Disabilities, disorders, and other health conditions

When and how to mention someone’s health

Background:

Unnecessary mentions of a person’s disease, disability, or other health condition may introduce bias. In addition, because there is a broad range of disabilities, diseases, and mental illnesses, if it is necessary to disclose someone’s health, saying someone has “a mental illness” or “a disability” does not give much information.

Recommendation:

Mention a person’s disability, disorder, disease, or other health condition only when it is relevant and when there is a medical diagnosis. If it is necessary, specify the condition or symptoms. Do not use outdated terms. See also “Recognize overlapping identities.”

Examples:

People-first language and identity-first language

Background:

People-first language, also called person-first language, puts the person first, with wording like “person with” (e.g., “person with autism”), while identity-first language puts the condition first (e.g., “autistic person”). Proponents of people-first language believe that naming the person first emphasizes that someone’s disability, disease, or disorder does not define them. Proponents of identity-first language believe that a health condition is integral to their identity and that using phrases such as “person with” perpetuates the belief that disabilities are shameful. Individuals have different preferences. Some groups, such as the autism community and the Deaf community, have been outspoken about preferring identity-first language. When discussing mental health, people-first language is generally preferred.

Recommendation:

Ask people how they would like to be described, and respect that choice. If you cannot determine someone’s preference, generally use the language that most people with the condition prefer. For example, consult official organizations that represent and are led by people with a condition. Be aware that some organizations purporting to represent a group of people may speak for only a subset of a group. If you can’t determine a preference, use people-first language by saying "people with [condition]." Avoid equating people with a condition (e.g., use “she has epilepsy,” not “she is epileptic”), and avoid using condition-related adjectives as nouns to refer to people (see “Avoid labeling people by a characteristic”).

Examples:

Capitalization of health conditions

Background:

For most diseases, disabilities, and disorders, only proper names, as in a person’s name, are capitalized. An exception is the word "deaf," which is commonly capitalized when it refers to the cultural group of Deaf people (and members of that group) who share a sign language, traditions, and customs. People who don’t identify with the Deaf community use the lowercase word, which is also used to refer to deafness as an audiological condition. Although AP style uses lowercase “deaf” for individuals, the National Center on Disability and Journalism recommends differentiating between “deaf” and “Deaf.” Similarly, people who identify as part of Deaf-Blind or DeafBlind culture capitalize “D” and “B.” Some people and organizations use a hyphen in the term. Others, including most organizations outside the US, omit the hyphen as a way to signal that deafblindness is more than the sum of vision loss and hearing loss.

Recommendation:

In general, follow a standard dictionary for the capitalization of disabilities, diseases, and disorders. For the word “deaf,” capitalize it when referring to Deaf culture, the Deaf community, or people who identify as Deaf with a capital “D.” Lowercase when referring to people who use lowercase “deaf” or when referring to the audiological condition. Similarly, capitalize “Deaf-Blind” or “DeafBlind” when referring to people who identify as part of the culture or community, and use the lowercase versions when referring to the general condition or people who do not identify with the culture. Ask people whether they want to use the hyphen. If it’s not possible to ask, generally omit the hyphen.  See also “Ask people how they want to be described, and respect that language.”

Examples:

Neutral language for disabilities, disorders, and diseases

Background:

Phrases like “suffers from,” “is afflicted with,” “is a victim of,” and “is stricken with” in reference to people with disabilities, diseases, or disorders connote pity and helplessness and imply a person has a reduced quality of life. In addition to the connotation of helplessness with “victim,” the word is problematic because it’s unclear whether the person died. When phrases like these are used to describe disability, they create an ableist narrative—one that assumes people with disabilities are worth less than nondisabled people. (See also “Avoid euphemisms related to disability,” “Avoid metaphorical uses of disability-related terms,” and “Avoid using disability-related terms to describe something negative.”)

Militaristic terms like “battle” in reference to health imply that if someone fights hard enough, they can overcome a health condition, and those that died, or “lost their battle,” weren’t strong enough to survive. Individuals have different preferences regarding the term “survivor.” Some people feel that it is empowering, whereas others do not identify with the term and find it offensive or misleading. The term is also imprecise. For example, the National Cancer Institute says, “In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.” But many people tend to use the term to refer to people who have completed treatment.

Recommendation:

When describing a health condition, use neutral terms like “with” or “has” instead of terms that connote pity or imply a person has a reduced quality of life. Use "uses" or another neutral word to describe the use of assistive devices. Also avoid martial terms to refer to having a disease, and use caution with the term “survivor.”

Examples:

Avoid euphemisms related to disability

Background:

Many euphemisms—such as “handicapped,” “handicapable,” “differently abled,” and “special needs”—have been proposed to stand in for the person-first phrase “people with disabilities” and the identity-first term “disabled” because some people, mostly from outside disability communities, think these two terms sound negative. Similarly, the euphemism “able bodied” is used to refer to nondisabled people without mentioning disabilities at all and implies that the bodies of disabled people are not capable or useful. To many people with disabilities, these euphemisms make “disability” sound like a taboo word and can obscure the common issues that people with disabilities live with and possibly share. Since about 2015, the #SayTheWord movement has emerged from the disability community on social media to encourage people to use the words “disability” and “disabled.”

Recommendation:

Avoid euphemisms like “handicapped” for people with disabilities. Ask people what terminology they use, and refer to a person’s specific disability if the person prefers that (see also “Ask people how they want to be described, and respect that language” and “When and how to mention someone’s health”). Also avoid “able bodied” for referring to people without disabilities.

Examples:

Avoid metaphorical uses of disability-related terms

Background:

Using diagnoses or disability-related terms flippantly and outside a disability context is a form of ableism—a system of discrimination against disabled people. This type of use trivializes disabilities and can reinforce misconceptions. For example, calling someone OCD because they are very organized equates obsessive-compulsive disorder with a relatively harmless personality trait. The Micropedia, an encyclopedia of microaggressions, explains, “Describing oneself as OCD when you’re not diminishes the difficulties experienced by people living with OCD. It perpetuates the notion that OCD is a casual desire for order [as] opposed to a mental illness.” The hyperbolic or joking use of disability-related terms is especially problematic when people profit off their misuse, such as marketing food by comparing its addictive quality to that of crack. But even in everyday, personal interactions, the casual use of disability-related terms by nondisabled people can perpetuate stigma. And studies have shown that stigma makes it harder for people with mental illness, for example, to seek treatment and can slow recovery.

Recommendation:

Avoid using disability-related terms hyperbolically or metaphorically. Instead, use accurate words to convey your meaning. For example, instead of describing a penchant for organization as OCD, use “organized,” “neat,” or other synonyms. Lydia X. Z. Brown offers substitutes for ableist terms on the blog Autistic Hoya. Disability terms are accurate when used to refer to people with a disability, and disabled people may choose to reclaim certain terms that were previously used as taunts. Nondisabled people shouldn’t use these formerly offensive terms, even in a disability context. See also “Neutral language for disabilities, disorders, and diseases” and “Avoid using disability-related terms to describe something negative.”

Examples:

Avoid using disability-related terms to describe something negative

Background:

One aspect of ableist language—language that devalues people with disabilities—is using disability-related terms to mean negative things. For example, using “crazy” to describe something or someone erratic, wild, or impractical creates a negative association with disability and disabled people. In a 2021 Forbes article, Andrew Pulrang explains that disability-related words that are used for negative concepts “reinforce the idea that a good way to describe bad things is to compare them to disabilities, or to disabled people.” Similarly, Rachel Cohen-Rottenberg, in a 2013 post on her blog Disability and Representation, says, “If a culture’s language is full of pejorative metaphors about a group of people, that culture is not going to see those people as fully entitled to the same housing, employment, medical care, education, access, and inclusion as people in a more favored group.” Beyond the harm of associating disability with negative characteristics in general, using disability-related terms can reinforce specific misconceptions, such as the idea that people with mental illness are violent (think of “going postal,” “blind rage,” and “mad man”).

Disability advocates argue that using disability-related terms for negative concepts contributes to ableism even if the words’ meanings have changed over time and are no longer intended to harm people with disabilities. Cohen-Rottenberg explains in her blog post: “Moron—and related terms, like imbecile and idiot—may no longer be used clinically, but their clinical use is not the issue. They were terms of oppression, and every time someone uses one without respect for the history of disabled people, they disrespect the memory of the people who had to carry those terms to their graves.” In an effort to assert power and autonomy, some people with disabilities have reclaimed terms formerly used to oppress—like “cripple” and “mad.”

A phrase in itself might not be negative, but if a disability-related word within the term has a negative use, the term could still be considered ableist. For example, Rachel Ades, in a 2020 post on the Blog of the American Philosophical Association, writes, “One might say that ‘blind review’ process is supposed to be positive, just like when we say that ‘justice is blind,’ we are speaking to the virtue of impersonality in justice. However, in these phrases, ‘blind’ is meant to mean that a process is ignorant of features of an applicant, plaintiff, or defendant. Metaphors like ‘blind review’ code to the lack of a function most have–a ‘blind review’ is different than a regular review because a reviewer will knowingly lack information about particular things. This then conditions us to consider blind people as those who are lacking the ability to fully know the world, and this perpetuates negative stereotypes about blind people.” Alternatives to “double-blind study” are “double-anonymized study,”  “double-anonymous study,” and “double-masked study.” In 2020, draft recommendations from the Association of Scientific, Technical, and Medical Publishers Working Group on Peer Review Taxonomy recommended “double anonymized” instead of “double blind” as a peer review term in recognition of the latter’s ableism.

In addition to being more respectful of disabled people, using alternatives to disability-related words has the advantage of being more specific, avoiding clichés, and being more accurate.

In contrast to the use of disability-related terms for negative things, many metaphors for positive things refer to physical abilities, such as the ability to see (“eye opening”), stand (“stand up for what you believe in”), or hear (“make our voices heard”). These phrases may imply that a lack of these abilities is bad. The combination of such terms may accumulate to enforce a view that nondisabled people are inherently better. Writer and disability rights advocate Amanda Leduc says in a 2021 Toronto Star article, “Nothing is ever just something that people say—the words we use all have power, and ableist language is powerful precisely because it hides its harm beneath a veneer of innocuous mundanity, behind the smokescreen of it’s just a figure of speech.” She also warns against “putting the power of metaphor above the power of harm.”  

On the other hand, organizations advocating for blind people have recommended not avoiding using “see” neutrally. The American Foundation for the Blind’s “Resources for Reporters Writing about Blindness and Vision Loss” says, “It is perfectly fine to use ‘visual’ words and phrases in conversation, e.g. ‘Nice to see you,’ ‘See you later.’ ” Similarly, the Courtesy Rules of Blindness from the US-based National Federation of the Blind says, “It’s ok to still use words such as see and look. I will talk with you like everyone else, although I may not be able to make direct eye contact.”

Recommendation:

Avoid using disability-related terms as negative descriptions of people or things. For a list of ableist terms and alternatives, see Lydia X. Z. Brown’s post on the blog Autistic Hoya. Nondisabled people should not use words formerly used as slurs against disabled people, even if those words are being reclaimed by people with disabilities. When considering whether to use positive metaphors based on physical abilities, consider whether the metaphor is the most apt for the situation and whether there is an alternative that does not equate physical ability with success. While it’s not necessary to avoid every physical ability–based metaphor, avoid defaulting to using physical terms for positive things. Instead, consider your content’s purpose, audience, and context. Using words like “see” neutrally, as in “see page 5,” is generally acceptable, but respect the wishes of any disabled people who ask you to use other terms (such as “refer to page 5”).

Examples:

Person versus patient

Background:

Calling people “patients” when their role receiving a diagnosis, treatment, or other medical service isn’t important can dehumanize people and emphasize the disability or disease instead of the person. Not all people with disabilities or diseases are patients, so the term can be inaccurate (for example, many people with depression do not receive treatment). In addition, conflating disability with illness or disease can be inaccurate, as many people with disabilities are healthy.

Recommendation:

When a person’s role as a patient is not relevant, generally use the word “person” instead of “patient.” But when discussing health issues in a medical context, such as describing diagnosis and treatment, “patient” is acceptable.

Examples:

Drug use

Background:

“Abuse” has connotations of crime and violence. The phrase “drug abuse” carries a stigma and tends to trigger negative judgments in people.

Recommendation:

Use caution when using the term “abuse” to describe drug use. Instead, use “misuse” or an adjective plus “use,” such as “excessive use” or “heavy use,” depending on the meaning.

Example:

Resources on inclusive language for health

• Andrews, Erin. E., Anjali J. Forber-Pratt, Linda R. Mona, Emily M. Lund, Carrie R. Pilarski, and Rochelle Balter. “#SaytheWord: A Disability Culture Commentary on the Erasure of ‘Disability.’ ” Rehabil. Psychol. 62, no. 2 (2019): 111–18. Advance online publication. http://dx.doi.org/10.1037/rep0000258.
• Associated Press. AP Stylebook Online.
• Brown, Lydia X. Z. “Ableism/Language.” Autistic Hoya (blog). Last modified Nov. 16, 2021.
  
• Center for Disability Rights. Disability Writing and Journalism Guidelines.
• Maggio, Rosalie. “Mental Illness.” Unspinning the Spin: The Women’s Media Center Guide to Fair and Accurate Language.
• National Center on Disability and Journalism. “Disability Language Style Guide.” Last modified August 2021.
• Rahman, Labib. Disability Language Guide. Stanford Disability Initiative: July 2019.
• Research and Training Center on Independent Living, University of Kansas. Guidelines: How to Write about People with Disabilities, 9th ed. 2020.
• Volkow, Nora D., Joshua A. Gordon, and George F. Koob. “Choosing Appropriate Language to Reduce the Stigma around Mental Illness and Substance Use Disorders.” Neuropsychopharmacology 46 (2021): 2230–32. https://doi.org/10.1038/s41386-021-01069-4.
• Wise, Hannah. Disability Matters: A Toolkit for Newsrooms to Better Serve the Disability Community. Last modified Sept. 22, 2022.