International Journal of Mental Health Nursing (2008) 17, 208–214 doi: 10.1111/j.1447-0349.2008.00532.

Feature Article
An overview of swearing and its impact on mental
health nursing practice
Teresa E. Stone and Mike Hazelton
University of Newcastle, University Drive Callaghan NSW 2308 Australia and Hunter New England Mental Health,
Newcastle Australia.

ABSTRACT: Swearing is a subject largely ignored in academic circles but impossible to ignore in the
workplace. Nurses encounter swearing from patients and their carers, staff and managers and use
swearwords in communication with each other. Language is the major tool of the mental health nurse
and swearing an aspect of language frequently used in situations of intense emotion. This paper
provides an overview of the historical, legal and cultural aspects of swearing in an Australian context
in order to assist nurses in their practice.
KEY WORDS: communication, dialectical behaviour therapy, language, swearing, therapeutic rela-
tionship, verbal behaviour.

INTRODUCTION tice. While much of what is argued may apply to other

countries, the paper focuses especially on the Australian
Nurses are regularly exposed to swearing by patients and
context.
carers and from professional colleagues. Given the extent
One theory of language has it that speech originated in
of such exposure, it is surprising that no literature exists
utterances comparable to swearing: before the develop-
on this aspect of nursing practice in general and mental
ment of spoken language humans gave expression to
health nursing in particular. In this paper, we will take
strong feelings of shock, pain or surprise by emotionally
swearing to mean language use in which the expression:
charged cries and such expletives were understood and
‘(i) refers to something that is taboo and/or stigmatized in
sympathized with by others in the group, becoming the
the culture; (ii) [may] not be interpreted literally; and (iii)
basis of language (Montagu 1967; p. 5). Owing to
can be used to express strong emotions and attitudes’
the taboo nature of the subject, we know little about the
(Andersson & Trudgill 1990; p. 53). Defining features of
origin of swearwords because they were rarely written
swearing are its capacity to shock because of its associa-
down. Swearwords do not occur in written texts from the
tion with a tabooed object and the vital role it plays in
Anglo-Saxon period. In the Middle English period, dis-
both normal and abnormal communication (Van Lancker
tinguished as an age of religious intensity, the disciplined
& Cummings 1999). In what follows we begin by briefly
use of language was valued, but paradoxically profanity
discussing the historical and legal aspects of swearing
was prevalent in the spoken word and is in ample evi-
before examining gender and legal issues; the paper will
dence in the writings of Chaucer (Hughes 2006), who
then shift to a discussion of how swearing is responded to
included an astonishing range of sexual and scatological
in the clinical setting, with implications for nursing prac-
words. Elizabethan England was familiar with swear-
words used judiciously by Shakespeare, and more prolifi-
cally by some of his contemporaries – for example, Ben
Correspondence: Teresa Stone, School of Nursing and Midwifery,
Faculty of Health, University of Newcastle, University Drive, Cal- Jonson who declared that his plays would demonstrate the
laghan, NSW 2308 Australia. Email: teresa.stone@newcastle.edu.au ‘language such as men do use’ (1598 cited in Lund 2002;
Teresa Elizabeth Stone, RN, RPN, BA., M. Health Management.
Mike Hazelton, RN BA MA PhD FACMHN.
p. 262) – while the queen herself and her father Henry
Accepted November 2007. VIII were known for their enthusiastic swearing (Hughes

© 2008 The Authors

Journal compilation © 2008 Australian College of Mental Health Nurses Inc.
SWEARING AND MENTAL HEALTH NURSING PRACTICE
1991). Waves of repression inspired by fundamentalist
sects such as the Puritans induced change; and later the
Victorian Age ushered in greater censorship and a squea-
mishness manifesting itself in euphemisms but also a par-
allel rise in pornography (Hughes 2006). In contemporary
Western societies swearwords are frequently used in film,
television and song lyrics and there is corresponding
concern about the apparent rise in the use of swearwords
in society (e.g. Ackland 2004; BBC 2000; Leonard 2002).
Swearing in Australia
Only 50 years after the establishment of the penal colo-
nies in Australia it was noted by Haygarth in 1848 in a
letter to Joseph Banks that ‘profane swearing prevails
throughout the interior of New South Wales to an extent
hardly conceivable but by those who have actually wit-
nessed it’ (Hughes 2006). Nineteenth century Australian
bushmen have been described as being deeply committed
to the proletarian practices of swearing, drinking, and
gambling, and their practices and values would soon
became those of the nation as a whole (Waterhouse 2006).
Perhaps uniquely Australian is an awareness of and a high
value placed on coarse speech. The genesis of the high
incidence of swearing has been associated with the origins
of Australia as a convict colony, the original settlers being
‘convicts and the sweepings of English backstreets well-
versed in vulgar speech’, and ‘the country itself . . . one to
stir exasperation and helpless fury in even the most
patient soul’, (Baker 1945, p. 251). Hughes (2006; p. 14)
relates a story dating from the mid 19th century of a New
South Wales bullock driver who used the word ‘bloody’ 27
times in an hour, estimating that over 50 years this man
would have used ‘this disgusting word no less than
18 200 000 times’. This ‘disgusting’ word recently caused
a stir when Tourism Australia in 2006 launched an inter-
national tourism campaign, ‘So where the bloody hell are
you?’, to attract prospective travellers – the message sup-
posedly capturing ‘the essence of Australia’s famous
warmth and hospitality’ (Koumelis 2006). In the UK and
USA, where the word ‘bloody’ carries more taboo than it
does in Australia, the advertising caused legal problems
because of the offensiveness of the terms and the cam-
paign was modified for many Asian countries.
Swearing has been described as having a special func-
tion in Indigenous culture and in some Aboriginal com-
munities has an integral role in ‘making everyone happy’.
It is an ingredient of good-natured banter in the context of
formally defined joking relationships (White 2002); it also
plays an important part in managing disputes (Taylor
1995), and among the Indigenous people of northern
Queensland there exists an elaborate etiquette of swear-
© 2008 The Authors
Journal compilation © 2008 Australian College of Mental Health Nurses Inc.
209
ing. In mainstream Australian culture, people frequently
have rules about swearing which may include ‘not swear-
ing in front of their parents’, that ‘women should not
swear’ and that ‘you should not swear in front of your
social betters’. There are no such sanctions in many
Aboriginal communities (White 2002) where swearing is
part of everyday interaction.
One young Indigenous man interviewed in the course
of the Royal Commission into Aboriginal Deaths in
Custody in 1991 stated that ‘. . . a lot of adults don’t like
the way we talk, and it’s just the way we’ve been brought
up,’ cos of our Aboriginal background, you know, I got
brought up saying ‘fuck’ and ‘cunt’ and stuff like that you
know and a lot of people hate that, but I can’t help it, I was
brought up like that’ (White 2002; p. 31).
Legal aspects of swearing
In Britain until the end of the 17th century the penalty for
blasphemy was burning at the stake (Peters & Taylor
2002). In the 15th and 16th centuries Diest in Holland
was afflicted several times by the plague. Historical
accounts show that the city took several counter-measures
such as efficient disposal of insanitary water, rubbish,
food, and infected clothes. In 1470 there emerged pro-
phylactic measures of a religious nature, which included
the imposition of severe fines for cursing and swearing
(De Backer 1999). Penalties for swearing have included
imprisonment, excising of tongue and other forms of
severe physical punishment, fines, and the prospect of
eternal damnation (Rawson 1989).
Since the restoration in New South Wales in 1988 of
the crime of offensive language, prosecutions for this
offence have risen sharply and generally speaking
Aboriginal people are over-represented among alleged
offenders. The law with regard to swearing is not even-
handed; Taylor’s (1995) article discussing this imbalance
cited the absurd example of an Aboriginal man in Broken
Hill who was charged with saying to a policeman, ‘Don’t
tell me to get fucked’ (Glover in Taylor 1995; p. 242).
The Royal Commission investigating Aboriginal deaths
in custody examined factors contributing to the over-
imprisonment of Aboriginal people (Wootten, 1991). The
Commissioner’s comments on the role played by the
‘police’s self-imposed reaction to swearing’ could also
apply to nurses: ‘Over and over again during this Com-
mission there has been evidence about Aboriginals using
the term “cunt” in relation to police. I have been led to
wonder how police could continue to remain offended by
a term they heard so often and routinely. It is surely time
that police learnt to ignore. simple ‘bad language’. In this
day and age, many words that were once considered
210
obscene have become commonplace in many circum-
stances, and are in common use. It is particularly ridicu-
lous when offence is taken at the rantings of drunks, as is
so often the case’ (Taylor 1994; p. 245).
Present day authorities concur with ancient religious
proscriptions against swearing, that is, that ‘words can
wound’, and legal sanctions against language including
swearing, harassment, discrimination and obscenity rec-
ognize the powerful effect that words have on people (Jay
1999; p. 212). Words change in degree of offensiveness,
and words deemed legally offensive change over time; for
example, in Australia ‘bloody’ is no longer regarded as
really offensive and is used as a variant of the word ‘very’
(Burridge 2002; p. 77) in a process referred to as ‘seman-
tic bleaching’ (Abd el-Jawad 2000) wherein words lose
their power to shock. Swearwords by definition attack
taboos. These change over time and racism, sexism and
ageism are emerging as the major taboos. Burridge (2002)
reported that the constant repetition of swearwords in
films and television has robbed them of their potency,
reducing them to meaningless insults.
Swearing and gender
The issues of gender and swearing are particularly per-
tinent because stereotypically nurses are female, as is
the majority of the nursing workforce. There is an
‘asymmetry’ between the sexes in the use of body parts
as an insult (Burridge 2002; p. 226), and frequently a
term applied to women bears a negative and disparaging
connotation missing from the male equivalent (Richler
1999). Swearwords, in particular probably the most
taboo word, ‘cunt’, tend to refer to women’s bodies
rather than men’s (Davis 1999) and are regarded as
being more offensive.
Female parts are used as insults for both sexes; men
receive the doubly offensive implication of being a ‘sissy’
and being likened to a woman. Women, however, are
rarely abused by being called a male body part; in fact to
call a woman ‘ballsy’ is a compliment. On the other hand,
use of the uniquely Australian insult ‘dickhead’ – refer-
encing the male sexual organ – is generally restricted to
men. Insulting or shameful words which originally applied
to both genders frequently shift in meaning to become
applicable only to women. ‘Whore’ was once a polite term
meaning ‘lover of either sex’, but came to refer solely to
women and later took on the derogatory meaning of ‘sexu-
ally promiscuous woman’ (Burridge 2002; p. 65).
Traditionally swearing has been seen to be character-
istic of male speech, proscribed by politeness in the
presence of women. It has been suggested that women
are more conscious of propriety and upward mobility, and
Journal compilation © 2008 Australian College of Mental Health Nurses Inc.
T. E. STONE AND M. HAZELTON
try harder than men to avoid swearing (Trudgill 1979),
but Trudgill found class also to be a factor, working class
women being more frequent users of tabooed language.
Later studies have indicated an absence of sex differences
in actual usage (McEnery 2006; Preston & Stanley 1987),
but women use the most taboo words less frequently than
men (Jay 1992), and men and women swear more often in
the company of their own sex (Coates 1993).
Swearing in inpatient mental health settings
Swearing is a significant issue in a mental health context.
It plays a prominent role in various neuropathologies of
language. For example, it is one of a small set of speech
functions – automatic speech – selectively preserved in
the severely aphasic patient (Van Lancker & Cummings
1999). Association with conduct disorder, antisocial per-
sonality disorder, mood disorder, disinhibition and psy-
chosis is frequently observed, but the role of swearing in
these disorders has not been systematically researched
(Jay 1999). Patients may describe voices that swear at
them (Leudar et al. 1997), and coprolalia is the feature of
Tourette Syndrome which causes the most distress to
those living with the disorder. Ordinary language may fail
to capture the intensity of the experience a patient is
attempting to communicate; swearing is unique in its
ability to provide an emotional intensity to speech that
other words cannot achieve (Jay 1999).
Management of swearing
Nurses in Australia thus have a complex and changing
cultural and historical background to navigate in dealing
with swearing in the course of their work. Given the
complexity of the issues involved, how are mental health
nurses to deal with them – on a day-to-day basis? Because
of the attendant taboos the matter is rarely explicitly
addressed, nurses new to the mental health workforce
may be shocked by the language they encounter and left
unsure of how to respond.
Nurses are often faced with the task of managing
behaviour thought to be intolerable in the world outside
(Bowers 2005). Dealing with the extremes of human
emotion and behaviour is central to the activity of mental
health nurses – whether this be with the minority of
mental health patients who display extreme aggression or
the much greater numbers whose language, stories,
and/or behaviour confront the central beliefs of the
greater community about decency and the wider percep-
tion of what it means to be a nurse (Stone & Davis 2006).
Most definitions of verbal aggression include swearing
or profanity (e.g. Adams & Whittington 1995; Atkin et al.
2002; Cameron 1988 cited in Uzon 2003) with one author
© 2008 The Authors
SWEARING AND MENTAL HEALTH NURSING PRACTICE
maintaining that ‘obscenity represents the most violent
form of verbal aggression’ (Buss 1961, p. 7). Incorporating
swearing in a verbally aggressive message intensifies the
force of the communication (Kinney 1994; p. 207).
Poorly described in the literature, the effect on mental
health nurses of exposure to verbal aggression by patients
can be considerable; some anecdotally report intense
immediate reactions and of leaving positions because of
being ‘worn down’ and demoralized by the levels of
swearing. Such attacks often provoke hurt feelings, anger,
irritation, embarrassment, discouragement, anxiety, and
even physical aggression (Roberto & Finucane 1997).
Angry and powerless when subjected to verbal abuse,
some have felt that their emotional distress compromised
patient care; it also has been found to correlate negatively
with job satisfaction, and increase error rates (Braun et al.
1991). The cumulative effects of verbal aggression may
lead to emotional exhaustion and depersonalization (Win-
stanley & Whittington 2002).
There is increasing concern that mental health nurses
are spending limited amounts of their work time directly
interacting with patients (Cameron et al. 2005; McLaugh-
lin 1999), clearly limiting their ability to build therapeutic
relationships. Many factors are involved, but high levels of
verbal aggression also contribute to staff withdrawal from
therapeutic interaction.
How individuals cope with aggressive communication
is an important factor in effectively managing this behav-
iour. The ability to monitor reactions to patients is impera-
tive to establishing and maintaining a therapeutic
relationship (Austin, Bergum, & Goldberg 2003). It is thus
important to overcome the emotional impact and address
the patient’s needs, conflicts and stressors rather than
simply reacting to the words themselves (Jay & Clermont
1996).
No guidelines exist for managing the use of swear-
words in mental health settings and the subject has
received little attention in the literature (Maier & Miller
1993; p. 228). No swearing (or a similar injunction) fre-
quently appears at the head of the list of rules for psychi-
atric inpatient units. NSW Health’s Zero Tolerance policy
conveying the message that violence and verbal abuse will
not be tolerated (NSW Health 2003) has sometimes been
interpreted in ways which cause disquiet among some
mental health nurses. The fact that the term implies a
strict prohibition on aggression and verbal abuse, irre-
spective of circumstances, and also the use of the same
term in a law enforcement context, perhaps induce uncer-
tainty in interpretation. The strict prohibition of verbal
abuse in an inpatient mental health unit is deemed to be
unrealistic because of general recognition of the habitual
© 2008 The Authors
Journal compilation © 2008 Australian College of Mental Health Nurses Inc.
211
use of such language, particularly in situations of height-
ened emotion (Bloom 1977; Maier & Miller 1993).
In the absence of literature directly relevant to the
issues facing nurses we have had to extrapolate from
other contexts. The bulk of the literature is written by
teachers documenting findings on the management of
swearing with children in a classroom setting. Clearly
there are major limitations on applying their approaches
in adult mental health settings. The authors have used
their own clinical experience as the basis for developing
approaches to dealing with and responding to swearing
that acknowledge the therapeutic potential present in
most encounters between nurses and mental health con-
sumers. The following section presents our preliminary
thoughts on what might be considered in seeking to deal
with swearing (and other forms of verbal abuse) in a
therapeutic manner.
Bloom (1977), in an article addressing the manage-
ment of children’s swearing, highlighted much that may
be more generally relevant to management in an inpatient
context. Frequently the swearwords are the first part of a
message to be registered, and it is likely that the first
response is a defensive one based on the emotional
impact of the swearwords. Bloom argued that adults who
are intimidated by adolescents’ use of obscenity in addi-
tion to being unable to help them may exacerbate the
problems; he talked about the need to ‘free ourselves
from the captivating power of obscenity’ so we can
separate our ‘irrational reactions from the child’s true
meanings and needs and thus be able to respond thera-
peutically to children who swear’ (Bloom 1977; p. 210).
Knowledge about this type of communication may assist
in countering its emotional effects and allow us to under-
stand why swearing is used and what it does to others
(Kinney 1994).
A key element in responding effectively to swearing is
to understand the direction of the associated frustration,
conflict, or anxiety – whether the child is regressing and
losing control or whether the swearing represents his
gaining control (Bloom 1977; p. 209).
The author suggests it is instead preferable to focus
first on the content of the action, and only after that has
been dealt with on the behaviour. While these observa-
tions were made in relation to working with children, this
would seem also to be a reasonable approach to adopt in
working with adolescents and possibly even adults.
Castillo (1978) notes that frequently there are injunc-
tions against swearing, with teachers thinking that ‘no one
has a right to swear at me,’ ‘I should stop the child swear-
ing at me like that,’ ‘what will other people think of me if
I allow the swearing to continue . . .’
212
He comments that most adults tend to react to the
child’s swearing behaviour, viewing it as a moral trans-
gression, and failing to respond to the meaning or needs
of the child. Again, there are possible insights here that
ought at least to be explored in relation to the way in
which swearing by adults is viewed.
Suggested approaches for dealing with such ‘deviant
behaviours’ include empathy; appeal to values and rules;
redirecting the behaviour; teaching appropriate behav-
iour; interpretation; planned ignoring; and behaviour
modification, which may include response cost, satiation,
punishment, and counter-conditioning (Bloom 1977; p.
208). Further, that the most effective way to reduce
verbal aggression – from supervisors, visitors and doctors
as well as from patients – is to create a culture of respect
through appropriate strategies (Gerberich et al. 2004).
Swearing has been associated with workplace and school-
yard bullying (Anon 2002; Thompson’s Law 2003); anec-
dotal evidence implies that appropriate strategies to
reduce levels of swearing have gone some way to address
these problems.
However, it is important to move beyond these con-
cerns to consider options for managing such situations in
a more explicitly therapeutic manner. Possibly we should
train mental health nurses (and other health profession-
als) in the use of mindfulness techniques: to note what has
been said without making judgements about it, in order to
reduce the urge to react defensively – and thus counter-
therapeutically.
Mindfulness has been described as ‘paying attention
in a particular way: on purpose, in the present moment,
and non-judgementally (Melbourne Academic Mindful-
ness Interest Group 2006: 286). Cognitive behavioural
treatment models such as dialectical behaviour therapy
stress the relationship between logical thinking, emo-
tional experiencing and intuitive knowing (Linehan
1993). Developing mindfulness skills involves learning to
achieve a more effective balance between these primary
mind states. Importantly for the topic of this paper, the
aim is to reduce any tendency towards reaction and
impulsiveness by improving an individual’s ability to
observe, describe and participate in what is happening
in the present, and learning how to do so non-
judgementally (Linehan 1993).
Mindfulness makes it possible to ‘listen’ for the distress
underpinning a patient’s swearing and to provide help in
the form of distress tolerance techniques. The ability to
accept and tolerate distress is an essential aspect of
mental health care as emotional pain and distress
are unavoidable aspects of life. The distress tolerance
skills associated with cognitive behavioural treatment
Journal compilation © 2008 Australian College of Mental Health Nurses Inc.
T. E. STONE AND M. HAZELTON
approaches are designed to enable an individual to reduce
contact with events that trigger painful emotions; to
modify parts of an emotional response; to learn to be
comforting, to nurture, to be gentle or kind to oneself; to
replace immediate negative events with more positive
ones; and to think about the positive and negative aspects
of tolerating or not tolerating distress (Linehan 1993).
While such techniques have usually been associated with
the treatment of specific disorders such as borderline
personality disorder, there is increasing support in the
literature for their use with other groups of patients
(Robins & Chapman 2004). We would also argue that
such techniques may help staff to deal with swearing and
other forms of verbal abuse, and that the acquisition and
refinement of such skills would also be a basis for more
effectively helping patients who express distress through
swearing. The intention here would be to treat swearing
as a legitimate clinical problem, rather than a social
problem requiring legal or quasi-legal sanctions; to work
with the patient to manage the distress that has fuelled
the swearing; and to work towards more effective ways of
expressing intense emotions.
The positive aspects of swearing are perhaps less
obvious than the negative. When a person uses swear
words, the intention may not always be to wound.
Although swearing is used to express anger, racism, and
other negative emotions, humorous and erotic verbal
exchanges frequently draw on swear words (Jay 1994).
Queen Elizabeth I ‘never spared an oath in public speech
or in private conversation when she thought it added
energy to either’ (Lund 2002; p. 263), and swearwords are
still used today with this intent. There may well be clinical
situations in which the strategic use of swearing by either
staff or parents acts as a kind of pressure valve – releasing
tension, or providing distraction from distressing situa-
tions. At the very least such possibilities ought to be
explored as legitimate therapeutic concerns of mental
health nurses and other health professionals.
SUMMARY
A better understanding of the role played by swearing,
culturally, developmentally and in relation to mental
health disorders, is likely to lead to improvements in
the therapeutic relationship between nurses and their
patients and thus have positive effects on treatment
outcomes. This paper has outlined ways in which the
emotional content of swearing can be dealt with more
strategically. The experience of being sworn at and
exposed to swearing is common to all mental health
nurses. It is time to move beyond treating swearing in
© 2008 The Authors
SWEARING AND MENTAL HEALTH NURSING PRACTICE
punitive ways, to look for the therapeutic opportunities
that are inherent in all verbal exchanges between nurses
and patients.
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