manuals do not ratify pet peeves,” he said. “Their usage advice is based on evidence.”

In any case, Pinker said, “correct usage is the least important part of good writing,” compared with a conversational classical style, a coherent ordering of ideas, factual accuracy, and sound argumentation.

Sanism and the language of mental illness

As I was reading about the stigma of mental illness, I was struck by the lack of a mainstream term to describe the discrimination that arises from that stigma. This void in our everyday terminology is telling: it implies that the oppression people with mental illness face is so commonplace and routine that it doesn’t merit its own label. I submit that until we name it, we can’t effectively discuss it, and the absence of this name makes it easy for many of us to ignore it or deny its existence.

Advocacy and research organizations such as the Mental Health Commission of Canada tend to use the term “mental health stigma,” but I’d argue that finding a single word to describe discrimination against people with mental illness helps put it on par with similar forms of bigotry, including racism and sexism.

Sanism versus mentalism

Two terms that have been proposed to label the discrimination against people with mental illness are sanism and mentalism, which have appeared in legal and social science research circles but haven’t caught on with the public or with mass media. Sanism was coined by attorney Morton Birnbaum in the 1960s, when he was representing Edward Stephens, a patient with mental illness who claimed he was receiving inadequate treatment. Law professor and mental health advocate Michael L. Perlin has perpetuated the term in legal literature, writing extensively about it since the 1980s. American activist and educator in the psychiatric survivor movement Judi Chamberlin coined the term mentalism in her book On Our Own: Patient Controlled Alternatives to the Mental Health System, published in 1978. Neither sanism nor this definition of mentalism appears in the Oxford English Dictionary (OED).

I strongly prefer sanism, not least because mentalism already carries meaning in many other contexts, including:

  • the performing arts, where it refers to a magic trick or illusion that makes the performer appear to have extraordinary mental abilities;
  • philosophy, where it refers to the doctrine that objects of knowledge exist only in the mind; and
  • psychology, where it refers to areas of study that focus on mental perception, in contrast to behaviourism.

And with mentalist gaining a foothold in pop culture within the name of a long-running TV show, calling out discriminatory behaviour as mentalist would be confusing.

Ableism (attested in the OED in 1981—thus a more recent coinage) has been used to describe discrimination against people with disabilities, including cognitive disabilities, but because mental illness doesn’t necessarily lead to disability, I see value in distinguishing between ableism and sanism.

Embracing the use of sanism in our everyday language lets us better acknowledge the many parallels between it and other isms (or –isms masquerading as phobias).

Islamophobia and sanism compared

Whenever we hear of an individual committing an act of mass violence, it seems we’re eager to pigeonhole them into one of two categories: Muslim or mentally ill (or sometimes both, as in the case of Michael Zehaf-Bibeau). Muslims are all too aware of our knee-jerk reaction to point the finger at Islamic extremists for all acts of terror. From a Washington Post story after the 2013 Boston Marathon bombing:

As a Libyan Twitter user named Hend Amry wrote, “Please don’t be a ‘Muslim.'” Her message was retweeted by more than 100 other users, including well-known journalists and writers from the Muslim world.

Jenan Moussa, a journalist for Dubai-based Al-Aan TV, retweeted the message “Please don’t be a ‘Muslim'” and added that the plea was “The thought of every Muslim right now.” Moussa’s message was forwarded more than 200 times.

When the perpetrators turn out not to be Muslim, the public is eager find out what kind of mental illness they must have had. Anders Behring Breivik, the Norwegian gunman who took 77 lives in 2011, was branded a paranoid schizophrenic following an initial court-ordered psychiatric review, and although a later review concluded he that did not have schizophrenia, the first diagnosis still made its way into articles and books, often with no corrections or retractions. When Germanwings co-pilot Andreas Lubitz deliberately crashed his plane into the French Alps, killing all 150 people aboard,

[t]he incident sparked headlines such as “Madman in the cockpit” from the Sun newspaper, “Killer pilot suffered from depression” from the Daily Mirror, and “Mass-killer co-pilot who deliberately crashed Germanwings plane had to STOP training because he was suffering depression and ‘burn-out’” and “Why on earth was he allowed to fly?” from the Daily Mail.

These headlines, as Ingrid Torjesen wrote in a BMJ feature, fuel stigma that could prevent people from seeking help for mental health problems.

Our rush to classify terrorists as either Muslims or mentally ill is misguided in both cases. According to a 2014 Europol report, only 2% of all terrorist attacks were committed by people motivated by Islamic extremism. Similarly, according to an Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance-Use Conditions,

roughly 3–5 percent of violence in the United States could be attributed to persons with mental illnesses. Moreover, results of studies from England and New Zealand indicate that in those countries, the percentage of homicides accounted for by persons with major mental illnesses has fallen in recent decades despite policies of deinstitutionalization that have placed more people with severe mental illnesses in the community. Data also suggest that most violence committed by persons with mental illnesses is directed at family members and friends rather than at strangers and tends to occur in the perpetrator’s or the victim’s residence rather than in public places… Thus, while there may be a causal relationship between mental illnesses and violence, the magnitude of the relationship is greatly exaggerated in the minds of the general population.

In fact, people with mental illness are far more likely to be victims of violence: a 2012 meta-analysis of observational studies found that adults with a mental illness were 3.86 times as likely to be on the receiving end of violence compared with adults with no disability.

Automatically attributing mass violence to people with mental illnesses is sanist, completely analogous to the Islamophobia that columnists and advocacy groups are becoming quicker to condemn.

Homophobia and sanism compared

A systematic review by UK researchers revealed that lesbian, gay, and bisexual people were twice as likely to attempt suicide in their lifetime, compared with heterosexual people. Researchers at Columbia University, however, found that for lesbian, gay, and bisexual youth

the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96 – 0.99]).

Among those who are transgender or gender non-conforming, 41% attempt suicide sometime in their lives, according to the National Transgender Discrimination Survey. However, “A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors,” according to UK researchers.

In other words, homophobia and transphobia exacerbate suicide risk.

Mental illness, particularly mood disorders and substance misuse, is also associated with an increased suicide risk. Risk and Protective Factors for Suicide and Suicidal Behaviour, a 2008 literature review funded by the Scottish government, reported that among the 894 cases of suicide they studied, “the majority of cases (88.6%) had a diagnosis of at least one mental disorder. Mood disorders were most frequent (42.1%), followed by substance-related disorders (40.8%).” It also reported that “risk of dying by suicide in those diagnosed with schizophrenia as 4.9%,” compared with 0.010% to 0.015% in the general population. However, as Simon Davis reports in Community Mental Health in Canada, “often [suicide] occurs not in response to symptoms, such as command hallucinations, but when the individual is seeing reality clearly and facing (apparently) a future of diminished prospect and social rejection.”

Much like homophobia and transphobia, sanism—including self-stigma—exacerbates the suicide risk among people with mental illness.

Racism and sanism compared

In the wake of incidents of police violence against members of the black community in the United States, including the deaths of Michael Brown in Ferguson, Missouri, and Eric Garner in New York, activists in and around the #BlackLivesMatter movement have worked to expose the myriad ways racism has become institutionally entrenched:

  • Poverty: U.S. Census Bureau data show that in 2010, 27.4% of black Americans lived in poverty, compared with a national average rate of 15.1%.
  • Unemployment: The Bureau of Labour Statistics shows the unemployment rate of black Americans hovering at around 10%—double that of white Americans.
  • Health disparities: According to a Centers for Disease Control brochure, African Americans are 25.4% more likely to die of cancer, twice as likely to die of diabetes, and 30.1% more likely to die of heart disease and stroke, compared with white Americans. Black Americans have a life expectancy 3.8 years lower than white Americans.
  • Involvement with the criminal justice system: According to statistics from the U.S. Department of Justice from 2009, although African Americans make up only 13% of the U.S. population, they make up 40% of the male inmates in correctional institutions. A 2013 report on racial disparities in the U.S. criminal justice system, submitted to the United Nations, stated that “one of every three black American males born today can expect to go to prison in his lifetime.”

People with mental illness experienced a history comparable to that of black Americans, with segregation manifesting as institutionalization, and they are overrepresented in the same contexts:

  • Poverty: Poverty is both a cause and a consequence of mental illness. A 2013 U.S. study found that having a person with a severe mental illness in your household increases your risk of poverty three-fold.
  • Unemployment: According to the Canadian Mental Health Association,

The unemployment rate of persons with serious mental illness reflects these obstacles and has been commonly reported to range from 70–90%, depending on the severity of the disability. These statistics are particularly disturbing in light of the fact that productive work has been identified as a leading component in promoting positive mental health and in paving the way for a rich and fulfilling life in the community.

  • Health disparities: People in poor mental health are also likely to be in poor physical health. A combination of psychiatric medications that increase the risk of metabolic syndrome, lifestyle, and socio-economic factors contribute to a mortality ratio six times that of the general population. People with serious mental illness can expect to live 15 to 20 years less than people without a mental illness.
  • Involvement with the criminal justice system: According to a 2006 U.S. Bureau of Justice Statistics report, people with mental illness represent “56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.” The National Alliance for the Mentally Ill’s 2003 survey found that 44% of people with a serious mental illness will have had dealings with the criminal justice system.

Much like systemic racism, sanism may take the form of subtle “microaggressions” that contribute to general oppression. Discrimination is common even among healthcare professionals, which can help reinforce the status quo.

Sanism in our language

"Insane" or "insanely" appears in four of the six articles on the front page of Cracked.
“Insane” or “crazy” used in four of the headlines on the front page of Cracked.com on May 9, 2015.

Advocates of inclusive and conscientious language use have campaigned to raise awareness of sanism in our communications, suggesting the best ways to write about suicide, for example, and encouraging writers to use “people first” language (that is, “people with a mental illness” rather than “mentally ill people” or, worse, “the mentally ill”). These same guidelines often recommend that people avoid using stigmatizing words like crazy or psycho, but these terms have so become a part of our daily language, not to mention popular culture, that eradicating them from general use is unrealistic.

Idiot, lunatic, and insane were once clinical or legal terms, but they’ve all had their turn on what psycholinguist Steven Pinker calls the euphemism treadmill, where a term becomes more and more corrupted semantically until a new euphemism is needed to take its place. They’ve also lost much of their clinical meaning with widespread use.

These kinds of broad umbrella terms used to describe mental illness may be hard to contain, but where we can make headway is in educating the public to avoid using names of specific mental illnesses to describe personal quirks, as Miley Cyrus did in a 2010 interview, saying, “I’m kind of bipolar in my acting choices because I just want to do a little bit of everything.” In a recent Vanity Fair article, Saturday Night Live alum Will Forte claimed to be “a little OCD” about his shampoo routine, a usage that has also been criticized.

The most difficult sanist language to sanitize may be terms describing substance misuse: we derisively throw around words like junkie, crackhead, and wino without a second thought. Until policy makers fully acknowledge that drug use should be a medical rather than a legal issue, we may find these loaded descriptors hard to eliminate.

A call to action—and articulation

It’s high time sanism entered the mainstream. I call for everyone (and especially journalists, bloggers, and mental health advocates) to look out for it, name it when you see it, and condemn it. Only when we end the stigma will people with mental illness feel comfortable seeking the help they need to keep themselves—and the rest of us—safe.