The evolution of neurologic terminology: Reflecting changes in language, social norms, and perceptions

Introduction

Language in medicine continually evolves, reflecting shifts in social norms, cultural sensitivity, and scientific understanding. In neurology, terms that were once clinically precise have transformed or have been replaced altogether as their usage became associated with stigma or misunderstanding. This entry explores the historical context and the changes in language related to neurologic terms, highlighting the relationship between terminology, social norms, and perceptions.

From "mental retardation" to "intellectual disability"

One of the most significant changes in neurologic terminology is the shift from "mental retardation" to "intellectual disability." Originally, "mental retardation" was a purely clinical term introduced in the early 20th century to describe individuals with significantly below-average intellectual functioning and adaptive behavior. The word "retardation," derived from the Latin retardare (to delay), was used in a neutral, descriptive sense.

However, over time, the term "retardation" became pejorative, used as an insult in everyday language. Its clinical utility was overshadowed by the negative connotations it acquired in society. Advocacy groups and professionals recognized the harm caused by this terminology, and in 2010, the United States Congress passed Rosa's Law, which mandated the replacement of "mental retardation" with "intellectual disability" in federal health, education, and labor policy.

The shift to "intellectual disability" reflects a broader societal movement towards person-first language, which emphasizes the individual before the condition (eg, "a person with an intellectual disability" rather than "an intellectually disabled person"). This change promotes dignity, respect, and a more holistic understanding of individuals with cognitive impairments.

Revising "epileptic" to "person with epilepsy"

The term "epileptic" has also seen a shift in usage. Historically, it was used to describe individuals who have epilepsy. However, labeling someone as "an epileptic" reduces their identity to their condition, contributing to stigma and a sense of otherness.

In response, advocacy groups and the medical community have encouraged the use of "person with epilepsy" instead. This change aligns with the principles of person-first language, which seeks to recognize the individuality and humanity of those affected by neurologic conditions, rather than defining them by their diagnosis.

The shift from "hysterical" to "functional neurologic disorder"

The term "hysteria" has a long and problematic history in neurology and psychiatry. Originating from the Greek word hystera (meaning uterus), hysteria was historically associated with women and was thought to be caused by disturbances in the uterus. By the 19th century, "hysteria" was used more broadly to describe a range of neurologic symptoms, including paralysis, tremors, and convulsions, with no identifiable physical cause.

The term became increasingly controversial due to its gendered implications and its use as a catch-all diagnosis for unexplained neurologic symptoms. It was often used dismissively, suggesting that the symptoms were imagined or exaggerated. In recent years, "hysteria" has been replaced by terms like "functional neurologic disorder" or "conversion disorder," which more accurately describe the condition as a dysfunction in how the brain processes signals from the body, without the negative connotations of hysteria.

Replacing "demented" with "person with dementia"

Similarly, the term "demented" was once commonly used to describe individuals with dementia, a syndrome characterized by a decline in memory, reasoning, and other cognitive functions. However, "demented" has since fallen out of favor due to its pejorative nature, implying that the person is irrational or “out of their mind.”

Today, the preferred terminology is "person with dementia." This change reflects a growing awareness of the importance of language in shaping perceptions of aging and cognitive decline, emphasizing the person's dignity and agency despite their condition.

Conclusion

The evolution of language in neurology reflects a broader societal shift towards more respectful, person-centered care. Terms that were once clinically descriptive have been reassessed as society's understanding of neurologic conditions has grown and as the impact of language on stigma and discrimination has become clearer. By adopting more accurate and compassionate terminology, the medical community not only improves communication but also fosters a more inclusive and supportive environment for patients.

The ongoing dialogue about language in neurology underscores the need for sensitivity and adaptability in medical practice, ensuring that terminology evolves in step with societal values and scientific knowledge.

MedLink acknowledges the use of ChatGPT-4, an Artificial Intelligence chatbot, in drafting this blog entry.

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