"Developmental Delay" or "Mentally Retarded?" Getting Off the Euphemism Treadmill
It was an all too common story in our School Achievement Clinic: 12-year-old Bertie was doing terribly in school and had just failed 6th grade. Her parents believed it was because she was "lazy" and because the school had lousy teachers.
On formal testing, Bertie's IQ was in the high 60s, meaning she had scored in the "mild mental retardation" range. So it was no mystery to us why school was so difficult for her.
But it was to her parents. "Mentally retarded!?" they exclaimed, incredulously and angrily. "We have known she was developmentally delayed since she was 3 years old, but no one ever said anything about mental retardation."
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This is one example of a pediatric euphemism that was taken too far and used for too long, which then created misunderstandings, inappropriate expectations, and insufficient therapeutic services. Mea culpa.
I know why this happens so often. Nice guys and compassionate to a fault, we pediatric providers hate to give bad news and avoid it when we can. We want to keep hope alive (even if it isn't particularly justified) and, at the same time, avoid our own discomfort with not being able to cure a problem. We think we are doing the family a favor: doesn't "developmentally delayed" sound so much more hopeful, so much nicer, than "mentally retarded?"
One reason is that "developmental delay" implies that the child's developmental functioning may some day catch up to her peers. After all, a delayed train eventually reaches its destination. But after a certain point - different for every child - it becomes clear that she will not catch up, that her intelligence will always lag well behind her peers, that she is, in fact, retarded and will remain so, no matter what her educational program provides.
By avoiding straight talk, by sugarcoating what is really going on, we pediatricians don't allow parents to understand their child's true potential. How are they then to provide the best possible environment to meet the unnamed developmental challenges?
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A euphemism is "a word or expression intended to be less offensive and troubling to the listener." In some cases - such as pet words for a child's genitals or excretions - it's a way to avoid a word that is embarrassing to the speaker. I think this sort of thing is harmless and most families have funny pet names for their child's wee-wee and poop. No harm, no foul.
But other times, a euphemism is meant to lessen the emotional hurtfulness inherent to some terms. That's why we pediatricians have now been advised not call kids "obese" but "overweight" or "at-risk for overweight." That's another reason we prefer "developmentally delayed" to "mentally retarded."
Why? What's so bad about the word "obese?" Well, people have negative associations with "obesity," so it's felt that a kinder, gentler word will dispel that hurtful emotional baggage and perhaps even serve to change our attitudes towards obese kids. Thus is born "political correctness," wherein absurd word acrobatics are mandated, that we might soften our prejudices.
One slight problem: it doesn't work. The negative connotations of a word come not from the word itself, but from people's pre-existing prejudices. Changing the offending words is a stop-gap non-solution, because eventually the politically correct euphemism acquires the same negative baggage as the old word. This called the "euphemism treadmill" by Steven Pinker, the neuropsychologist. (A patient of mine was recently ridiculed by a bunch of kids on the playground who pointed and hollered, "Overweight! Overweight!" Do you think he now experiences the word "overweight" as kinder than "obese?").
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Nowhere has the euphemism treadmill been clearer - and more heartbreakingly ineffective - than the terms we use for people with developmental disabilities. In 1900, the terms "imbecile," "moron," and "idiot" were introduced to define a person's developmental level. These terms were seen as a great advance in their scientific precision. But, since our society doesn't take kindly to folks with disabilities whatever we call them, these terms - initially devoid of offense -- became insults and had to be dropped.
New terms came and went ("lame," "crippled," "handicapped," "disabled," "retarded") on the treadmill, until someone decided that even implying a problem was dehumanizing. Thus the term "differently-abled" was created. Aside from its absurdity and its insensitive trivialization of what is really a hard road to hoe on many levels, the politically correct crowd actually thinks such a term will improve our attitudes. Would that it were so easy to do so. I shudder to think what term will come next, after "differently-abled" becomes an unacceptable insult.
Another problem with euphemisms is that they amplify the undue negative power of the old, banished term. If "retarded" is now an unmentionable insult, it wounds even more when hurled at your child.
Finally, euphemisms are confusing for kids. So your dead doggie "went to sleep." That's so much less harsh than "died", right? But explain that to the five-year-old who then is afraid to fall asleep, lest she meet the same fate as Rover.
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Go ahead and use euphemisms all you want with your kids. But, remember, when the stakes are high, avoiding explaining to your child about hurtful words only furthers their power to hurt. In that case, it's OK to embrace simple, direct, unambiguous terms, to teach your vulnerable child that "sticks and stones may break my bones but names can never hurt me," and to teach all your kids that wounding others with bad words is unacceptable.
But don't count on clear, unambiguous words from pediatricians, because we are forever developmentally delayed at not always giving you the unvarnished truth. Excuse me, I'd like to write more, but I have to go perform a not entirely benign procedure on a consumer.
Related Topics: Technorati Tags: euphemism, mental retardation, obesity, pediatrics, health and wellness
