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What's in a name

September 1, 2008
by Douglas J. Edwards, Editor-in-Chief
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As attitudes toward people with mental illnesses have changed, so have the names of the places that care for them. Many state hospitals were officially labeled as institutions for the “insane” or “lunatics” (e.g., the Georgia State Lunatic Asylum and the West Virginia Hospital for the Insane), but such stigmatizing titles have been dropped in favor of words such as “recovery” and, in the case of the facility in this month's cover story, “hope.” Perhaps as a natural progression of that trend, some agencies serving people with developmental and intellectual disabilities are considering whether to remove “mental retardation” from their names.

In my hometown, the nonprofit Center for Mental Retardation changed its name to the Arc of Greater Cleveland last month.1 The Arc of the United States, a community-based organization of and for people with intellectual and developmental disabilities with chapters throughout the country, has changed its name four times during the past 50 years, dropping “retarded” from its name in 1992. I suspect we eventually will see the “R word” (as some refer to it) join the ranks of lunatic, moron, insane, idiot, imbecile, and other stigmatizing terms no longer embraced by the provider community.

Yet any name change has to be accompanied with extensive public outreach and education. As Lon Mitchell, director of public affairs at the Lucas County (Ohio) Board of Mental Retardation and Developmental Disabilities, told my local newspaper, “One of the arguments against changing our name is, ‘Will people who support those levies understand what we're asking for if we don't have the understandable name on the ballot?’”1 (In Ohio, county boards raise money for services for people with developmental disabilities through property taxes.)

I suspect even “behavioral healthcare” could fall out of favor someday. Although “behavioral healthcare” is a convenient way of describing the broad range of mental health and substance abuse services, I have found that people unfamiliar with the field are fuzzy on what “behavioral healthcare” means. Some would prefer the field ditch the term altogether, but “mental health and substance abuse care” just doesn't roll off the tongue as nicely. Even the term “substance abuse” is being scrutinized, with advocates pushing for Congress to change the National Institute on Drug Abuse to the National Institute on Diseases of Addiction as well as the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.

The Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services is considering both “mental retardation” and “behavioral healthcare” as it prepares to change its name on the orders of the state assembly. The agency is removing “mental retardation” from its title, and three of the four suggested names it has floated include “behavioral” (as in the Department of Behavioral and Developmental Services, for example). The fourth name the agency submitted for public comment (as of late July it had received more than 1,250 responses) has no reference to mental illnesses, substance abuse, or developmental disabilities: Department of Supportive and Recovery Services. That suggestion is certainly bold and innovative, but I wonder if it is too vague. When people are in crisis, they need to find services fast, and eliminating commonly used words could make finding help more difficult.

Big companies spend a lot of money on choosing and revising their names, but health and human service organizations don't have the funds for extensive market research. Yet it's encouraging that many provider and government agencies do recognize the importance of what they are called and are considering the best way to present themselves to the public.

Douglas J. Edwards, Editor-in-Chief


  1. McRae S. ‘Mental retardation’ is issue in board names. Plain Dealer.Aug. 17, 2008:B1, B8.

Behavioral Healthcare 2008 September;28(9):6