I posted over the past week several criticisms of Peter Boghossian that generally put me off him (especially this). I think he’s not a very good philosopher, and is far too wrong about far too many important things. Yesterday I expanded on one of those criticisms (his failure, perhaps even refusal, to study and thus understand contemporary feminism, expanding on my remarks in Why Atheism Needs Feminism). Today I introduce another, which is another special reading I had prepared for students of the class I co-taught with Boghossian last year (on his book A Manual for Creating Atheists). As with yesterday’s reading, he didn’t interact on the matter, so I don’t know what he thought of it. But again it’s time I just published this for everyone’s benefit, too, and as another corrective to his book.

Many have criticized Boghossian (and not just him, but many others) for arguing that religion should be classified as a mental illness. I believe some of those critiques have merit, and some do not. And those that have merit are largely only apt in what they have to say about the problems of vocabulary, presentation, and lack of nuance and sensitivity in treating the issue. Here are my thoughts on the matter.

• One valid concern is “splash damage”: inadvertently aiding harm to innocent parties when attacking an intended target.
• Another is contributing to ableist stereotypes and bigotry: perpetuating or reinforcing negative beliefs about and attitudes toward the mentally ill.
• Yet another is the fallacy of over-generalization: painting everyone, and every case, with the same brush, thus whitewashing crucial nuances, and leading to inaccuracies in both argument and claims to fact.

I’ll have something to say on each of these points. But there is a lot to say. So if you prefer (if you are vexed with TL;DR), you can skip past the long analysis and get right to the conclusion instead.

A Prospective Vocabulary

We could employ something like the following terms according to the following definitions, not because science says so, but because of the way language and prejudices operate in the general public (who are generally not scientists, much less psychologists):

• mental defect : a cognitive bias present in everyone, which is not disabling (it only renders us error-prone), and which cannot be cured, only understood and controlled or compensated for. (See Wikipedia’s List of Cognitive Biases.)
• mental disorder : a mental defect not present in everyone, which is not disabling (though it can present problems for self and society), but can be either treated or cured. (Above “mildly delusional” and below “worrisome” on my delusion scale, displayed in my video, noted below.)
• mental illness : a mental disorder present in a minority, which is disabling in some fashion (it makes it difficult for a person to live, safely and productively), and can be either treated or cured.
• insane / crazy / etc. : a mental illness so crippling it renders a person incapable of rational thought and which may pose a significant danger to themselves or others. (Extremely few people warrant this description.)

And even if we demarcated distinctions with such terms in this way, I still think these words should be used sparingly. Here is why…

It’s Not Always a Mental Disorder

I believe Boghossian is largely right: most religion is in fact a delusion, and shares the same pathology and requires the same treatment as one. As you’ll know from one of my most popular Skepticon videos, “Are Christians Delusional?” But remember how, even there, I included a lot of qualifiers (while Boghossian and many others who write about this often don’t).

Not all religion is actually delusional. A lot of it is just apathetic, nominal, uncertain, or conformist, for example. In such forms it lacks the incorrigible certainty of an implausible false belief requisite to a delusion. For these people, atheism is not a threat to their beliefs, but it can be a threat to their social order: you are not conforming, and it is that fact in and of itself that might scare them and motivate them to oppose your arguments, since it means to them that you are not predictable and cannot be trusted, and your attempts to break others away from social conformity must also be stopped. Consequently their arguing belief with you is often disingenuous. It’s not their beliefs that they are really defending. It can be helpful to learn how to detect when this is occurring.

And then a lot of religion is only “mildly delusional” at best, classifiable with countless mild delusions found in everyone, which does not rise to the level of requiring correction or treatment. Outside of actual brain damage (which is quite rare), almost all mental disorders are actually normal cognitive functions that have been dialed to such extremes (or are triggered by incongruous stimuli) as to potentially become a hazard to the individual or those around them, which at a mild level is not a medical problem (and thus not productively referred to even as a disorder, much less as an illness, any more than over-estimating your competence at something is an illness or disorder). Only at a basic (beyond mild) level would such a condition benefit from, yet does not mandate, treatment. And only at an extreme level (posing a significant threat of harm to self or others) would it mandate treatment (raising the specter of institutionalization, which we wisely set a very high bar for, to protect human rights). Otherwise, OCD, for example, is really just an adaptive function (fastidiousness) dialed to a disabling extreme. We don’t call a highly fastidious person (someone with mild OCD) mentally ill. Neither should we call the mildly delusional so. But neither should we call the majorly delusional so. Technically they have a mental disorder, but it still typically does not rise to the level of an illness, and it may not be in any way productive even to mention its status as a disorder. It’s just a delusion. Period.

We must also remember that we have to make a distinction between error and delusion. Cognitive biases (natural faults in our brain’s information processing, native to almost everyone) are not mental illnesses (any more than our lacking an armored exoskeleton is a physical illness). A brain system that produces false belief is not the same thing as delusion. It can contribute to producing or sustaining a delusion, but a delusion only exists when all three conditions are met: an extreme feeling of certainty (which is an emotion) and an extreme resistance to evidence and argument (which is a defect of reasoning) both relating to a belief that is manifestly false or absurd (which is a point of fact). Many religious believers lack that certainty. Many religious believers lack that incorrigibility. And many religious believers no longer maintain manifestly false beliefs. Hence we need to be careful not to over-generalize.

But Neither Is It Always Not a Mental Disorder

Nevertheless, there are certainly a lot of religious believers who have all three. J.T. Eberhard, an atheist activist and blogger who openly identifies as mentally ill (he has, and has sought treatment for, depression and anorexia) has added his thoughts on the matter in “On Calling Religion a Mental Illness.” He thinks it isn’t a mental illness, but resembles one. On the colloquial meaning of that term, which means the meaning almost everyone assumes the term has, he’s right. A scientist using technical vocabulary might challenge that, but that’s a failure in basic communication science. If technical language will only confuse the public, it should not be used when communicating with the public.

Eberhard does fail to interact with the literature on the specific condition of delusionality, however. And thus he confuses different arguments. So, for example, he says:

There are also some key differences [between religion and mental illness]. Whereas an inability to see the world as it really is is thrust upon the mentally ill (a schizophrenic cannot help but hear the voices) that same inability is actually pursued by the religious (they want to hear the voices). I think that difference actually earns religion some embarrassment that is completely undue to the mentally ill. I also think that in both cases the similarity of hearing the nebulous voices is something we should seek to cure, even if there is no shame for the schizophrenic being sick.

The only problem with this analysis is that there are plenty of mental illnesses characterized by the ill seeking out what’s bad for them. He’s right that religion is not schizophrenia (there are religious people afflicted with schizophrenia, or milder forms of schizotypality, and some expressions of religiosity are thus explained, but rarely; and delusions can be a symptom of schizophrenia, but are not thereby identical to it). Reading charitably, we could say Boghossian is not saying religious belief should be classified that way, but only as a delusion. And delusional people do willingly seek out the things that reinforce their delusions (and often willingly avoid or attack the things that challenge those delusions).

So if all clinically defined delusions are a mental illness, then all incorrigible religious belief is a mental illness. But if we reserve the phrase “mental illness” only for genuinely disabling delusions, and not all delusions as clinically defined, then most incorrigible religious belief is not a mental illness. And therefore we should not be saying it is. And here is the key point: since the general public understands the phrase “mental illness” to mean a disabling disorder, when communicating with the public we need to use words as the public understands them. Otherwise, we are at best misleading the public (or even each other), and at worst manipulating them with an equivocation fallacy.

Wikipedia now includes a fairly decent treatment of the medical condition called delusion. It even has a good section on various philosophical and scientific nuances to defining and diagnosing a delusion (e.g., delusional people are not always in a delusional state, but can waver in and out if it; delusions are not always literally false but can include true beliefs falsely acquired). But more useful is the online Encyclopedia of Mental Disorders entry on Delusional Disorder (although be aware, by using public domain material, it is still very out of date). The most authoritative diagnostic tool is the DSM. The fourth edition of which defined a delusion clinically as (emphasis mine):

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other membersof the person’s culture or subculture (e.g. it is not an article of religiousfaith). … Delusional conviction occurs on a continuum and can sometimes be inferred from an individual’s behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion)

That comes from DSM IV (2000), p. 765 (this has been importantly revised in the DSM V, but not relevantly to the present point).

The way religion is exempted from this diagnosis is by allowing that a cultural norm (something many others around you believe: the words I’ve placed in bold above) can’t be a delusion. But that doesn’t make practical sense, because it doesn’t explain incorrigible beliefs. It only makes sense as an exception for beliefs for which the believer has no access to evidence of their falsity. For example, claims about their family or their people’s history that they are prevented from checking, or that can’t be checked (such that they have to trust their informants); or cults that outright prevent members from checking facts; or people who are so isolated culturally that they have not yet been able to or encouraged to check any facts; and so on.

But when the attribute of incorrigibility is absent, such people will abandon their belief as soon as they have access to sufficient evidence. That is why they are not delusional. It is not because their belief is culturally normative. This is why Boghossian is right to believe that any time a culturally normative belief is combined with the certainty and incorrigibility of that belief, it is still a delusion. Because the same defect is indicated in that incorrigibility and excessive certainty. That can be a mental illness—when it’s disabling to a person’s ability to live their life. But far more often it’s merely a mental disorder: their mind is not working as it could be (like an engine that needs a tune up), but they are not ill. Yes, something is not working correctly in their mind. Something far beyond an illusion or mere bias in cognitive processing. Something beyond shared cultural assumptions or lore. Something that would benefit from the same psychiatric treatment as any other delusion. But in common parlance an illness is presumed to be something even worse than that.

Saying a religion cannot be a mental disorder of any sort because mental disorders are not taught or learned is also not true. Religion is caused by the environment, but so are other mental disorders. Not just PTSD or the effects of brain injuries, but phobias, eating disorders, and many non-religious delusions can be instilled in a person by social pressures or abuse. And many religious family environments, even in the US (though not all, and we must not over-generalize), are more than sufficiently abusive to cause other mental disorders (read Winell, Tarico, Heimlich). They can therefore just as easily cause the disorder we call a religion (they can even, and have, caused outright mental illnesses).

Like other delusions, certain people are also more genetically predisposed to religious belief than others (religious belief is 40 to 50% genetically predetermined; which does mean it can be de-programmed, since it is then 50-60% environmentally determined, but in the same sense as any other delusion one may be genetically predisposed to). And like other delusions, the form that religious beliefs take is heavily dictated by one’s culture. Adding an environment (e.g. a culture, a society) that encourages the disorder, reinforcing it with approval, rather than treating it, does not negate that fact. Rather, it can make it appallingly worse (as the barbaric and murderous extremes some religious subcultures go to illustrates).

Sometimes such an environment can make a mental disorder better, as when anyone with a mental disorder finds greater acceptance in a community whose culture channels their disorder productively, e.g. schizotypal persons who accept their hallucinations as hallucinations and behave accordingly and openly and no one freaks out over this, or autistic persons whose idiosyncrasies are understood, accepted and accommodated, even appreciated, by their community, a community whose culture facilitates this (e.g. by mainstreaming interaction therapy in primary and secondary schools, as has occurred in much of Canada). But sometimes it can make it worse, as when a culture or sub-culture (like, say, the modeling industry) normalizes eating disorders, resulting in increasing harm to the health and intellect of those afflicted, and motivating them to avoid treatment by denying they even have a problem.

Religious cultures are more like the latter than the former: toxic environments that exacerbate rather than treat mental disorder or illness (in this case a central organizing delusion). The effects are not beneficial. Most particularly, by maintaining a defective epistemology (which can have widely harmful and self-defeating consequences, in social life, moral life, and politics, by increasing the abundance of false beliefs guiding behavior) and a dangerous hostility toward anything challenging the delusion (hence the persecution of doubters, critics, dissenters, and apostates, suppression of free speech and free inquiry, destruction of art and books, and support for institutions designed to conceal or obfuscate facts and disseminate false information).

A close analogy are dangerous sub-cultural delusions like the anti-vaxxer movement, whose members are characterized by an incorrigible certainty in a false belief maintained in the face of overwhelmingly contrary facts (hence, a delusion), which literally has lethal consequences for themselves and others not sharing their delusion. And yet they have built their own self-reinforcing sub-culture, which would meet the DSM criteria for excluding their belief system from a diagnosis of delusion. That of course makes no sense. They are suffering from the mental disorder called delusion. The symptoms are the same. The treatment is the same. Arguably, their condition even rises to the level of being an outright mental illness, given the material harm it causes.

Chris Stedman’s Assessment

This means Chris Stedman, in “5 Reasons Atheists Shouldn’t Call Religion a Mental Illness,” is right to say that religion is “not” a mental illness, as long as we understand “mental illness” in the colloquial sense most ordinary people take it. Notice, for example, that Stedman appears to assume it means “damaged” or “incapable of reasoning,” which false assumptions might actually be the problem he should be attempting to combat. But he is unaware of that. He also does not examine the clinical criteria for a delusion, and indeed seems to assume ordinary delusion is not a kind of mental illness. Which again, accords with what ordinary people understand by the term, regardless of how scientists might use that term.

One can argue that the examples Stedman gives of “mental illness” accord with prejudiced assumptions (that all mental illness is wholly crippling to one’s entire life, which is false) and the definition he borrows of “religion” (“looking for patterns[,] and feeling like a part of something larger than oneself”) is not what religion is, certainly not in the sense we are classifying as a delusion (a belief system about the nature of the world and its contents, which is held with a certainty excessively out of proportion to the evidence, and in the face of considerable contrary evidence). But I think this is yet further reason why he is correct to object to calling all, or even most, incorrigible religious belief a “mental illness.” That term just does not mean in public discourse what it might mean in technical scientific jargon.

So we should separate that issue from other claims Stedman makes, which happen to be false.

Stedman’s claim that religion is adaptive ignores the fact that religion, in its delusional form, inculcates an epistemology that is significantly maladaptive, by both increasing the frequency and intensity of false beliefs, and in turn causing behaviors, e.g. persecution and discrimination, that become systematically dysfunctional for a society. Atheism is not immune to the same dangers. There are delusional atheist beliefs that perpetuate godless forms of misogyny, homophobia, and racism, for example (as I explored in articles last week). But that just means those ought to be combated just as much, and for the same reasons and in the same ways. They cannot be defended on the principle that they are “adaptive.”

Stedman’s claim that religious belief produces wellbeing is also false. The evidence shows that it has no correlation, or a negative one. All the benefits attributed to religion derive from socialization and sense of identity whether associated with religion or not. See my survey of the evidence, and how it has been misused to dupe even atheists like Stedman, in “Atheism Doesn’t Suck” and “Bad Science.” In fact, religiosity is strongly correlated with several markers of societal misery and dysfunctionality. See Gregory Paul, “The Chronic Dependence of Popular Religiosity upon Dysfunctional Psychosociological Conditions” [ Evolutionary Psychology 7.3 (2009), pp. 398-441] and “Cross-National Correlations of Quantifiable SocietalHealth with Popular Religiosity and Secularism in the Prosperous Democracies: A First Look” [Journal of Religion and Society 7 (2005)] and Gary Jensen, “Religious Cosmologies and Homicide Rates among Nations: A Closer Look” [Journal of Religion and Society 8 (2006)]. To which can now be added R. Georges Delamontagne, “High Religiosity and Societal Dysfunction in the United States during the First Decade of the Twenty-First Century,” Evolutionary Psychology 8.4 (October 2010): 617–57.

Even if the causation is from dysfunction to religiosity (and not the other way around, or bi-directional), this means religion is both caused by systemic dysfunction and fails to alleviate it, which is not indicative of an adaptation. Religion is also highly correlated with violence and physical and emotional abuse, and the suppression of the liberties and well-being of others (e.g., Avalos, in conjunction with, again, Winell, Tarico, and Heimlich). So it cannot really be maintained that incorrigible religious belief is good for us. Thus here it is crucial to differentiate religious systems (as in, social systems) and religious beliefs. The latter do not track as adaptive. The former are human inventions and thus not subject to biological selection.

As it happens, every effort to eliminate the negative effects of religious belief is identical in effect to eliminating the delusionality of religion. And non-delusional religion is not what we would classify as a mental disorder. Stedman conflates all forms of religion as if they were the same (although to be fair, so, typically, do his opponents in this matter, and he is responding to them). Stedman also confuses mere “irrational thinking” with “delusion.” Mere irrational thinking is correctable. It is precisely when it resists correction that it becomes a delusion. And that’s what makes it a problem that rises well above mere error, a problem that can only be alleviated by the actual therapies prescribed for curing delusions.

A cure is partly diagnostic of the disease. If the cure for delusions works on religions, that is a sign that religions are also delusions. That religions also meet the entire description of a delusion even in their symptomology confirms that conclusion. That religious delusions can sometimes be harmless is no more relevant to this conclusion than that the very same thing can be true of conditions already clinically diagnosed as delusions (such as delusionally believing your cat is a benevolent alien observer from another planet). It’s still a delusion. Although, again, that does not make it an illness.

But Stedman is right on two other points.

First, it is ableist, and thus disrespectful to the disabled, to use mental illness (and related terms) as an insult. Quoting Miri Mogilevsky (linked below), “When done to make fun of or put down religion, it also puts down people struggling with” mental illness. She’s quite right. I’ll have more to say about this shortly. It’s not a direct concern for Boghossian’s Manual, because there he does not employ the idea as an insult. But it warrants general notice that we should no more be laughing at or disparaging the religious because they are “insane” (even if they were) than we should be laughing at or disparaging any disabled person for being disabled. And doing the former entails, and by any conscientious person will be perceived as, doing the latter. Ridiculing the ridiculous is fine, as long as what you are ridiculing is the belief or behavior or that is ridiculous (and not a person’s mental health), and as long as it actually is ridiculous (because just because it seems so, doesn’t mean it is so), and as long as there is some worthwhile point to ridiculing it (just doing so merely because it’s fun is not a legitimate reason; it’s just pointlessly cruel).

Second, even if religion is a delusion, merely dismissing it as a delusion can all too easily become an excuse not to make any attempt to understand it or engage with and thus treat it. Using the fact that religion is a delusion in order to dismiss it is not productive. It does not make the world a better place. Therapists treating delusions take them seriously and with sympathy and aim to help the patient escape their delusion with congenial reasoning. In the case of central organizing delusions like religions, this requires a lot of informed understanding of just what is going on, what the beliefs actually in fact consist of, and why they are actually held. And it requires sympathetic engagement. Notably, these are features that are emphasized by Boghosian’s method in his Manual, even though he does not appear to follow them in his public discourse. And anywhere else, when you see this use of the “mental illness” model to be dismissive of religious belief or any productive understanding of it, you should point out, “That’s not helpful.”

Miri Mogilevsky’s Assessment

A more careful treatment of the subject comes from Stedman’s inspiring source, Miri Mogilevsky. (See “Religion vs. Mental Illness, A Bit More Concisely” and then her more extensive, and I think even more important discussion, which that only briefs: “What This Depression Survivor Hears When You Call Religion A Mental Illness.”) She makes four points worth reading up on:

First, as inspired Stedman’s valid beginning point, Mogilevsky says calling religion a mental illness, “when done to make fun of or put down religion” also “puts down by association people struggling with problems like depression, anxiety, eating disorders, or schizophrenia,” and people “with these serious mental illnesses already face plenty of stigma and discrimination, so derogatory remarks about how religious people are ‘all crazy’ or ‘belong in a mental institution’ are harmful.” Again she’s quite right. And I’ll have more to say about that shortly.

Her second point is that, “I think we should save” the term mental illness “for situations in which people are truly suffering and having trouble going about their lives.” Hence, for example, “in extreme cases…religious beliefs and observances reach a level at which people cannot function normally, but we do the secular movement no favors by focusing on these instances to the exclusion of the vast majority of religious people who are healthy, happy, productive members of our society.” This is my point, too. Relegating the designation of “insanity” to the genuinely disabling is what society already understands by the word. Yes, this might indicate prejudicial assumptions about what having a mental illness (in the scientific sense) actually means. But it’s what the public already assumes, and thus what they already hear when you use the term. So you should be using the term as the public understands it when communicating with the public.

Thus, “delusion” is the only word we should use in respect to religious belief (and then only incorrigible religious belief etc.), not illness. Even “disorder” can be misleading and thus avoided unless you absolutely must employ it. And even when it does rise to the level of an illness, this may warrant the same sympathy as any other illness, rather than derision or scorn. A delusion that leads you to deny your children medical treatment is still a delusion whether it’s “because aliens told me not to” or “because vaccines are a corporate plot” or “because Jesus will punish me if I don’t.” There is no therapeutic or clinical difference. Nor between that and a delusion that your cat is from Mars. The former is causing harm, in a way the latter probably won’t. The former is therefore an illness even in the colloquial sense. But the latter is still a delusion, and fully so by the DSM criteria. Heed the difference.

The bottom line is this: many clinically delusional people are “healthy, happy, productive members of our society.” They are still delusional. What is wrong is the assumption that people with mental disorders cannot be “healthy, happy, productive members of our society.” Of course, by definition they cannot be in perfect health. As they have at least one illness (such as delusionally believing their cat is from Mars). But they can be entirely healthy in every other respect. And happy. And capable. And that’s crucial. Because insofar as people falsely assume “being mentally ill” (or even “having a mental disorder”) means this cannot be, the problem is with that very assumption, and not with the fact that this is a delusion, or that a delusion is a mental disorder.

And that can still be a valid reason to be more restrained in how we use terms like “mental disorder” even when they apply. As Mogilevsky might say, it would be more productive to only elevate a delusion (even meeting the DSM criteria) to the explicit status of an illness in public discourse when it is actually causing significant harm or impairment to the one suffering the delusion, or to others whom their behavior affects. And yes, I think that means people who let their kids die while praying to Jesus rather than seeking a doctor should be treated for a mental illness and not jailed untreated—not least because, being mentally ill, a threat of jail would have had no effect on them as a deterrent, so it accomplishes nothing that a psychiatric institution would not do more productively.

Mogilevsky’s third point is that religions are not just beliefs but also social systems that provide community, aid, comfort, and other valuable resources, and yet “calling religion a mental illness is a convenient way to avoid thinking about what we could actually be doing to make the secular community more welcoming and inclusive, and what sorts of resources we are lacking that people can find in religious communities.” She’s quite right, again. This is why separating religious beliefs from religious social systems is so important. As with Stedman’s second valid point, using the insanity model of religion to be wholly dismissive of religion is unproductive, or even counter-productive. It is only all the worse that it is inaccurate, given what “insanity” actually means in public discourse: something far worse than merely having a condition that’s listed in the DSM.

Hence Mogilevsky’s fourth point is the most important: “calling religion a mental illness in the general sense is a clumsy, inaccurate, alienating thing to say” (emphasis mine). That’s spot on. Religion is not “a mental illness” in some generic sense, even in the rare cases that it rises to the status of an illness in common parlance. Nor is it a “mental disorder” in some generic sense. That simply plays right into cultural stereotypes about “lunatics” and “crazies.” Religious belief is only a mental disorder in the highly limited, specific, and technical sense that it is a delusion, and a delusion just happens to be a mental disorder, and that only in one technical classification scheme. Hence saying religion or religious believers are “insane” or “mentally ill” is clumsy (it’s far too vague, imprecise, and misleading, and too subject to stereotyping, to be helpful) and inaccurate (the word “illness” does not mean to the public what usually applies to the case) and alienating (it throws innocent people under the bus, people who are struggling with mental illnesses they are perfectly well aware of).

Mogilevsky also goes on to touch on many of the points I have already raised (e.g. that not all religious people are delusional, not all religious belief is incorrigible or certain or obviously false). But the overall point is that there are valid criticisms of over-using or mis-using the mental illness model of religion. When using “illness” in common parlance, it’s simply not an accurate model at all (as few disorders are actually illnesses in the commonly understood sense). And we should write with awareness and sensitivity to that. Indeed, I think it’s often unproductive to use the phrase “mental illness” or even “mental disorder,” or any of their more vulgar synonyms. Even if technically correct in one or another arcane sense, it can be socially inept, because society in general does not consist of people well versed in just what that means. They are instead well versed in prejudices and stereotypes.

And this brings me to the last matter to address…

Sensitivity, Social Prejudice, and Avoiding Splash Damage

Discussion of mental illnesses and disorders needs to be well-informed and conscious of the actual presence and commonality of mental illnesses and disorders in the population. Many of your friends probably suffer from a mental illness or disorder but owing to the stigma have never told you about it. But certainly, if you are engaged in mass communication, it is a statistical certainty that hundreds or thousands of your readers are mentally ill or have a mental disorder and are aware of this and seeking treatment for it or just living with it. You should remember these are the people you are speaking to, and whom your words will be affecting. Many of them are your allies and share your goals. Which is why you should be more sensitive to how the way you use and speak about mental illness may appear to and affect them. Especially when it may even be damaging their goals, as in the case of mental health activists.

If you want someone to take up your goals, you can’t be pissing on theirs.

Unless, of course, their goals are precisely the false and toxic beliefs it is your goal to combat. But if you’re goal is to promote discrimination and prejudice against the mentally I’ll, you are an enemy of the good society, and that goal could use a good pissing on. But if you share the goal of helping, and ending discrimination and prejudice against, the mentally Ill, then you need to actually take that goal into account in the way you speak about insanity, attending to context and the consequences of the occasion.

This is the case with the overly casual way “crazy” and “insane” are used as insults or descriptors. Though not a concern in Boghossian’s book (I don’t believe he employs such words in that way there), it is a concern for many involved with blogs, tweets, conversations and speeches. I now believe I over-used the words “crazy” and “insane” in my Skepticon talk. I don’t think such language needs to be avoided altogether—I am okay with my Delusion Scale, and its use for humorous effect; though some will still object to either, I framed it within a discussion of nuances and qualifiers, thus giving it an appropriate and educational context, and I believe that’s the most we should expect. But there were several other cases where my casual use of the epithets “crazy” and “insane” were not carefully thought out, or properly contextualized, thus contributing to an already existing culture that negatively stereotypes the mentally ill.

The problem isn’t necessarily what we mean by the words (usually “a disturbingly off the rails mind”). The problem is how society treats those words cognitively as synonyms for mental illness generally, and thus over-using those words, or using them carelessly, inadvertently reinforces the stereotype that “mentally ill” means “a disturbingly off the rails mind.” The implications are then automatic that anyone who has a mental illness is dangerous, or incompetent, or pervasively irrational, or any or all of the above. Those with mental illnesses, like the disabled generally, then have to fight the effects of these false perceptions in society, making their lives more difficult, and in some cases even exacerbating their mental illness rather than helping to treat it. These social perceptions and assumptions do real harm. Often to people we care about.

This ableist stereotyping is ironically evident even in some of Boghossian’s critics, when they assume calling religious believers “mentally ill” entails calling for their institutionalization. By assuming that, they are the ones who are actually internalizing the ableist narrative that “mentally ill” means “dangerous, or incompetent, or pervasively irrational.” And they don’t even realize that this means they are the ones being ableist, not Boghossian (or at least not in his book; I don’t read all his social media so I can’t comment on anything else he may have said). Boghossian does not there say anything about institutionalizing all religious people nor does he equate “mentally ill” with “dangerous, or incompetent, or pervasively irrational.” However, when we don’t mention this explicitly the cultural stereotype is automatically assumed. This is the problem with cultural assumptions: we did not cause them to exist as writers, yet nevertheless as writers we need to compensate for them and not ignore them, because our readers will always bring them to the text we write. Thus, not explicitly clarifying that “mental illness” does not mean “dangerous, or incompetent, or pervasively irrational” only contributes to reinforcing that narrative. That is not our intention, but alas it’s what cognitive science has shown is what happens.

Thus, once we are informed of this—that there is a harmful cultural assumption that will automatically be read into any discussion of mental illness unless we disarm it by confronting and correcting it—then we know that we have to add such qualifiers every time we discuss the subject. This is true in discussions of race, gender, even atheism. It’s true anywhere the most common cultural assumptions are falsely stereotyped, in other words anytime a culture is plagued with intrinsic prejudice. This is just as much the case in cultural attitudes toward the disabled. And mental illness is a form of disability. In this respect it’s not relevantly different from a physical disability.

Most mental illnesses do not render the afflicted “dangerous” or “incompetent” or “pervasively irrational.” So neither do mental disorders, which do not rise to the status of illnesses. The delusional will often only be irrational about the object of their delusion. They can be perfectly rational and competent in every other aspect of their life. Someone suffering from a phobia is not unable to hold a job, or lead a government, company, or organization, or make a competent speech, or write an authoritative book, or be a reliable friend, or any of the other things cultural prejudices assume about “crazy people.” Someone with PTSD, for example, is as capable of doing all those same things as someone who is blind or confined to a wheelchair. Those physical disabilities make doing those things in some respects more difficult or in need of special accommodations (e.g. assistance software; ramps), but usually we readily respect that, and don’t denigrate them as incapable because of it, but are usually sympathetic to assisting them overcome their disability to perform. We should treat PTSD or any other mental illness with the same sympathy and respect. Yet this is a hard trend to promote when our culture is locked in the prejudicial narrative that “mental illness” or even “mental disorder” means “incompetent.” And the way we use disparaging synonyms for mental illness (like “crazy” and “insane”) ends up reinforcing that prejudicial narrative, rather than helping to combat it.

On this point I highly recommend Parker Marie Molloy’s very handy article “15 Crazy Examples of Insanely Ableist Language,” and I agree with her measured conclusion, that by trying as much as we can to find other words to convey what we want instead, “not only will your writing be more descriptive,” but “you’ll avoid the collateral damage of offending innocent people.” And yet, as she notes, this is still “entirely up to you. I am not out to language police anyone, nor do I believe any of these words should be censored. Every once in a while, though, it’s good to take a look at one’s actions and choices.” And that’s apt. We should be aware of how our use of words might be making life more difficult for people we intend to have no such effect on. And then adjust how we speak and write as best we can, if for nothing else than to show we care more about innocent people our actions might affect, than about stirring a crowd with entertaining hyperbole. (I have written on this question myself in more philosophical detail before, in “The Art of the Insult and the Sin of the Slur.”)

In the case of mental disability, note how strong the stigmas are to such terms as “mental illness” and “insanity” that it seems wholly inappropriate to designate autism or low IQ as an “illness” or as being “insane.” This incongruity is a product of the innately prejudiced way our culture has caused us to intuitively “hear” words like “illness” and “insanity.” They are “bad,” and imply damage or danger or instability (as if having a strong phobia of spiders was “bad” or meant you were “damaged” or untrustworthy). To try and bypass this prejudice, autism and low IQ are more commonly referred to as mental disorders, rather than mental illnesses, and as “having a mental disorder” rather than “being insane.” Even though they are disabling. And even though scientifically these may be synonyms. But culturally they are not. We stereotype what the word “insane” means so extremely and negatively that it is no longer in common parlance synonymous with having a mental disorder (or a “neurodevelopmental disorder,” as some who find the prejudices attached even to the term “mental disorder” have resorted to saying, even though the latter means the former). (See “Is Autism a Mental Illness?“)

This is irrational. But it’s the cultural fact of the matter all the same. Calling an autistic person “insane” simply triggers all these cultural stigmas and prejudices. And consequently serves no good purpose in practice. You might “rationally” know that it should mean the same thing as “mental disorder,” and yet you will at the same time feel the pressure of the word “insane” as being far worse in meaning. And because language works by relying on cultural assumptions (the innate lexicon and associations in every brain speaking and hearing that language), you can’t change this. Thus, you need to be more sensitive to the effect language has in practice, regardless of what you think that effect rationally should be. And if this is so for autism, a disorder that in some cases brings significant cognitive advantages (and becomes then more like a different cognitive style than an actual disorder, only manifesting as a disability in respect to social interaction), think how it will also affect any discourse you engage in about religion.

All the same can be said of calling religion a virus. For example, Darrell Ray’s definition of a virus (as applied to god-belief, quoted at the opening of chapter 9 of Boghossian’s Manual), though entirely correct, is actually equally descriptive of science, logic, humanism, democratic values, and almost every important system of belief. But is it in any sense useful to call science and democratic values “viruses”? Or is it rather misleading, and thus counter-productive, by playing on the cultural assumption that “virus” always means “bad”? Insofar as faith is bad, it is not because it transmits and survives like a virus. Because science and democratic values transmit and survive like a virus, too. What makes faith bad is that it compels people to settle on and cling to and spread false beliefs, and builds defenses against correcting any of its errors. In short, it acts as a malignant virus. Whereas viruses that cure them of that are entirely praiseworthy. And yet the word “virus” does not have a positive connotation in general society. And that’s the problem.

Again, the virus model of religion is still useful to discuss, because the fact that ideas and systems of ideas move around and survive the same way viruses do is crucial to understanding the importance of being self-critical and ensuring that the memetic viruses that infect us are not harmful to us, nor preventing us from realizing or admitting they are harmful to us. But any such discussion must explicitly discuss how not all viruses are bad, but some in fact welcome, and even to be sought out (the same way we have a probiotic model of bacterial infection now, we need the same for benevolent memetic virus infection).

Conclusion

The take-away is threefold.

First, we should not so casually call people “crazy” or “insane.” We should ask ourselves why we are resorting so readily to that, rather than some other way of describing what’s going on. Do we really know they have a mental illness? Do we actually have sufficient evidence even to suspect that? And even if they do have a mental illness, is it even relevant to the question at hand? Should we be sneering or poking fun at someone with a disability? Or should the fact that we think they are disabled actually be a cause of sympathy and concern? And if we don’t really mean they have a mental illness, why are we using words that ascribe a mental illness to them, and why do we think that’s funny? And either way, how are people who have mental illnesses in our audience or readership going to be helped or harmed by what we say? Is the splash damage worth it? Is it really?

Second, because our society is intrinsically prejudiced in this way, whenever we discuss religion as a mental illness, we must address this elephant of prejudice in the room and make an explicit effort to ensure we are not reinforcing that prejudice by not challenging it. That’s why we must challenge it every time we discuss the matter. Only that will actually make things better for the disabled, rather than worse. The idea that mental illness means “dangerous” or “incompetent” or “unstable” must constantly be challenged. The idea that all mental illness is the same must constantly be challenged. The idea that all mental disorders are illnesses in the popular sense must be challenged.

Third, we must not over-generalize. We must always acknowledge that not all religion is delusional, and not all delusional religion rises to the level of mental illness or disorder, and even when it does, we should treat it informedly as such. Which means, acknowledging that delusions have a well-studied pathology and treatment, and becoming well-informed as to what those are, and not treating a delusion like disorders or illnesses it is not (like schizophrenia).

Accordingly, I recommend only using phrases like “mental illness” or “mental disorder” in ways that rely on what the public already assumes they mean, or only when you are prepared to remind the reader of all these caveats and nuances, so as to not contribute to reinforcing social prejudices, but to combat them instead. Otherwise, only ever be specific, accurate, and correct. So, for example, refer only to incorrigible religious belief this way, and only as a delusion. And then correctly speak about it as such. Do not call it a mental illness or insanity, or even a mental disorder. If someone else makes such an inference from what you are saying, that then becomes an opportunity for you to educate them on what “mental illness” or “insanity” actually means in common parlance and how that then differs from a “mental disorder” (as here defined) and what that difference means, and on the necessity of de-stigmatizing such terms and fighting the prejudiced assumptions they evoke.

In sum, don’t casually talk about religion as a mental illness. In common parlance, it almost never is. It clinically rates as a delusion by scientific criteria. But even then only when we are talking about an incorrigible religious belief (an excessive and seemingly immovable certainty contrary to the evidence), which not all religious beliefs are, nor does “religion” consist solely of beliefs. The term “illness” in common parlance refers only to more serious or disabling diseases of the mind than that. The term “disorder” might suffice as a substitute, but even that has common social prejudices attached, and therefore readily confuses the matter unless you are prepared to explain how “disorder” differs from “illness,” and are ready to challenge the prejudices in anyone who assumes they both mean a crippling or dangerous disability (which most incorrigible religious beliefs are not).

Basically, always keep in mind how the way you discuss this issue affects innocent people.