Labels for mental health illnesses have the potential to both stigmatise and alienate individuals. We can quickly fall into the trap of dichotomous thinking. You have a mental health problem, or you don’t and are healthy. Labels create an artificial divide between ‘normal’ and ‘abnormal’. We are then inclined to treat apparent abnormalities as discrete, treatable entities, such as anxiety, depression and various psychological disorders.
Once this kind of thinking becomes embedded, it can become institutionalised in healthcare to the point it reinforces, rather than alleviates, the presenting symptoms. The medical model of psychological distress comes to the fore here, with conceptual difficulties arising whenever we accept the permanence of a label.
For example, as soon as we accept ‘schizophrenia’ or ‘bipolar personality disorder’ as labels for diseases in medical terms, we can become bound by largely unhelpful, fixed definitions. One person’s experience of ‘schizophrenia’ may be totally different from the next person’s.
This is the fallacy of diagnosis, as pointed out by clinical psychologist, Mary Boyle: “The problem with language is that it confers on these concepts a permanence and solidity which is quite unwarranted, and suggests they are entities possessed by people.”
Beware the label
Unfortunately, diagnostic labels tell us nothing about a unique individual, or their personal struggle to come to terms with the difficulties of their situation. Such labels merely pigeonhole people in a way which obscures their true worth, making us unable to hear a story that needs to be told. Ahead of his time, Carl Jung, the Swiss psychiatrist, believed that a correct diagnosis could only be made at the end of treatment.
Rather worryingly, the mere presentation of symptoms, such as hearing voices, can gain one admission to a mental health hospital. Some fascinating research by Rosenhan enlisted the help of eight researchers who posed as ‘pseudo patients’ hearing voices which seemed to say ‘empty’, ‘hollow’ and ‘thud’. Apart from this they behaved perfectly normally.
Nevertheless, they were all diagnosed as schizophrenics, except one, who was diagnosed as a manic-depressive. All were admitted to hospital immediately. Having used professional subterfuge to gain admission, they then began the process of trying to get out again. This proved far more difficult than expected. Their average stay was 19 days, with one forced to stay 52 days before being released.
When they asked doctors to be let out, they were typically ignored. The doctors and hospital staff simply carried on with their business. It would appear that an ‘unhealthy’ label can create huge problems, even for a healthy individual. Once a label has been assigned, it is difficult to shake off.
This finding is consistently borne out by other research. In an experiment by Yale psychologists Able and Langer, a video of an ordinary man being interviewed about work was shown to psychotherapists. Half the therapists were told the interviewee was a ‘job applicant’, whilst the other half were told he was a ‘patient’. The therapists themselves came from different training backgrounds. Half were from a more traditional background; half had been specifically trained to avoid the use of labels.
Able and Langer found that when the man was called a job applicant, both groups of therapists tended to see him as a well-adjusted individual. When he was labelled a patient, the therapists trained to avoid the use of labels continued to see him as well-adjusted. However, many of the other therapists saw him as having serious psychological problems.
What are the implications?
Just for a moment, reflect on the findings from these two pieces of research, and the implications for the whole mental health sector. It was relatively easy for the researchers in Rosenhan’s study to gain admission to a mental health hospital. Once inside, it was difficult for them to persuade the health professionals that they should be released, despite being in possession of a sound mind.
From Able and Langer’s experiment, we know that the mere use of the word ‘patient’ can encourage a far more pathological view of someone’s behaviour (if therapists haven’t been trained to avoid the use of labels). There is a real risk, therefore, that a mental health diagnosis can ‘trap’ someone experiencing psychological difficulties, especially if that person colludes with the diagnosis. The more someone believes in the label attributed to their difficulty, and the more it registers with them as a fixed medical condition, the harder it is likely to be for them to change.
Labels also seem to prevent a mindful appreciation of all the sensory, perceptual information available to mental health professionals. If, for example, therapists aren’t trained to collect more information – the personal experiences, situations and relationship dynamics a person faces – they will likely miss a hugely important chunk of personal information. Beyond a person presenting symptoms, there is a rich, underlying narrative to explore. In difficulty, we may all present psychological symptoms, but we should never be left at the mercy of diagnoses which leave ourselves wholly identified with those symptoms.
A diagnosis of ‘schizophrenia’ or ‘bipolar personality disorder’ can potentially serve to embed a person within a framework of institutionalised care. If a diagnosis is confirmed, then cemented, in both the mind of the affected person and the mental health establishment, it can play out in detrimental ways for all concerned.
The labelling effect of a diagnosis has the potential to defeat the primary aim of helping someone recover to relative wellbeing and happiness.
Optimism for the future?
In the US, the tendency to use labels for mental health problems is likely to be exacerbated by the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), approved by the American Psychiatric Association. Excessive eating just 12 times in three months is now defined as Binge Eating Disorder. Normal grief has been packaged up as Major Depressive Disorder. A child’s temper tantrum is now called Disruptive Mood Dysregulation Disorder. These so-called disorders, with their roots in diagnostic hyperflation, are steering us down the path of over-medicalising what often falls within everyday human experience.
We can only hope that more critical thinking, and a new generation of mental health professionals, will be better able to respond to the challenge of understanding the human being behind the symptoms, labels and diagnoses still so prevalent.
The mental health establishment, in the UK and abroad, will also need to follow suit in refusing to accept mental health diagnoses at face value. Such diagnoses threaten to do more harm than good.