Language evolves for a reason, and so should we. However, there are always reasons we may need to employ older terminology in writing, especially if your story is set in – or based on – an older period of time.
Note: this article contains ableist language and beliefs held throughout history, which may be distressing to read. Suicidal behaviour is also touched on under the heading of Multiple Personlity Disorder to Dissociative Identity Disorder.
Autism Spectrum Disorder vs Asperger’s Syndrome
Asperger’s Syndrome has its roots in Nazi Germany, where Austrian paediatrician Hans Asperger introduced the new diagnostic label in 1944.It was revealed in an eight year study published in 2018 that the paediatrician had a history with the Nazi regime and even found him to have assisted the Nazi’s euthanasia programme, of those labelled with the Asperger’s diagnosis. Ever since then, it has become rather contentious to use the label, especially for people who have a more recent diagnosis than 2018. The UK’s National Autistic Society has a fantastic page on this topic.
Nowadays, the label of Asperger’s is inactive in a lot of countries. It aligns with an Autism Spectrum Disorder (ASD or Autism) diagnosis and is listed as a category of such. In Australia and a few other countries, Autism has 3 “levels” or categories, and those previously termed Asperger’s mostly fall under Level 1. Some countries, such as the UK I have been told, are more inclusive again and have no levels system. Rather, one either has Autism, or they don’t.
When talking about the Levels of Autism nowadays, keep in mind that it is preferred to talk about the levels using support- or needs-based language (“she has low support needs”) rather than functioning labels (“he is high-functioning”). Functioning labels can make people feel like they aren’t valid in their diagnosis or are being judged for being “too high” or “too low” functioning. On top of this, someone who has high support needs may feel like more of a burden if they’re termed “low functioning”. Needs-based language simply allows us to provide for the Autistic person as required, and takes away some negative stereotypes one may presume when they hear “low functioning”or “high functioning” as a descriptor for someone.
Remember: Even people with low needs still have needs; every Autistic person has a base level of needs in order to live comfortably, the higher needs requirements are added on top.
Psychopathy to Antisocial Personality Disorder to Callous Unemotional
The American Psychological Association (APA) have a fantastic article which goes into all of this, but I’ll paraphrase and bring out the need-to-know facts for your writing here. I’d also like to preface this section with a reminder that psychopathy and psychosis are not the same, so be aware of which term you’re using.
According to the APA, “About 1.2% of U.S. adult men and 0.3% to 0.7% of U.S. adult women are considered to have clinically significant levels of psychopathic traits.” Anyone can be affected, no matter their race, sexuality, gender identification, or social standing.
The current Diagnostic and Statistical Manual (DSM-V; compiled by the APA for much of the English speaking world) does not include such a diagnosis, and this is apparently due to deeply-rooted stigmatisation from society, making it risky to one’s wellbeing to diagnose them as psychopathic. The term psychopath was therefore removed from the third edition of the DSM, where it was replaced by a broader diagnosis: Antisocial Personality Disorder (ASPD). The APA reports that approximately a third of those diagnosed with ASPD fit the old criteria for a psychopath.
In more recent years, the diagnosis has changed again, whereby the DSM-V allows for a youth diagnosis of conduct disorder, with traits of Callous Unemotional (CU), and various other tagged-on terms befitting a person’s specific presentation and maturity level. The newer way of thinking is that psychopathy exists on a spectrum, hence the various specifying terms.
While there is a genetic factor, and it is something which can usually be seen on brain scans (particularly in an underdeveloped Amygdala, among other signs), there are studies which show that upbringing from a guardian that isn’t the child’s affected biological parent can reduce and even eliminate the chance of the child growing up to have this disorder.
The following information has been taken from the US National Library of Medicine’s online publication of The Criminal Psychopath: history, neuroscience, treatment, and economics, 2011.
In 1806, the first medical professional to term such a personality disorder was French doctor Pinel, who described “maniaque sans délire”, or “insanity without delirium”. The term “moral insanity” rose in popularity in the US and England throughout the 1800s and into the early 1900s. “Psychopath” was coined by a German psychiatrist in 1888 (“psychopastiche” or “suffering soul”). Sociopathy, on the other hand, didn’t enter doctors’ vocabulary until the 1930s, and was for a time used somewhat interchangeably with psychopathy.
In 1980, the DSM-III introduced ASPD and sociopathy dropped from our language. There were revisions made for the DSM-III-R in 1987 which narrowed the diagnostic criteria a little too much, by many accounts. Later the DSM-IV reintroduced some of those dropped details, but had issues of its own.
Shell Shock to Post-Traumatic Stress Disorder
The following account of dates and records are according to History (you know, like the History Channel). The term Post-Traumatic Stress Disorder (PTSD) entered our language in 1980 with the DSM-III, however its meaning – and parallel terms such as Shell Shock, soldier’s heart, combat fatigue, and war neurosis – have remained ultimately unchanged throughout the decades. In fact, the first representation in literature of this phenomenon appeared in around 2100 B.C., in the Epic of Gilgamesh, in which the titular character experiences the symptoms we today would recognise as classic PTSD after the death of his dearest friend.
The first term ever ascribed to the condition was “nostalgia”, which appeared in the 1600s, coined by Swiss physician Dr. Johannes Hofer, and was used to describe despair and homesickness alongside more classic PTSD symptoms in Swiss soldiers. Elsewhere, the same term was being adopted by German, French, and Spanish soldiers to describe the same symptoms in their military patients. Eventually nostalgia was noted in American soldiers of the Civil War. Already negative connotations were being created, with some doctors viewing the diagnosis as a sign of weakness and “feeble will”. During this period, recommended “cures” included public ridicule.
In the 1800s, doctors were beginning to notice that symptoms of nostalgia weren’t limited to soldiers, but were particularly present among the high volume of railway accident survivors during the Industrial Revolution.
The first World War brought us the term Shell Shock, first appearing in a medical journal in February of 1915, when Capt. Charles Myers of the Royal Army Medical Corps noted soldiers displaying PTSD symptoms after being exposed to exploding shells on the battlefield. But, by 1916 soldiers nowhere near these shells were displaying the same symptoms.
In the very first DSM in 1952, “gross stress reaction” was included, a diagnosis for acute psychological issues as a result of a specific traumatic event, including combat and disasters. The DSM-II (1968) removed anything resembling PTSD, with the closest being “adjustment reaction to adult life”, however this didn’t capture those symptoms previously acknowledged, which led to many veterans unable to access appropriate help.
The diagnosis of PTSD – still the current terminology today – came in with the DSM-III (1980) and drew a clear line of understanding between trauma and life stressors. Over the years since, the diagnostic criteria has been revised between editions. Most notably, as of the current DSM-V, PTSD is no longer considered an anxiety disorder, but now exists under the “Trauma- and Stressor-Related Disorders” category.
Dissociative Identity Disorder to Multiple Personality Disorder
Long ago believed to be the result of possession, Dissociative Identity Disorder (DID) is the most current diagnosis for an incredibly complicated mental disorder categorised by a person having two or more personalities (often complete with their own presentations, names, gender identities, likes, fears, and more). Deeper research is required if this is something you wish to portray in a story, especially as many cases vary in how and why they “switch”; whether the “host” is aware of the switches; whether memory loss between identities exists; how new identities form; triggers for switches; and the types of trauma which trigger a new identity to form.
Sadly, the media has taken what is a complex diagnosis and morphed it into the creation of serial killer identities, most notably in the Unbreakable trilogy (movies Unbreakable, Split, and Glass), as well as individual episodes of many television crime series. Conversely, according to the DSM-V the reality is that over 70 per-cent of people living with DID have attempted suicide, and self-harming behaviour is particularly common. Violence is rare with this sort of mental illness. It is never okay to use a psychological diagnosis (or any disability for that matter) to vilainise a character.
Most of what I’ve learnt about DID has been from friends who were willing to talk with me about the topic and answer respectful questions about their experiences. Keep in mind that the cause of this disorder is always deep trauma – this should guide your questions and expectations if you do find someone to talk to about it with, as much of a person’s experiences will be clouded by painful triggers and often memory loss.
The diagnosis Multiple Personality Disorder (MPD) was updated to DID in 1994 to reflect a better understanding of the disorder.
Retarded to disabled, asylums to hospitals
The Disability History Glossary of the UK has a fantastic, interactive glossary of terminology for more specific uses you may have for period writing. I’ll include a few notable terms many people may be familiar with here, including dates of usage.
An asylum was a charitable institution for people with mental illness or developmental disabilities in England from the late 1700s, which the state began building and providing from 1815. Eventually the majority became state-run institutions. (Apparently the last asylum closure in Australia wasn’t until 1993!)
A chronic lunatic was used in the 1800s to describe someone who was believed to be unable to recover from their affliction.
A colony was “a type of asylum institution established by the 1913 Mental Deficiency Act where both adults and children with learning disabilities lived in a 'village' arrangement of a number of 'villas' each housing up to 60 people.”
Cripple was common terminology for a disabled person up until the later half of the 1900s. Prior to this, in the Medieval period, it was creple.
Defective was used around the 1900s to describe someone with a learning or developmental disability.
Degeneration was “A theory propounded by eugenicists in the late 19th and 20th centuries that breeding by people who have disabilities, mentally ill people or people who are seen as 'feckless' or 'idle', particularly those from the poorer classes, will cause general racial deterioration in a society.”
Dumbe described someone who was either deaf or mute, from the Medieval period and used through to the 1700s.
Eugenics was “A movement prevalent in the later half of the 19th century and first half of the 20th century. Based on the writings of Francis Galton, eugenicists believed in the sterilisation or even euthanasia of disabled people and others such as the mentally ill or 'morally degenerate' to prevent what they described as racial deterioration.”
Feeble minded was a descriptor during the late 1800s and early 1900s for those with learning or developmental disabilities.
An idiot described the lowest form of intelligence and functional ability under Europe’s first classification system, introduced in the early 1800s. Imbecile was the next functional label assigned to classify people with learning or developmental disabilities, followed lastly by moron as the least impacted while still having a learning or developmental disability.
Insanity was and still is (though far less so than in the past) often associated with criminals or “highly irrational behaviour”.
Someone termed lame had limited functionality of one or more limbs.
Lunatic was a broad term for someone with mental illness.
A madhouse was a private institution house which cared for mentally ill patients, beginning at the end of the 1600s and becoming particularly prevalent during the 1700s.
Mentally handicapped or deficient were used in the 1900s to broadly describe a person with a learning disability.
Moral imbecility was “A category influenced by the ideas of Eugenics in the early 20th century, which labelled as a type of 'feeblemindedness' those people who were believed not to be able to distinguish right from wrong.”
A spastic was someone whom, by today’s terminology, would be diagnosed with cerebral palsy.
Thanks Rose, great article. I love how you provide links in the body of the text.