Mental Health, Autism and the Cost of Stigma
By Karl M. Garcia
There is a simple reason many people still hesitate to see a psychiatrist:
Nobody wants to be called crazy.
But the fear is about more than one word.
It is about what the word implies.
“Crazy.”
“Baliw.”
“May diperensya.”
“Coo-coo.”
“Delulu.”
“Abnoy.”
“Retarded.”
“Weird.”
“Attention seeker.”
These words are not equivalent. Some are slang. Some are outdated. Some are explicitly derogatory. Some may be used jokingly among friends. Context matters.
But together they reveal something important about how societies often respond to difference:
When people encounter behavior or characteristics they do not understand, they turn the unfamiliar into a label.
The label makes the unfamiliar easier to explain.
It can also make the person easier to dismiss.
That is where stigma begins.
THE PROBLEM IS DEEPER THAN WORDS
It is tempting to make mental-health awareness a vocabulary exercise.
Don’t say “crazy.”
Don’t say “baliw.”
Don’t use psychiatric diagnoses as insults.
Don’t use “retarded.”
Don’t call someone “autistic” simply because they are socially awkward.
Don’t diagnose strangers on social media.
All of that is reasonable.
But vocabulary is only the surface.
The deeper process is:
Difference becomes a label.
The label becomes a stereotype.
The stereotype becomes an assumption.
The assumption creates distance.
Distance can become exclusion.
Exclusion can become discrimination.
And eventually, repeated exclusion can make another person’s suffering easier to ignore.
That is why stigma matters.
It is not merely about somebody being offended by an inappropriate word.
Stigma can influence whether people seek help, disclose a condition, remain in school or employment, maintain relationships, participate in community life and receive appropriate care.
The World Health Organization has repeatedly identified stigma and discrimination as barriers to mental-health care and social participation. Philippine research likewise points to stigma, shame, concerns about losing face, financial constraints and limited access to services as factors affecting help-seeking.
The more important question, therefore, is not merely:
“Are we using the politically correct word?”
It is:
“Does the way we think and speak make it easier or harder for another human being to ask for help and remain part of society?”
AWARENESS IS ONLY THE BEGINNING
There is a useful progression.
Awareness means knowing that mental health, disability and neurodevelopmental differences exist.
Literacy means understanding what those conditions actually are.
Sensitivity means recognizing that words and actions can affect people living with them.
Empathy means trying to understand another person’s experience rather than immediately judging it.
Action means doing something useful: listening, referring, accommodating, treating, protecting or supporting.
And then there is apathy.
“Not my problem.”
“They’re just being dramatic.”
“That’s how he is.”
“Let the family deal with it.”
Apathy matters because stigma does not always look like hatred.
Sometimes it looks like indifference.
Sometimes the most damaging sentence is not:
“You’re crazy.”
It is:
“I don’t care.”
AUTISM SHOWS THE PROBLEM CLEARLY
The issue extends beyond psychiatry.
Autism is a neurodevelopmental condition, not simply another form of mental illness. It involves differences in social communication and interaction and restricted or repetitive patterns of behavior, interests or activities. It exists across a wide range of abilities and support needs.
Yet autism is routinely misunderstood.
A child behaves differently and is called:
“Abnoy.”
“Weird.”
“May diperensya.”
“Attention seeker.”
“Pasaway.”
The problem is not that everyone using these words consciously intends discrimination.
The problem comes when the label becomes society’s explanation for the human being.
Different becomes defective.
That is the deeper cultural problem.
THE CHILD EVERYONE CALLS PASAWAY
Imagine a child who repeatedly leaves their seat, becomes overwhelmed by noise and struggles when the daily routine suddenly changes.
A teacher may initially see defiance.
Classmates may see someone strange.
Relatives may say:
“Kulang sa palo.”
“Spoiled.”
“Pasaway.”
Now suppose the child is autistic.
The behavior has not changed.
The interpretation has.
And interpretation changes treatment.
The teacher may begin considering sensory overload, communication differences, predictable routines and appropriate accommodations.
The family may seek assessment and support.
The child may gradually learn that being different does not mean being bad.
That distinction can affect an entire childhood.
Notice, however, what awareness does not mean.
It does not mean automatically diagnosing the child.
The same behavior can have many possible explanations.
The important first step is not diagnosis.
It is curiosity.
“What is this child experiencing?”
That question replaces condemnation with investigation.
“RETARDED” AND THE CONVERSION OF DISABILITY INTO AN INSULT
Another word exposes the problem even more clearly.
“Retarded” was historically used in terminology referring to developmental delay, but it became widely used as an insult. Contemporary professional terminology uses intellectual disability.
The important issue is not simply that terminology changed.
It is what happened culturally.
A term associated with disability became a synonym for stupid, useless or inferior.
Society converted a condition into an insult.
That is stigma expressed through language.
A person can have an intellectual disability without being worthless.
An autistic person is not automatically unintelligent.
A person with a psychiatric disorder is not automatically dangerous.
A person who needs support does not lose dignity.
A disability is a condition. It is not a measure of human value.
THE ADULT WHO WAS “JUST WEIRD”
Not every autistic person is identified during childhood.
Some adults reach their twenties, thirties, forties or beyond having spent years being described as:
“Odd.”
“Too sensitive.”
“Socially awkward.”
“Obsessive.”
“Difficult.”
“May sariling mundo.”
These descriptions may identify observable behavior.
But they may completely miss the underlying explanation.
An adult may eventually seek an autism assessment after encountering information that helps make sense of lifelong experiences.
The person did not suddenly become autistic.
They acquired a framework for understanding themselves.
That matters because without an appropriate vocabulary for difference, people often invent explanations.
And invented explanations frequently become moral judgments.
THE FAMILY THAT DOES NOT KNOW
Imagine a Filipino family whose child communicates differently, struggles with transitions and has unusual sensory sensitivities.
The family does not know what autism looks like.
Relatives offer explanations.
“Spoiled.”
“Kulang sa disiplina.”
“Gadget.”
“Masungit.”
“Lilipas din iyan.”
Some families fear the diagnosis itself.
They worry about relatives.
They worry about school.
They worry about the child’s future.
They worry about money.
They worry about being blamed.
That fear does not necessarily mean a lack of love.
Sometimes it comes from too little information and too much stigma.
Love without understanding can still lead people in the wrong direction.
THE OPPOSITE ERROR: DIAGNOSING EVERYBODY
There is an equally important danger on the other side.
Awareness must not become amateur diagnosis.
Someone who avoids parties is not automatically autistic.
Someone with a special interest is not automatically autistic.
Someone who does not make eye contact is not automatically autistic.
Someone who is highly organized is not automatically autistic.
Likewise, not every sad person has depression.
Not every angry person has a psychiatric disorder.
Not every eccentric person is mentally ill.
Not every person displaying narcissistic behavior has narcissistic personality disorder.
And not every bad decision requires a psychiatric explanation.
Awareness should make us more careful about assumptions, not more confident about diagnosing strangers.
A meme is not a psychiatric evaluation.
A TikTok video is not a clinical interview.
A political disagreement is not a diagnosis.
A difficult personality is not automatically a disorder.
THE PERSON WHO IS AFRAID TO SEE A PSYCHIATRIST
Return to the person considering psychiatric care.
They may not actually fear the psychiatrist.
They may fear everything that follows the label.
Will my family think I am crazy?
Will my employer know?
Will friends treat me differently?
Will people think I am dangerous?
Will the diagnosis follow me forever?
That is why psychiatric consultation should not be treated as a declaration of insanity.
It should mean what seeing any other physician means:
Something may be affecting your health, and you want it assessed.
A psychiatric evaluation can result in a diagnosis.
It can also clarify that a feared diagnosis is not present.
Treatment may involve medication, psychotherapy, psychosocial interventions, rehabilitation or combinations of these approaches.
And the person remains a person throughout the process.
Diagnosis should be a tool for care—not a weapon for humiliation.
THE FAMILY THAT WAITS
Consider a young adult whose mood, sleep, social behavior and academic performance have changed dramatically.
The family notices but interprets it as laziness or attitude.
“Pagod lang.”
“Nag-iinarte.”
“Kulang sa disiplina.”
Someone eventually suggests professional help.
The family hesitates.
“Baka isipin nilang baliw ka.”
The family may believe it is protecting the person from embarrassment.
But concealment can also delay assessment.
Sometimes protection becomes postponement.
This is where stigma becomes a health issue.
THE STUDENT WHO LOOKS LAZY
A student repeatedly misses deadlines.
The teacher sees poor performance.
Classmates see someone who does not care.
Parents see irresponsibility.
Perhaps the student really is disengaged.
Perhaps there is anxiety.
Perhaps depression.
Perhaps a learning difficulty.
Perhaps a family crisis.
Perhaps something else.
The point is not that every failure deserves a psychiatric explanation.
The point is that we often decide what behavior means before asking what caused it.
A better question is:
“Something seems to be interfering with this person’s ability to function. What is happening?”
That question preserves both compassion and accountability.
THE EMPLOYEE WHO HIDES
Imagine an employee experiencing significant anxiety or depression.
The person worries that disclosure will affect promotion, assignments or how colleagues perceive them.
So the employee says nothing.
Performance eventually deteriorates.
Management sees a performance problem.
The employee experiences a health problem.
Those are not necessarily the same thing.
Workplaces need standards.
Mental-health awareness does not mean eliminating performance expectations.
It means distinguishing accountability from humiliation and, where appropriate, creating reasonable pathways to support, treatment and accommodation.
Understanding is not the opposite of accountability.
THE HEALTH PROFESSIONAL WHO DOES NOT SEEK HELP
There is another irony.
Doctors, nurses and other healthcare workers may understand mental illness extremely well and still hesitate to seek care themselves.
Will colleagues think I am unreliable?
Will patients lose confidence?
Will my career be affected?
Will people treat me differently?
Knowledge does not automatically eliminate stigma.
A person can understand mental illness intellectually and still fear its social consequences personally.
That is why mental-health culture must change inside healthcare institutions as well as outside them.
WHEN THE LABEL OUTLIVES THE CONDITION
Imagine someone who receives treatment, improves and returns to ordinary life.
Years pass.
The person works.
Builds relationships.
Raises a family.
Contributes to the community.
But someone still remembers:
“Siya yung nagpa-psychiatrist dati.”
The episode ended.
The label did not.
This is one of stigma’s cruelest features.
The illness can change while the social identity remains frozen in time.
Recovery therefore requires more than symptom reduction.
It also requires social reintegration.
A diagnosis should help someone access care.
It should not become a permanent social sentence.
WHEN THE INTERNET BECOMES THE PSYCHIATRIST
Social media has intensified another problem.
A celebrity behaves strangely.
A politician makes an outrageous statement.
A content creator becomes emotional.
A stranger posts something incoherent.
Within minutes, thousands of people begin diagnosing the person.
“Bipolar.”
“Narcissist.”
“Psychotic.”
“Delulu.”
“Crazy.”
But a video is not a psychiatric evaluation.
A political disagreement is not a psychiatric symptom.
A bad decision is not necessarily a disorder.
Eccentricity is not pathology.
Mental health is too complicated to diagnose with a meme.
This is particularly important in political discourse.
People should be able to criticize a politician’s words, policies, decisions or conduct without pretending to diagnose the person’s mental health.
Likewise, people should not be dismissed as mentally ill simply because their political views are unpopular.
Disagreement is not diagnosis.
THE “DELULU” QUESTION
“Delulu” illustrates why context matters.
It is internet slang, often used playfully to describe unrealistic optimism, fantasy or expectations.
In many settings, it is harmless humor.
Humor has a legitimate place in human life.
Filipinos joke about politics, celebrities, romance, bureaucracy, family and almost everything else.
The objective cannot be a humorless society in which every imperfect word becomes a moral offense.
That would create another problem.
The better objective is contextual intelligence.
Ask:
Is this clearly a joke among friends?
Is somebody being singled out because of an actual disability or mental-health condition?
Is a diagnosis being used as an insult?
Is somebody being excluded because of a label?
Is the joke replacing actual understanding?
Those questions are more useful than mechanically asking whether a word is politically correct.
POLITICAL CORRECTNESS IS NOT THE SAME AS EMPATHY
Political correctness can become a superficial vocabulary exercise.
People learn which words are discouraged, substitute another word and assume the problem has been solved.
But somebody can use perfectly acceptable language while behaving cruelly.
And somebody can use an imperfect word without intending harm.
Language matters. Intent matters. Context matters. Consequences matter.
The mature objective is not linguistic perfection.
It is human dignity.
That means we should correct harmful language without making people afraid to discuss mental health, autism or disability at all.
We need people to ask questions.
We need families to talk.
We need teachers to notice.
We need employers to respond appropriately.
We need friends to listen.
We need patients to feel safe seeking help.
And we need society to become better at correcting ignorance without humiliating the ignorant.
Sensitivity should open conversations, not close them.
EMPATHY DOES NOT MEAN EXCUSING EVERYTHING
There is an equally important distinction.
Empathy does not mean agreeing with everything someone says or does.
It does not mean eliminating boundaries.
It does not mean excusing harmful behavior.
It does not mean abandoning accountability.
A person can be mentally unwell and still need to take responsibility for harmful actions where responsibility is appropriate.
A person can also behave badly without being mentally ill.
Understanding a cause is not the same as approving the behavior.
We can understand a person without excusing every action.
This distinction matters because anti-stigma advocacy can fail if it creates a false choice between compassion and standards.
There is no contradiction between saying:
“This person deserves dignity.”
and:
“This behavior cannot continue.”
FROM LABELING TO DISCRIMINATION
There is a broader social pattern worth recognizing.
Ignorance says:
“I don’t understand this.”
Stigma says:
“There is something wrong with people like that.”
Discrimination says:
“People like that should not have the same opportunities.”
Apathy says:
“Their suffering is not my concern.”
Dehumanization says:
“They are less deserving of dignity.”
These are not necessarily stages that every person or society passes through in a fixed sequence.
But they can reinforce one another.
Repeated stereotyping can normalize exclusion.
Exclusion can make suffering less visible.
And when people are repeatedly portrayed as inferior, dangerous or disposable, more severe forms of hostility can become easier to justify.
Most insensitive jokes never reach that point.
It would be irresponsible to call every joke hateful.
But it would also be naive to pretend that language, social norms and repeated exclusion have no consequences.
The deeper question is:
What kind of human beings does a culture teach us to see as worthy of understanding?
THE PHILIPPINE PROBLEM IS ALSO CAPACITY
There is a major hole in many mental-health discussions.
We tell people:
“Don’t be afraid to seek help.”
But what happens when they seek help and cannot find affordable, accessible care?
Stigma is only one barrier.
Money matters.
Distance matters.
Waiting time matters.
The availability of professionals matters.
Confidentiality matters.
Referral systems matter.
Continuity of care matters.
Community services matter.
The Philippines has made policy commitments toward integrating mental-health services into primary and community care. But awareness campaigns cannot carry the entire burden.
You cannot normalize help-seeking without building somewhere for people to go.
A person who finally finds the courage to seek help should not encounter another wall.
The system must provide a pathway from:
recognition → assessment → referral → treatment → follow-up → recovery → reintegration.
That is mental-health infrastructure.
THE BARANGAY MATTERS
Imagine someone experiencing psychological distress in a community where there is no psychiatrist nearby.
The first person they talk to may be:
A parent.
A spouse.
A friend.
A barangay health worker.
A general practitioner.
A teacher.
A religious leader.
Or nobody.
That first point of contact matters.
The local system does not necessarily require a psychiatrist in every barangay.
But it needs people who know:
What signs should raise concern?
What can be managed locally?
What requires referral?
Where is the nearest appropriate service?
What happens during a crisis?
How is confidentiality protected?
How does the person return to ordinary community life?
This is the difference between mental-health awareness and mental-health infrastructure.
AUTISM AND DISABILITY NEED INFRASTRUCTURE TOO
The same principle applies to autism and disability.
Awareness cannot stop at posters and social-media campaigns.
Families need access to assessment.
Children need appropriate educational support.
Teachers need training.
Parents need information.
Adults need pathways to assessment and support.
People with higher support needs need services that continue beyond childhood.
Employers need to understand reasonable accommodation.
Communities need to understand that inclusion is not simply allowing someone to be present.
Inclusion means making participation possible.
A ramp is not merely a symbol of disability awareness.
It allows someone to enter a building.
A classroom accommodation is not merely a gesture of kindness.
It can make learning possible.
An accessible diagnostic pathway is not merely a service.
It can give a family an explanation from which useful support can begin.
CONTACT CAN CHANGE PERCEPTION
Information matters.
But human contact can be even more powerful.
It is harder to maintain a stereotype about “mentally ill people” when the person you know is your friend, colleague, neighbor, relative or respected professional.
Likewise, autism becomes less abstract when the autistic person is someone you know and value.
That is why people with lived experience should have a voice in mental-health and disability conversations.
Not as objects of pity.
Not as inspirational props.
Not as representatives of an entire diagnosis.
But as people whose experiences can teach the rest of society what statistics cannot.
THE PROBLEM WITH AWARENESS AS PERFORMANCE
We have become much better at saying:
“Mental health matters.”
But awareness can become another form of performance.
We post an infographic.
Share a quotation.
Use the correct terminology.
Then somebody in our own family struggles and we tell them to pray harder.
We call an employee unstable.
We call a student lazy.
We laugh at an autistic child.
We gossip about somebody seeing a psychiatrist.
We use “autistic” as an insult online.
We use disability terminology as shorthand for stupidity.
That is the gap between awareness and behavior.
Awareness says:
“I know mental health and disability exist.”
Empathy says:
“I will change how I treat you because I know it matters.”
Action says:
“I will help create conditions in which you can actually participate and receive help.”
EVEN RESILIENCE CAN BECOME A BARRIER
There is another Filipino paradox.
We value resilience.
“Kakayanin.”
“Laban lang.”
“Malalampasan din.”
These can be powerful expressions of hope.
But resilience becomes harmful when it is interpreted as refusing assistance.
We do not normally consider someone weak because they see a cardiologist after developing heart disease.
We should be equally careful about treating mental-health support as evidence of personal failure.
Asking for help is not the opposite of resilience.
Sometimes it is how resilience is sustained.
MENTAL HEALTH IS ALSO A SYSTEM ISSUE
Mental health cannot be left entirely to psychiatry.
Housing matters.
Education matters.
Employment matters.
Poverty matters.
Violence matters.
Bullying matters.
Family relationships matter.
Social isolation matters.
Digital environments matter.
Community matters.
A psychiatrist can treat a condition.
But psychiatry cannot by itself fix domestic violence, extreme poverty, an abusive workplace, school bullying, social isolation or an inaccessible health system.
Sometimes the patient needs treatment. Sometimes the environment needs treatment too.
That does not mean every social problem is a psychiatric problem.
It means health exists inside a social environment.
THE COMMON THREAD IS NOT DIAGNOSIS
Autism is not schizophrenia.
Intellectual disability is not mental illness.
Depression is not autism.
Social awkwardness is not automatically a disorder.
And unusual behavior is not automatically pathology.
These distinctions matter.
But the subjects share a broader social problem.
Society often turns difference into hierarchy.
Different becomes strange.
Strange becomes defective.
Defective becomes inferior.
Inferior becomes someone we can laugh at.
Someone we can exclude.
Someone whose suffering we can ignore.
The common denominator is therefore not diagnosis.
It is how society responds when a person’s mind, body, communication, behavior or abilities differ from what the majority expects.
THE OBJECTIVE IS NOT TO MAKE EVERYONE “NORMAL”
Perhaps even the word “normal” creates the wrong expectation.
The objective should not be to make every autistic person behave like everyone else.
It should not be to make every person with a psychiatric condition appear indistinguishable from everybody else.
It should not be to force every person with a disability into a single model of acceptable behavior.
The objective should be:
Dignity.
Safety.
Participation.
Opportunity.
Functioning.
Appropriate treatment.
Appropriate accommodation.
And the freedom to be more than a diagnosis.
WHAT SHOULD WE ACTUALLY CHANGE?
Not every Filipino needs to become a mental-health professional.
Not everyone needs to memorize diagnostic criteria.
But society can become better at five things.
1. RECOGNIZE
Notice significant changes in mood, behavior, communication, development or functioning.
2. DISTINGUISH
Do not confuse mental illness with eccentricity, disability with inferiority, autism with mental illness, or bad behavior with psychiatric disorder.
3. RESPOND
Listen without immediately diagnosing.
Encourage appropriate professional assessment when warranted.
4. ACCOMMODATE
Where appropriate, adjust environments and systems so people can participate.
5. PROTECT
Respect privacy, dignity and rights.
Do not turn someone’s diagnosis, disability or difference into gossip or entertainment.
These are modest demands.
But they require a major cultural change.
THE TEST OF A HEALTHIER SOCIETY
We should not measure progress merely by the number of awareness campaigns we conduct.
We should ask harder questions.
Can a student ask for help without being mocked?
Can an autistic child enter a classroom without being treated as a disciplinary problem simply because adults do not understand the behavior?
Can parents seek an autism assessment without feeling that their family has been disgraced?
Can an employee disclose a mental-health difficulty without automatically becoming professionally suspect?
Can a person with intellectual disability participate in society without being treated as lesser?
Can a psychiatric patient recover without carrying a permanent social label?
Can we criticize someone’s actions without diagnosing them?
Can we disagree politically without turning psychiatric language into a weapon?
Can we joke without dehumanizing?
Can we correct insensitive language without humiliating the person who used it?
Can we distinguish a person from a condition?
Can we distinguish a condition from a stereotype?
Can we distinguish compassion from excuse-making?
Can we distinguish accountability from cruelty?
These are harder questions than whether somebody used the correct word.
THE DEEPEST REFRAME
Perhaps the cultural change we need is not to eliminate every word that can offend.
It is to change what happens after we notice that another human being is different or struggling.
Awareness tells us that difference exists.
Literacy tells us what we may be looking at.
Sensitivity tells us to be careful.
Empathy tells us to care.
Action tells us to do something useful.
Ignorance tells us to guess.
Stigma tells us to label.
Discrimination tells us to exclude.
Apathy tells us to walk away.
And repeated dehumanization can make exclusion seem acceptable.
The answer is not to create a society where nobody ever makes a joke.
It is not to make everyone afraid of saying the wrong thing.
It is not to diagnose every difficult personality.
It is not to excuse harmful behavior by invoking mental health.
It is not to pretend that every difference is a disorder.
It is something more demanding:
A society capable of seeing the person before the label.
That means we can still laugh.
We can still criticize.
We can still disagree.
We can still hold people accountable.
But we become more careful about turning human suffering into entertainment, diagnosis into insult, disability into a synonym for stupidity, autism into a punchline, or difference into evidence of inferiority.
Because the person sitting across from us may not need a lecture.
They may need a teacher who understands.
They may need a parent who listens.
They may need a doctor.
They may need a psychologist.
They may need a counselor.
They may need medication.
They may need an assessment.
They may need an accommodation.
They may need a safer environment.
They may need time.
Or they may simply need somebody to stop laughing long enough to ask a question without judgment:
“Are you okay?”
And if the answer is:
“No.”
the next question should not be:
“Are you crazy?”
It should be:
“How can we help?”
That is the point at which awareness becomes empathy.
Empathy becomes action.
And action becomes culture.
Because the goal is not a society in which nobody is autistic, nobody has a psychiatric condition, nobody has an intellectual disability and nobody behaves differently.
That society does not exist.
The goal is a society in which human difference does not automatically become a reason for humiliation.
We do not have to make everybody the same.
We have to become better at making room for people who are not.
That is what mental-health awareness should ultimately mean.
Not merely knowing the right words.
Knowing the human being behind them.
