In March of this year, Leah Harris published a wonderfully thought-provoking article entitled Why We Must Strike the Terms High-Functioning and Low-Functioning from Our Vocabulary. It clearly describes both the limitations and potential pitfalls associated with labeling, and how this can lead to long-term negative outcomes. Often in my office, I am asked to provide such labels, especially for children who have been diagnosed on the autism spectrum as parents and others try to gain some understanding of what to expect from them now and in the future. But as noted in the article, I also feel that the question is fraught with complications, the first being that we all operate on so many different dimensions that it is impossible (and incorrect) to simply categorize a person in one term. Human beings can’t, and shouldn’t be equated to a simple descriptor, as we are a constellation of so many parts that make up who we are continually becoming. I appreciate Leah taking the time to flesh out all the different ways that functioning designations such as these can go wrong.
But since this article was published, I have found myself coming back to fundamental questions which still loom about the topic of labeling and stigma. The first is the topic of labeling itself, and the often asserted notion that labeling is bad and automatically results in stigma. I think that this belief, too, has its own pitfalls. Historically, there have been legitimate reasons to label and describe particular behaviors, including for the purposes of communicating more efficiently/effectively or providing an ability to research a particular trend. Not all labeling is sinister by nature. Some actually has, and continues to have good intent and outcomes. Just as words and weapons can be used for noble or abusive means, so labeling a particular behavior or conglomeration of symptoms can be done (or result) in positive or negative circumstances. I realize that many reading this may feel angry at the positive possibilities of labeling as they have experienced it in a negative way, but I think it is important to recognize that an alternative outcome can exist.
One of the benefits to providing a label for symptoms that are significantly distressing or impairing is simply to designate that there is a clear need for assistance. Leah and others in her article embrace the idea of the neurodiversity movement, where all experiences and behaviors are seen as part of natural, variation in the human genome and not abnormal or impairing circumstances. In theory, this sounds like a kinder, gentler way of perceiving what happens to all of us. In some ways, I agree that all that we do is part of the variation of the human experience, no matter how far off the “normal” or “healthy” pathway it may be perceived to be.
But there is at least one serious hiccup to this movement, in addition to my concerns previously expressed about how this provides a confusing landscape for teaching what is healthy and/or normal in order to provide for well-being. It is the matter of how we know who needs assistance and who does not, and then the authorization to provide resources for those who do. This was passionately, even angrily, articulated by the first commenter on Leah’s article, who stated:
“The neurodiversity movement is hurting those of us who genuinely are debilitated due to our autism. Do you even care about that? Not to mention that those of us who are debilitated by our autism need to be able to use the descriptor “low-functioning” so that we can get the supports we need. Without that descriptor, there’s no reason for anyone to think we need any help or support at all. Again, do you care about that? It seems to me like all you care about are autistic people who aren’t debilitated and who can function independently. Well, from an autistic woman who struggles daily with social anxiety, depression, hypochondria, and general anxiety disorder (and yes, all of those conditions were professionally diagnosed), and who can barely work as a result of all of those conditions, I’m not going to stand for that.”
It is a serious concern. There are many people who desperately need and desire help for conditions that have nothing to do with stigma or labeling, or cannot be accounted for by the social model of disability. There is no doubt that societal and cultural factors bear much responsibility for what happens to individual human beings. But I think it is a stretch to state that these factors are the main contributing factor to disability, as all kinds of societies see similar problems even if to varying degrees. I see this most in the families I work with who have a child diagnosed with an autism spectrum disorder (ASD), whose children often struggle significantly with a variety of basic skills that impair daily functioning even when all available resources and consideration are provided. Along the issue of stigma, too, it is interesting to note (for better or worse) that more parents of today (who come for an evaluation regarding ASD) are surprised, and even frustrated, when the diagnosis is not given than when it is. This in itself, though, is a discussion for a later time.
But the other position that often gets promulgated unfairly is that stigma is a one-way street. So frequently I see articles that suggest that a label given = stigma. Although I again realize this is a delicate, emotional subject, I think that simply suggesting that labels (and those that use them) are responsible for stigma is like suggesting a clinician providing a treatment is always responsible for negative outcomes. Certainly, treatments can be inappropriate, misused, or altogether ineffective, but we all understand that there is a bidirectional relationship that exists. Simply put, for every action, there is a reaction.
The same applies with labeling. I know many who have received a diagnosis, and have seen it as an empowering, freeing idea (again, for better or worse), in that they no longer feel solely responsible for their deficiencies or struggles. I know parents who have felt relief in understanding that a child’s problem-solving skills or even overall IQ was less-developed than his or her peers, as it helps validate confusion and reduce blaming about why repeated instruction of various natures was not having the same impact as it did with another one of their children. I believe that what we do with the labels given is just as important, or sometimes even more important, than the label itself.
Recently, a family friend by the name of Michelle Krack wrote a memoir of her struggle with Bipolar Disorder, aptly labeled Michelle May Crack. I admire her greatly for telling this story of intense struggle and resiliency, especially as it included difficult details about her childhood that most would not have known. On the inside of the book I purchased from her, she inscribed to me, “Make a difference—Beat the Stigma” as she has certainly dealt with much of it over her life. When I read this, something about the statement struck me, immediately arousing the question, “Just what are the best ways to stop the stigma?” as it certainly wasn’t just the label for her that led to many problems. It also led me to consider just how we often speak of stigma, as if it is almost a living, breathing organism itself that flows throughout our land. But of course, we all know that stigma is really an intricate composite of individual experiences and reactions over time, each that presses an individual into difficult, uncomfortable decisions and circumstances. Ultimately, it seems that stigma manifests itself most when fear and embarrassment (understandably) leads to a condition of low worth and feelings of powerlessness and/or isolation that persist over time.
But in order to counteract stigma both on an individual and societal level, we have to be honest about all of the parts and people involved in its creation. And that’s where I hope this article leaves off, and encourages many others to begin. Otherwise, I worry that the discussion of stigma and labeling risks becoming another sound off, and not a truly informative and dynamic conversation about all the factors that should promote labeling when it is needed and necessary, and either remove or neutralize it when it becomes detrimental. It seems we should spend as much time identifying (and teaching) factors that facilitate resiliency when labels are given as we should in reducing labeling in the first place. As mentioned in prior articles, I prefer minimizing the use of labels whenever possible in my own practice, but sometimes I believe that descriptors and even diagnoses are warranted, and even can be useful. Certainly there are many pieces in this human puzzle, all of which play an integral role in perpetuating the common good.
I will end with Leah’s conclusion. She said:
“Imagine what would happen if we began to have some respect for the varied ways that people do their best to adapt and function, sometimes with amazing creativity, in a deeply dysfunctional world? I would like to see us cease to blame or shame individuals for their level of functioning in society, and instead work to create a more equitable and just world that meets our basic human needs and human rights.”
It is a beautiful vision, only made more beautiful by one additional idea:
“Imagine, too, that all of us could better understand what role we played in our struggles and shame, and that in truly acknowledging what these might be, we would valiantly strive to overcome internal obstacles in seeking out the best possible alternatives for ourselves and others, even if many did not agree with, or value us, along the way.”
What a truly beautiful world it would be!
Thank you for this. I, too, do evaluations for ASD, but in teens and adults. Those I work with had their diagnoses missed and had been given a multitude of other labels. The autistic women, in particular, are often missed because they learn to mask their symptoms. Invariably in these cases, receiving the label of Autism reduces the stigma. It provides community, understanding, and a new sense of self that defeats the shame of having been blamed for being different for, for some, a lifetime.
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James: respectfully- I was dragged to Springfield Hospital in March 1989. When my daring escape was foiled I was summarily gang tackled put in a choke hold dragged to the isolation room, straight jacked to a bed shot full of Thorazine and left to defacate and urinate on myself. Later I was put in lock down mode trundled off to a near-by hospital and forced to undergo I suffacoting claustrophobic inducing Cat scan in order to locate a non-existent medical problem. More than a little punchy after all of this treatment I was discharged at the height of this anxiety inducing experience. Yes, I had one flat
Out panic attack shortly upon my realease as my mom and me tried to ply the crowded
Streets of DC.’After a harrowing trip of my mom’s non-driving skills we landed back in Wva. Where upon I settled an old score
With the neighborhood bully, where upon I was trundled off
To the Trans Allengheny Lunatic Asylem where I was left to rot with a thirty days to life situation.’Upon my release,’I retreated to my bedroom where upon I conteplated suicide.’after about a month of this in got my bearing and got
back in the saddle and completed
A bicycle race after seven weeks of training. 44 miles at the same time as
the peloton.
This was September 1989. After much haggling, I was finally placed in vocational rehab in March 1990.’I was separated from the lithium as it was at the nurse’ s station. I was unable to reach the desk at the specified time.’The withdraw did indeed leave me a
Little punchy. After about a month of
bouncing around town, my mom had me committed to a private
Hospital for three weeks I was then transferred to a community crisis
Unit where upon I finished my sixty day sentence. Upon my release into the community, I was first placed into a group home and subsequently given my own apartment
With a roommate. Diagnosis Manic Depression which morphed into Bi-polar
affective disorder with get this an Axis
II diagnosis form Narcism. By this time they were hitting with a stronger battery of drugs which slowed my hour speed on a
Bicycle from around 25 mph to around 23.5’mph. During this 15 month process
I was subjected to what amount to AmSpanish Inquisition and the ever helpful Rorscact (sic) test.’fast forward
to today.’I have
Whittled my psych drug intake to 1’mg of Zypreza and .5′ Klonapin.’I take
A
Small dose of blood pressure medication-I am currently about 20-25’lbs.’above
My fighting weight. At 54 I can still go toe to toe on the basketball court with inner city
kids at Job Corps,’and beat the foster kids to the top of the hill.’Oh did Immention that the Lithium damaged my thyroid and kidneys and that upon my
release in 1990’that I chanced upon a glimpse of my release papers (chronically
mentally ill).
Any way I have not consulted with my psychiatrist for 25′ months. In order to mollify my
wife’s concerns about my sleeping patterns,’i got myself penciled
In to see the psychiatrist’s nurse practioneer.’Where upon I put every one on notice,’that should anyone from the psychiatric profession come out me side ways’its going
To be WWIII. I have been compared favorably to Paul Westfall on the basketball court,’back in the day I was the Eddy Mercyx of the local
Vandalia Velos bicycle club,’and when it comes to urban guerrilla warfare,
Che Gueverra’s got
nothing on me. Keep your eyes peeled on old WVa, it’s going
to be one hell of a bumpy ride up ahead. The long and the short of it is that the APA
Went and messed with the wrong hombre-Ps the psychiatrist just refilled my Zypreza
prescription without an appointment.
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Before I fell into the system and was a licensed post grad Social Worker I would have agreed with your thoughts. To me labeling was away to get needed services. It still is. It is also or should I say was helpful to use to describe someone without going into a full blown narrative. I think I can honestly say I did this without prejudice. I don’t like labels anymore. Having been on the receiving end I now know why so many of troubled by it. There is nothing worse than describing yourself with a labeling and having an old friend who hasn’t talked to you in awhile change their tone of voice and eye contact. I have lost friends and the quality of the relationship due to my time as a self labeler thanks to wonderful NAMI propaganda.
You truly have no idea.My son could have tons of labels but he has rejected them and at times rejected what could have been great supportive services. So far he is doing well and I think he may make it – slow going as it is for him.
I would strongly suggest that those who are fine with labels take a three day immersion trip to a town not known to them and take on some labels and use them during that time.Own them and see what happens.
Patronizing talk and insincere niceness will happen.
Even just the term disabled can bring stigma in our society.
I would posit that now it is like all the hard work of the disabled civil rights movement has been washed down the drain. Fear has risen and risen – strongly supported by the media and other interests. Until we can all own own our brokenness as human beings
things will continue to be difficult.
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The author of the article writes of symptoms and conditions as being justifications for labels . Thus beings discrimination. That sets up the stereotype for the label. The is the stigma. Disabled. Thank you CatNite.
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should end with “There is the stigma.”
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James, wow, talk about an attention getter. These issues are my main focus of thought when it comes to our health and well-being as related to social ills and relationship dynamics. I agree with CatNight, down the line.
I actually lived fine with being labeled with a diagnosis for a good long while, almost 20 years. I went with it, managed it with medication while functioning well in society, accepted it was my reality and not really a big deal. The idea of ‘mental illness’ was never scary or off-putting to me. I though it was part of society, an experience that some humans had in life.
I wrestled with my demons like anyone else, but my life was fulfilling, socially and professionally. In short, I was indoctrinated into the norms of society, like everyone around me at that time. I wasn’t aware of stigma, not part of my experience at that time.
It was when I went to grad school to study psychology that this changed. I disclosed as usual, never had an issue doing so in the past, thinking it would enrich my education to have had this experience for most of my adult life while studying psychology in depth and doing my MFT training.
Instead, my information turned on me, and the issue was STIGMA, pure and simple. One professor, in particular, kind of persecuted me after I had disclosed, which I ended up reporting. For no reason other than his own prejudice, he made my life hell for a while in grad school, totally needlessly, from his ego. He had something up his bum, and it came in my direction, after I had disclosed to him, where I had thought it was totally safe to do so, should have been, more than anywhere.
From that point forward, the stigma undermined my life in ways that would take an entire book to describe (maybe one day).
The stigma from the labels is harmful and toxic, because it seems that people associate all sorts of myths and propaganda with them, especially these days. And it is aggressive, definitely energy-draining. So really, there is mass education to be had, here, but I’m not sure who would give this education. Seems there is something for everyone to learn, in this regard, so perhaps life will teach us where to go next.
These labels represent a cultural mindset that is false and prejudice, totally dualistic. Blatant stigma is oppressive because it is inherently discriminating. As CatNight suggests, try it on for size where no one knows you, and you will feel it in your heart and spirit, and it will disorient, confuse, and gaslight you, lowering your capacity to focus and function as usual.
The only way I learned to overcome this is to stop participating in the norms of society, and not buy into any of these illusions any longer. I know better now, because I awoke to all the double binding and gas-lighting that is involved with psychiatric diagnosis. It is mental torture to awaken to the internalized negative programming which has been defining us until we awaken to who we really are, way outside of any of this.
Going outside social norms guides us to our selves, and to a new and improved society.
You may feel that labeling with a diagnosis is a neutral action, and at one point, perhaps it was more benign than it is now, at least seemingly so. But these days, that is not the case. This diagnostic system does not work specifically because we, as a society, have stigmatized (think negatively about) the entire notion that we just may not be perfect after all. Regardless of how sensitive we are to this and how neutral we may feel we are, the preconceptions are felt, because the education is misguided.
True what you say, that we are all responsible for what we create in the world. There is no us vs them. That is the biggest illusion of all. When we see past the illusion of separateness, stigma will end, because when we dish it out, in turn, we feel it. And it is a truly horrible feeling, and undermining to a person’s active participation in society. It is marginalizing, inherently, and dehumanizing. That is not aligned with the cause of ‘unity.’
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Hi Alex & CatNight,
I greatly appreciate your time in responding, and as I noted in the article, I realize this is a very difficult and often divisive topic. Obviously, I do agree with many concerns voiced about the potential negative outcomes regarding labeling, especially when it comes to a diagnosis. I realize that many people (consciously and unconsciously) have negative reactions immediately upon finding out about a diagnosis, and this really concerns me especially as a father myself.
But there still remains real challenges with this. If we remove the issue of a diagnosis for a second, it still is clear that most communication involves some type of labeling. If I described you “down” or “sad”, this remains a label – and no matter how it/when and for how long it was used, the person remains labeled, and then the question is what becomes of it? Clearly, the DSM system is fraught with huge issues, and likely any system will always be although we should all advocate for something much better. But in the meantime, I think there are many ways people can be empowered and taught how to respond when people negatively evaluate them on the basis of perceived labels that could make a huge difference in their quality of life.
There is another side to this. When a person’s weight is above the 95th percentile, they are labeled as obese by the medical profession. When their blood pressure is 140/90, they are labeled as hypertensive. I wonder. Should these labels exist? Do these labels result in stigma? Obviously, we all know that these two issues are not purely physical by nature, but often significant psychological underlay.
I say all this in knowing that the answers are very complex, but I do feel like one of the best ways to combat stigma is to not necessarily throw all communication out that involves labeling and descriptors (as eventually ANY word can come to have a negative connotation if used long enough), but to really empower those who have been given the labels to disprove the faulty assumptions of those they encounter. It seems only then, when a person is face to face with their own humanity, and realizes that their judgments have been unfair and even wrong, does the grip of stigma start to lesson its tight hold. I say this largely because I have seen it happen before, and even experienced it myself and seen what a difference it can make.
Thanks again. I always appreciate the time spent to discuss subjects such as these.
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Thanks for your thoughtful reply but I strongly disagree. I would have written what you wrote as an experienced clinician in my thirties and and early to mid forties. Then life took over and I have changed my thinking.
When your life literally runs out of control with disease,multiple deaths,
betrayal, and bad luck your whole view of life changes. It is quite apparent
that you have not run into this yet. May you not!
I could write a treatise on language based on the social sciences Chomsky et al philosophy Wiitengstein et al and the literary theorists ie Larcan et al
and none actually gets at the personal experience of language as stigma.
I was always taught when and if you are in any disabled it is up to you to change the view of the other. I have found out that to be an utterly false expectation when it comes to emotional issues even in the almost stigma neutral ASD community.
One cannot alleviate a person’s fear of the different other. There is a two channel methodology n all of this as well. Not only s it the person on the street fear a person with a mental health history has to negotiate but the general tune and attitude of the service professionals.
This happens to all patients regardless of the their disabilities. Inflections count!
My daughter observed this at a prestigious medical facility with her internship. As soon as a medical professional would walk in the patients room her or his speech pattern would change.
I was taught and I taught my children to treat everyone they meet as an equal. This can be taken advantage of at times but more often then not it works to enhance connect between you and another human being.
If you talk to the service professional elders you will see what I mean.
Some were taught not to talk down to folks. There are times when I miss the old fashioned way of addressing patients. It did help to give dignity where sometimes it was hard to find.
I also think that there are other vocabularies that can be used then the DSM% and others of that ilk. An ISP does not need a label just goals and objectives period.
It is the insurance companies and others that have professionals like yourself backed into a corner with the only way out is thru pursuing a path of unpleasant change. I chose to leave my field.
and philosophy,
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CatNight, Alex, and James, Wow! You all have so much to say. (I haven’t read the rest of the posts yet.) One thing I’d like to suggest — let’s do away with the term “stigma,” and replace it with “stereotype.” “Stigma” seems to me to be a form of lingo or term reserved for those involved in the mental health system, and movements. The public understands the meaning of the word “stereotype,” which not only is much more descriptive a word than “stigma,” it also is used for stereotyping any group of people, based on personal prejudice (pre-judging). I’m told that the discussion of these two words is already starting in the mental health community.
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Maybe what you are saying is true but doesn’t this also become an excuse for bad… evil behaviour ?
I mean broken down the practicioner is essentially saying “it’s ok that I messed this person over because it made them stronger, so it’s good and i’m good”
I personally have a real problem with this kind of thinking. Maybe adversity can be good for a person… maybe life isn’t fair but if you’re setting out to prove it … how can you really know it’s the right thing to be doing and how are other people not supposed to assume you’re just a bad person ?
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Not all labels are created equal. This is a perfect example of a false equivalency.
“There is another side to this. When a person’s weight is above the 95th percentile, they are labeled as obese by the medical profession. When their blood pressure is 140/90, they are labeled as hypertensive. I wonder. Should these labels exist? Do these labels result in stigma? ”
If you are labeled obese is your opinion negated? Are you deemed incapable of thinking for yourself? Is it felt that you can not make basic life conditions? Are you greeted with fear and suspicion?
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Regarding obesity, my guess would be that while you would be seen as being able to live independently, all the other negative labels would apply.
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And in both cases mentioned, there is at least some objective measure being used to determine when the level of “obesity” or “hypertensive” is reached. While these levels are somewhat arbitrary, they can at least be argued about, objectively researched, and treatment can be determined to be effective/ineffective based on these measures. No such objective measure exists with psychiatric labels. They are entirely at the discretion of the labeler, and the label-ee has no logical way to disprove or modify the label they have been assigned, other than to find another “professional” to disagree with the first one. And research becomes confused hogwash, because people are arbitrarily lumped together who have little to nothing in common besides their emotional reaction to whatever has happened to them.
All labels are definitely NOT created equal!
— Steve
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Hi James,
I also have mixed feelings about the concern for labeling and stigma expressed here at MIA. Is labeling really the problem? People used to be labeled “type A personalities,” for example. This might have been a little silly, but it didn’t really harm anyone because no one developed type A personality drugs and convinced people that they had “type A disorder” and had to take type A drugs for the rest of their lives. I don’t think that banning all labels and saying that nothing is dysfunctional is a tenable position. Any real understanding of mental problems has to come with labels, it seems to me. “Procrastination”, for example, is the name of a common dysfunctional behavior that is recognizable in many people in many different circumstances. Even though I think it is very unwise to treat procrastination as a medical problem, I still think that “procrastination” is a useful term and a real thing in the sense that everyone who is procrastinating is basically doing the same thing, independent of social forces and their particular life circumstances.
Another aspect of the concern for labels is strongly focusing criticism on the DSM. To me, this is very justified criticism, but, still, don’t the greater harms come from the actual treatment guidelines like this one?
http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
Could it be that these guidelines are why PCPs prescribe psych drugs so freely and not because they are influenced by TV commercials or drug company perks? To me, the greatest sins are of psychiatry are harming patients very severely, gross institutional and scientific corruption and pretending to understand things which are not understood, in that order.
I’m also concerned about the anti-stigma concern! Just a few days ago, I saw a giant (more than six feet tall) advertisement at a bus stop here in Boston:
http://bringchange2mind.org/wp-content/uploads/2015/01/BC2M-PSA3-Print-Campaign_FINAL.jpg
The web site shows a spontaneous gathering of color coordinated citizens with a giant sign “IMAGINE IF YOU GOT BLAMED FOR HAVING CANCER”
http://bringchange2mind.org/stories/read-stories/
Is this concern for the harms of stigma or is this an effort to perpetuate the medical model via the unspoken assumption of the site (mental problems are medical problems, like cancer) and to encourage people to admit that they are biologically damaged and need to get the usual treatment?
– Saul
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Well spoken, Saul. It is always interesting that the pro-label, anti-stigma campaigns always seem to equate a lack of support for labeling with blaming the sufferer. How is this the truth? In fact, the psychiatric labeling process itself is a study in blaming the victim. You are not suffering because of poverty, or childhood tramatization, or an unknown infection, or being part of a bizarre society that expects unreasonable things from its members, or worrying about a world that is being ecologically destroyed when there is little or nothing you can do about it. Apparently, you’re not ever supposed to get upset about ANY of those things, and if you are, well, you’re “mentally ill.” I once said to a psychiatrist that PTSD is clearly caused by trauma. He said, “You can’t say that, because not everyone who is traumatized develops PTSD. There must be something about that person’s brain making them react differently.” As if there is a correct way to respond to trauma, determined, of course, by psychiatrists and their associates, and anyone who reacts in the “wrong way” has a mental disease!
That’s my main objection to labels – it subverts the process of actually understanding what is going on. And I agree 100% that the purpose of anti-stigma campaigns is mainly to normalize labeling and psychiatric drug use among the population, even though the research shows that the very process of labeling increases the very stigma they are supposedly opposing.
Follow the money…
—- Steve
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I agree, Steve, and you pointed out some important realities. And mine is a tale of concerns of the abuse of my child, and a bad drug cocktail given to cover up a “bad fix” on a broken bone, being misdiagnosed as “bipolar.”
I found that stigmatization, and the drugs given by psychiatrists based upon this stigmatization, highly harmful. Thankfully, the medical evidence of the abuse was eventually handed over by some decent nurses, and I found an oral surgeon who was smart enough to admit “antipsychotics don’t cure concerns of child abuse.” And this medical statement, of the blatently obvious, was enough to finally wake up my fifth psychiatrist, who took me off the drugs out of embarrassment.
It was a tremendous problem getting the stigmatization off my insurance records, particularly, my children and I had to go without insurance for years after my husband’s untimely death. We weren’t insurable until Obamacare. But I did find decent doctors were able to recognize the obvious malpractice once I pointed it out to them, despite the “complex” nature of the iatrogenesis. My current doctor called me “one in a million” at my last physical, because the student he was teaching during that physical was so impressed with my knowledge of medical terminology.
But the psychiatric industry seems to have a really big problem understanding their antipsychotics don’t cure real life symptoms of child abuse or ACEs in general, according to John Read’s research, too. Since his research shows two thirds of ‘schizophrenics’ are people suffering from ACEs or child abuse, who were likely misdiagnosed with psychosis, leading to a neuroleptic prescription.
And the neuroleptics are known to cause both the positive and negative symptoms of schizophrenia – via both the central symptoms of neuroleptic induced anticholinergic intoxication syndrome and neuroleptic induced deficit syndrome, and perhaps more ways I’ve yet to find.
And when the most common trait of all schizophrenics is untreated child abuse or ACEs, meaning lots of abused children are being mislabeled with psychosis, then turned into schizophrenics with the neuroleptics. We have to step back, as a society, and ask ourself, is it truly in society’s best interest to have stigmatizations which are primarily used to cover up abuse of small children (and easily and complex iatrogenesis)? Thus, of course, also allowing the child molesters to stay on the streets, committing their crimes over and over again.
I guess my main point is all stigmatizations / labels are not created equal, and I’m quite certain we need to start looking outside the stigmatized person’s brain for the most common traits of people who have been stigmatized with each scientifically “lacking in validity” DSM disorder. And decide, is the label actually benefitting, or harming, our society in general.
In the case of the bipolar / schizophrenia labels, I’d say they’re not actually proving to be labels that are resulting in positive outcomes for those so stigmatized. And I think our society should go back to arresting adults who harm and rape small children, even if they have a lot of money, instead.
But I do also know parents of autistism spectrum children, who are allowed to say no to the toxic torture drugs, but are getting services for their low IQ children, thus greatful for the label.
Some labels aid in getting benefits for children with special needs, some labels – like bipolar and schizophrenia – actually are just iatrogenic stigmatizing for, in most cases according to the actual medical evidence today, paternalistic, abusive and / or inappropriate reasons.
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But why should they need to be labeled to get necessary services? I have issues with that concept.
And I agree, the labels are often used in a way to let the real perpetrators of harm in our society off the hook.
Why do we bother spending so much time and money on genetic research, when decades of research have given us, at the very best, a probability distribution of genes that MAY be involved in at most 15% of the origin of “mental illness,” when we KNOW that 85% or more of “mental illness” is associated with trauma and childhood abuse and neglect? It only makes sense if your strong interest is to direct attention away from the very common causal factor and toward something that is more comfortable (and profitable) for those in power to attribute as a source. The fanatical dedication to finding genetic causes to these “disorders” says a huge amount about the real purposes of psychiatry as a profession.
—- Steve
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Steve,
I’m not saying I personally agree with the need to stigmatize in order to get needed services, just that I know other parents that don’t mind having their child stigmatized, since it allows them to get needed services.
But I personally agree with you. And I’ll mention, since “we KNOW 85% or more of ‘mental illness’ is associated with trauma and childhood abuse or neglect.” And the psychiatric industry has found no genetic bio markers for any of their so called “mental illnesses,” after God knows how many billions of dollars has been wasted into genetic research.
And it’s my understanding from an ethical pastor who confessed I’d dealt with “the dirty little secret of the two original educated professions.” Which is that the the primary function of the psychiatric industry, historically and apparently still today, is covering up child abuse for the religions and easily recognized iatrogenesis for the incompetent within the medical community.
Which means it is highly likely that the 15% of patients not dealing with trauma, ACEs, or child abuse were likely dealing with incompetent and unethical doctors who gas lighted and railroaded the patient into the psychiatric system to cover up easily recognized medical mistakes, to avoid a potential, but legitimate, malpractice suit.
No more genetic research needed, and the real purpose of the psychiatric industry is to unjustly protect unethical and incompetent religious leaders (or others with “zipper troubles”) and doctors.
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James,
Another problem is that diagnoses tend to promote the idea that whatever the person is labeled with is a distress-condition or impairment-state that will persist relatively indefinitely or for life. That may not be intended, but it nevertheless understood that way by many people under the medical model terminology. This is, to me, what is “done with the labels” that is so problematic; the background of pessimism and negative prognostication and long-term disability associated with the terms. Perhaps that is something that can be better clarified if labels are to be used at all.
I also noticed that your article only noted what I’d consider relatively less stigmatized labels, e.g. autism/anxiety/even bipolar (although these still do have stigma). I think some of your arguments would have run into trouble if you’d started discussing schizophrenia or personality disorders, which were not mentioned.
Maybe there are some people who have found it “empowering and freeing” to be labeled schizophrenic or personality-disordered by their psychiatrist – have you met any of them?
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Yes bpdtransformation and Alex too! I had no knowledge of recovery when I started having episodes of altered mental states first fragments and then it eventually overtook me despite how hard I tried to keep it all together. If I had known this could have been merely episodic, that harsh meds were not the answers, that recovery was possible I would have fought the whole diagnostic thing much harder and spoken up more and researched more. Ad far as my husband thought there was no hope except the wonderful ER and meds.
Luckily for me I did keep and find friends who were open and supportive, I did have a grandmother who was a teacher who knew the problems with labeling students.She personally saw it happen in the classroom.So there was enough of a background in me to keep on trying to figure things out. It took much longer than I would like to admit. Lost years literally.But if I was treated as a person embroiled n traumatic events beyond my control with just time and work as journey to recovery everything would have been so so much easier.
Sinead O’Conner has just found this out.
Maybe we need an Anti DSM5 book
with labeling of various recovery states?
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I write this as a woman with a significant physical disability and the resultant emotional challenges that go along with that.
When seeking help navigating the emotional impacts while distress I have received different diagnosis from each psychiatrist I’ve seen. (never get to see the same one twice) I’ve been labelled, depressed, paranoid, bipolar, borderline and suicidal. Those labels are part of my permanent medical and mental health records for the rest of my life viewable by anyone in my circle of care. I have witnessed new doctors read my chart and seen their faces change. These labels are garbage. These labels have irreparably harmed me, my reputation and my credibility and not provided me with any benefit. I am viewed as flawed or dangerous and needing to be drugged. In Canada there is no requirement for a psychiatric label in order to receive counseling or services unlike the states.
Yet when I tell people I have a diagnosis of MS and need a foot brace or a cane the diagnosis is useful in helping me get what I need. MS is not dangerous, threatening or a reflection on my character – there is a lot of discrimination in employment and such but not in getting medical services.
Psychosocial labels are too often inaccurate and inflammatory and wildly unscientific – they feed the stereotypes that harm innocent people seeking relief from psychic pain. Until that is fixed you can take your positive benefits and put them where the sun doesn’t shine.
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Well put, MCC. No way I’m getting out of this lifetime without the dark cloud of those labels (I used to call it “dart board diagnosis”) hanging in my wake. They have never been useful (to me) and have only served to make me feel totally screwed up. Now that I’m finding my way out of the psych drug tar pit and starting to realize food and chemical sensitivities (plus childhood trauma) and some other unique individual qualities are underneath all this, I’m pissed, too. I’m all for the label users placing their labels where the sun doesn’t shine.
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Dear James, you write: we often speak of stigma, as if it is almost a living, breathing organism itself that flows throughout our land. But of course, we all know that stigma is really an intricate composite of individual experiences and reactions over time, each that presses an individual into difficult, uncomfortable decisions and circumstances.
I found the ” living, breathing organism itself that flows throughout our land,” more accurate than the “knowing” labels that follow. Which is to say, the notion that we do know the reality of our actual experience, which is, as you say, that of a breathing orgamism, by the words/labels we have learned to use in communication with our fellow beings, are anything more than a symbolized sense of our own reality. From my own struggle to understand my abnormal experience from the inside-out, giving-up the educated sense that reality, especially my own, is a cognitive construct, has involved, not word/label recognotion but “stimulus” recognition and confronting the trauma fuelled impulse to escape into the dissociation of mind, which denys our actual nature.
Life begins with cognitive capacity but not cognitive function and I had to relearn the introceptive capacity which “normals” take for granted, in that gift of forgetting that has fuelled our success as a spicies. Resulting in a 21st century, 1st world, normal adult function which is in denial of its subconscious motivation, as we increasingly use language skills to aid survival.
How will the labelling dillema be resolved when it involves a false paradigm of everday perception, so concisely pointed out by millenia of sage experience? Like R.D. Laing’s intuitive: we are all in posthypnotic trance induced in infancy. While Buddha suggests: words do not describe reality, only experience unveils truth.
In my opinion the current feeding frenzy of medical diagnosis, will be seen in hindsight, as nature correcting our flight into exoteric sense-ability, which now needs to follow the circular nature of reality, back to an esoteric sense-ability.
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It’s a vicious cycle right ? Person gets the diagnosis, gets the stigma, needs welfare to live so then defends the diagnosis.
When it comes to autism, I know there is a movement with it for plain acceptance but if it’s an actual known neurological disorder… I mean it is what it is. Sorry to be blunt but if someone has brain damage or a neurological disorder and society can’t find a job for them then you can get as creative as you like with labels but the actual situation stays the same.
Though ironically the person you quote there in my mind is displaying enough acumen with communication that I would question if they really were debilitated to the point that they couldn’t work in some useful capacity.
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Hi James,
labels and stigma can be beneficial.
For example, I was drugged without my knowledge by my wife and then kidnapped by mental health services. They made an agreement with my wife to conceal the evidence of the drugging from me. Now I understand that this would be enough to give me a label of paranoid delusional. However, given that the documents showed that I had been drugged and conspired against and kidnapped I do not believe this label is valid.
However, when the Clinical Director of the hospital removed the documents that demonstrated this from the documents provided to my lawyers I was once again paranoid and delusional. This benefited them greatly as the trauma from being kidnapped etc now looked like a mental illness that required drugging, with you guessed it more benzos.
Major benefits for all except me
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Oh, and I suspect on the balance of probabilities that the same fraudulent documents would have been provided to the Coroner as evidence of my illness had my suicide attempt been successful.
Complaints process is about identifying what evidence to tamper with, and who tells what lies, before the Coroner gets to make his decision. Just set the fraudulent documents up, and some shill will pick them up and present them to the Courts for you.
Gotta love these guys eh?
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A difficult topic, indeed. I admire your courage for taking it on.
That being said, I think the essay misses the most salient point: psychiatric labeling is unique in being almost entirely BASED ON preexisting stigmatization, while at the same time PROMOTING AND EXACERBATING these stigma in society. There has always been a degree of stigmatization of those who act or think differently than the general population. This is generally based on a genuine fear of those who are different, but has also been co-opted in the past by people interested in manipulating the population, such as the Nazis in WWII and before, or Jaffe and his minions at the TAC.
Psychiatric labels differ from genuine medical labels in that they are almost entirely social constructs, but they are given the weight of medical “science” to cement them as “real” entities in people’s minds. No one is upset when someone says “she’s a cancer patient,” because it describes an objectively observable condition. And while such spurious or sketchy labels as “pre-cancerous cells” and whatnot, these do not carry the social weight of judgment that psychiatric labels do.
Furthermore, psychiatric labels can be used in ways that no other medical label can be. They can provide a pretext for removing children from a parent’s care, for influencing the outcome of a custody proceeding, for incarcerating a person in jail or letting them out of jail or for incarcerating them indefinitely in a psychiatric institution and forcing potentially deadly “treatments” on people against their wills, based merely on the clinical judgement of someone who may be as biased and even hostile toward “people like you” as any unobjective and uneducated lay person could be.
And since these social constructs have no objective basis in reality, they can’t be tested for, so the person who is said to “have” these disorders has no defense. At least if they say your cholesterol levels are too high, they have to identify a number and measure it, and you can argue about what the right number is or do things to lower your number, but at some point, there is a way you can say, “No, you’re wrong, I don’t have what you are labeling me with.” In psychiatry, there is no such recourse.
Finally, psychiatric labeling plays into the ability of the powerful to project their inadequacies and fears onto the labeled subject. I can’t tell you how many domestic abuse survivors have been labeled by the medical community with a psychiatric label, allowing the abuser to use this as an explanation for why the victim is reporting abuse. I’ve seen abusers get someone committed for exactly that purpose, and the psychiatric community almost always seems to go along with it. Moreover, clinicians who have not done their own work are absolved of any need to question their own inability to connect with a client and do useful therapy, because the client can be labeled with “borderline personality” or “bipolar disorder” and we can treat their brains instead of figuring out what is really going on with the client or with ourselves.
Some people seem to believe that saying no to psychiatric labels means saying “there is nothing wrong” with people who are suffering. This is objectively not the case. Lucy Johnstone and others have identified ways to characterize psychological struggles without attaching the stigma associated with being “mentally ill” in our society. Schools can also make provisions for children’s needs without having to label them with “ADHD” or “ASD” or anything else. While these labels can provide a common language for professionals, the cost in terms of allowing professionals to use their power to blame the child or client for the professionals’ inability or unwillingness to be genuinely helpful dramatically outweighs any benefits, in my view.
Social stigma against “mentally ill” people exists independent of the psychiatric profession. Unfortunately, rather than actually working to subvert these stigma by helping us understand that any or all of us could suffer from similar difficulties in sorting out how to live in our modern world, psychiatry has chosen instead to use and build on those prejudices and constructed a system that reinforces that the “mentally ill” are “different” from us biologically and so we can safely distance ourselves from them and leave it to the doctors to fix up their presumably screwed-up brains. There is recent research showing that believing in the biological model decreases empathy and increases the likelihood that “mentally ill” people will be feared and avoided. I am afraid that whatever small benefits may accrue are wiped out by this larger trend. Additionally, this labeling process lets society completely off the hook for creating a system where labeling and disabling language is required before someone is allowed to be helped. A truly compassionate system would not require that you prove yourself disabled before your needs can get met.
—- Steve
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Thanks Steve. You have the the nail on the head in an eloquent way.Always nice to read your commentary.
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Thank you – your appreciation is most valued, as your own incisive commentary is something I always look forward to.
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Clarity provides a beautiful vision. ‘Mental illness’ is simply a denigrating label, a maddening metaphor, a pejorative psychiatric label for the stresses and strains of a person’s life beginning at conception like the different timing of environmental risk factor such as toxins, infectious diseases during mom’s pregnancy and/or trauma; physical, mental, emotional, sexual (allostatic overload, Bruce McEwen, neuroscientist) that a person Unconsciously Reacts To and is simply given a description of that lived experiential life, a ‘diagnosis’ by a ‘professional.’ So What? To continue to call the person ‘mentally ill’ is to be obtuse, be ignorant about the facts, the reality, the truth of that person’s lived experiential life. Maddening metaphors, (addictions, ‘mental illness’) simply compulsive activities, done over and over, again to keep from feeling unconscious pain, traps a person endlessly in illusions, ultimately delusions until I wake up and begin to Consciously Create, Now. The concern- Allostatic overload effects (a person’s) epigenesis Colloquially speaking, Caretakers ill at ease with my original self, my essence inflicted their unconscious unfelt pain on me, a child. And this child developed a metaphorical story to deal with the pain and until I faced the truth of my life, I continued to be a pawn, from which money was extracted for ‘therapies’ that did not work. Yes the insanity, dysfunction of the world was Never about me. So for me No More Hocus Pocus Diagnosis and No More Show the ‘Pros’ my money. I got well Thank Goodness. Kurt E. Wilkens
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Again, I also agree with your perspective, Steve. Thanks for so elequently stating it.
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Great comment.
I’m going to copy and paste it for an anticipated future conversation. Hope that’s OK!
It sums up perfectly the points I was trying to make yesterday with my adult son, who is very enamored with the ‘science’ of ‘mental illness’.
Thanks for your succinct review of *how it is* out there in the current ‘mental health’ system.
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Thanks, and feel free to use this any way you like.
— Steve
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Hi Steve,
Thank you for your taking the time to read, and thoughtfully reply to this subject further. As noted in my article, I do have concerns about the stigmatizing effects of psychiatric labels/terms/diagnoses. I think about this a lot in my role as a child psychologist and a father, and do believe that the continued effort needs to be made with making sure that the labels used are as accurate and compassionate as possible.
In many ways, I agree a lot with what you said and appreciate the real challenges that people face when dealing with these issues. But (and without writing another article), there are a few fundamental differences that you and have.
You stated, “I think the essay misses the most salient point: psychiatric labeling is unique in being almost entirely BASED ON preexisting stigmatization, while at the same time PROMOTING AND EXACERBATING these stigma in society.”
I disagree, although like you, I have significant concerns about DSM and similar labels/diagnoses and feel there is a better way. But, for millennia, long before any the “psychiatric labeling” issue existed in the way it is largely criticized here, people have experienced true psychological symptoms that have significantly impaired their lives and caused tremendous distress, independent of a diagnosis. Reports show up throughout writings of any age. Whether it is someone who has no energy, stops working and eating regularly, can’t sleep, bombarded with recurrent negative thoughts – whether it is tremendous anxiety, constant edginess, repeated fears that won’t end – whether it feeling bugs crawling on their skin or hearing people screaming at them (when neither is truly the case) or believing that they are God or that the remedy to a sore toe is to cut it off. These have been, and remain realities to millions of people, regardless if we use the labels currently given or not. Personally, I believe it is a huge disservice to suggest that stigma and labeling is almost entirely responsible for the tremendous challenges that people have always faced on a daily basis. I worry that this message inadvertently backfires, and renders many people feeling disempowered because what they truly experience is being described as a “social construct” and not something they can change on an individual level.
You also said, “And since these social constructs have no objective basis in reality, they can’t be tested for, so the person who is said to “have” these disorders has no defense. At least if they say your cholesterol levels are too high, they have to identify a number and measure it, and you can argue about what the right number is or do things to lower your number, but at some point, there is a way you can say, “No, you’re wrong, I don’t have what you are labeling me with.” In psychiatry, there is no such recourse.
I again find myself disagreeing with you and other commenters on what I perceive to be a false dichotomy. First of all, many medical conditions (which ironically often have more to do with psychological and social issues than physical ones, such as obesity) carry significant stigma while others carry less, as is the case with psychological issues. People with AIDS, lung cancer, STD’s, lupus, obesity, and many other conditions experience much stigma, and many times over the course of history they have been subjected to treatments or detainments with which they did not agree. In regards to the “number” issue you mention, I think believe this is a misnomer – the statistics used for blood pressure are exactly the same type as is used for psychological measures. The difference, of course, is that one appears “objective” because it is mediated by technology whereas the other is based on a person’s self-report or many other methods. But the more I have learned about the “numbers” in medicine, the more it is clear that much subjectivity runs through this, and the numbers and parameters are always shifting. Regardless, though, at some point, it seems we must acknowledge that the condition of hypertension and obesity actually exists, just as I believe we must acknowledge that depression (or insert word of choice) or autism (by whatever name) is a real phenomenon because all of these in their true form cause serious outcomes if they remain.
Ultimately, I think that my biggest concern with this line of reasoning is that it seems to create a “situation of parts” and divorces aspects of an individual from their whole selves. Again, I recognize that psychiatric labels have caused significant harm and difficulties to many people, but as I said in the article, it is not a one-way street. But, if we keep carving out this issue, and negate a focus on our functioning at a whole, synergistic level, I really worry the outcome is going to be not what you and others desire. Stigma has, and will always exist, at a psychological, physical, social, and spiritual level. IMHO, we should tirelessly work to reduce it on an individual and organizational level, but along the way realize that there is a greater goal to pursue – that is, recognizing ALL factors that prevent an individual with living up to their highest capacity (whatever that may be in the context of the experiences they have had) and in communion with others. To me, anything that detracts from this possibility on an individual and global level should be met with significant caution, but I appreciate and understand that you and many others will disagree.
Thanks for the conversation on a really important topic.
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Dear James, I totally agree with this new post of yours, explaining the issue and reason for labeling. I especially appreciate your verification of the historicity of mental illnesses/symptoms. It’s may understanding that, prior to medications, people with psychotic mania would sometimes pace, sing and other things for days on end, while in a psychiatric hospital until they DIED of exhaustion and lack of sleep. We also have to realize that many people, including myself, have been protected from suicidal thinking, suicidal actions, or suicide. I grew up wishing I were dead. My family had to hear this from me on a regular basis, including my confidante and protective sister, who is six years younger. Thanks to my “label” of depression and bipolar 2 disorder, I no longer have these thoughts. If I understand it correctly, the DSM is based on historic records of symptoms, attempting to collect these descriptions into manageable categories (labels). Although the DSM is admittedly flawed but as you point out so well, other medical dx’s may also be flawed and are constantly “shifting” as you said.
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Sigh… I think you should re-read what I said. I was very careful to say that the removal of labels was NOT the same as saying that people were not in distress or requiring assistance. I quote: “Some people seem to believe that saying no to psychiatric labels means saying “there is nothing wrong” with people who are suffering. This is objectively not the case. ” I am the last person in the world to make such a suggestion. The point I am making is that schizophrenia, for example, is a concept that emerged from social discomfort with people who heard voices or experienced similar odd phenomena. There is no actual evidence that all people with “schizophrenia” have the same problem or need the same kind of help – the DSM itself acknowledges this in its introduction, which unfortunately no one seems to bother reading. Even more to the point, “disorders” like “ADHD” and “Oppositional Defiant Disorder” are clearly based on kids not fitting into the slots that we expect them to occupy, and there is not the slightest degree of effort required to determine why a kid is oppositional or hyperactive before such a label is affixed. To assert that all oppositional children are oppositional for the exact same reason or need the same kind of help is a reductionistic absurdity that has zero factual basis in reality. It is entirely a social construct, end of sentence.
So to re-assert my original point, something like “ADHD” exists because teachers (and many adults) don’t like having to deal with kids like that, and never have. A pre-existing bias LED TO the decision to label “ADHD” as a “disorder” rather than deciding to re-examine how we teach children and why it doesn’t work for a significant proportion of children we encounter. It allows the adults to put the blame on the child and not bother to explore the best ways to help. This is not saying that “ADHD” type “symptoms” aren’t problematic for the student – they definitely can be a big problem! But there are ways to help these kids (and I know this from both professional and personal experience, having two “ADHD” type boys) that do not require us to label them as defective or use harmful drugs to force them to fit into an environment that is not health for them.
As to creating a “situation of parts,” it seems to me that the current diagnostic system is responsible for doing exactly that. “Anxiety” is viewed in isolation from any context, and is “treated” as if anxiety itself were the problem, rather than a reflection of physiological or psychological loss of equilibrium in the person as a whole. As a result, analysis and solutions are limited to what will reduce the “symptoms” without concern for the long-term impact on the larger social context. Hence we have “miracle drugs” that reduce psychotic symptoms very quickly but kill you very slowly, and the symptom reduction is considered vitally important, while the loss of quality of life is denied or trivialized as a sad consequence of “the disease.”
So I agree with your last point of recognizing all factors that prevent an individual living up to his/her highest capacity, but I would assert that psychiatric labels do the exact opposite of this, by encouraging people to indulge in their projections about the dangers of the “mentally ill” and distancing themselves from the kind of empathy that is really needed to take a holistic healing approach.
As to other physiological conditions engendering stigma, this is certainly true and unfortunate. But this doesn’t counter my argument that these are all more objectively observable and falsifiable, protecting someone from false diagnoses, and are also not associated with the use of social force against a person.
Again, I understand that people suffering from anxiety, depression, psychosis, etc., need and deserve our compassion and assistance. I am simply noting that there is nothing about being diagnosed with “Major Depression” or “Generalized Anxiety Disorder” that helps me or anyone else know what to do to help, because the people in these groupings are heterogeneous and are grouped that way for the convenience of our own social comfort and prejudice. When we really dig into these “diagnoses,” as again I’ve had ample professional opportunity to do, we find a huge range of differences and nuances between people who are supposedly suffering from the same “disorder,” to the point that the categories themselves quickly lose any real meaning. They are generally descriptions of things that most people feel are odd or uncomfortable to deal with, and the unfortunate side effect of labeling is that it keeps most people from looking any deeper to find the rich tapestry of context in which the person exhibiting these “disorders” actually lives.
I could go on, though I’m not sure we’ll come to any agreement. But please, do not EVER suggest that because I don’t believe in these subjective and somewhat arbitrary categories it means I don’t believe that depressed, anxious or otherwise suffering individuals don’t need help. It is a very common and frankly insulting insinuation that the psychiatric community inevitably throws at those who disagree with their approach, and it is absolutely, 100% wrong.
—- Steve
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Hey Steve, thanks again for continuing to weigh in. Although we clearly have our differences, I think we actually overlap and agree on many areas.
But before I let go of this thread, I want to hone in on exactly what I was trying to say in my response to your initial post. Most recently you said this:
“To assert that all oppositional children are oppositional for the exact same reason or need the same kind of help is a reductionistic absurdity that has zero factual basis in reality. It is entirely a social construct, end of sentence. So to re-assert my original point, something like “ADHD” exists because teachers (and many adults) don’t like having to deal with kids like that, and never have.”
I and others are not saying that children are oppositional or ADHD-life for the same reason. I agree that some children are this way because different systems (e.g., home, school, etc…) have failed them. I agree (as clearly described in a past article entitled “Addressing the Mental Health Crisis) that many psychological issues exist due to lifestyle factors (e.g., sleep deprivation, poor diet, technology immersion). But where it seems that you and I depart is that I do believe that certain kids, who have resided in highly-functional systems and with good lifestyle circumstances, still exhibit seemingly innate difficulties with impulsivity/inattention or oppositional/antagonistic behaviors that is not entirely a social construct and can’t be blamed on unresponsive teachers or parents.
When you look at the research on early temperament (i.e., from day 1), we see kids really do arrive with different biological driven temperaments – whether it is an anxious/slow to warm up temperament, pleasant, or for a certain percentage, a difficult temperament (in addition to other differences, such as sleep patterns and feeding). Of course, most of these kids will develop and don’t deserve a formal label, but there are those few (and I have worked with them), that despite better efforts, remain either really impulsive/inattentive or significantly oppositional. We should always continue to find a better way, but it doesn’t mean that the reality doesn’t exist.
Again, I agree that diagnostic labels are often used unfairly in the ways you described (which I will address more in an upcoming column). But I do believe that just like every other area of physical, psychological, and social functioning, there are those cases, albeit much rarer than the current psychiatric community reports, in which functioning goes awry even without an environmental, social, lifestyle, etc… explanation. And I don’t think that this should be a far stretch to imagine, as this reality exists for every other area of human functioning.
Anyway, appreciate your interest and passion. And as a father of 5 boys (and 1 girl), I certainly understand how boys are often pigeon-holed into certain behaviors that are not fair in regards to their disposition. I just think that it is important to work from both sides (i.e., what they can do and others can do) in improving the situation.
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I would certainly agree that SOME cases of “Oppositional Defiant Disorder” or “ADHD” occur in the absence of other stressors or explanations. The point, I believe, of the article is to suggest that the labels have some added utility that makes them worth the downside of inappropriate use. That’s where we have the disagreement. Two of my kids, especially the oldest, were certainly oppositional, hyperactive, and intense from birth. Not disputing that at all. But I dispute that this represents any kind of an illness or disability – it was just the way they were. The first, we struggled with mightily. With the younger, 11 years later on, we were a lot smarter and started doing some things early that we didn’t do till a lot later with Patrick. But we adapted to their needs, found schools that worked for them, set up positive disciplinary programs that took their oppositional natures into account, and built on their many strengths. Both got excellent grades in high school, both are now functional adult citizens. There is and was nothing “wrong” with them just because they tended toward a personality style.
I would still maintain that labeling either of them would have been harmful, both because it would provide them with a built-in excuse to feel sorry for themselves and avoid responsibility for their actions, and because those dealing with them would have a built-in excuse if they failed to figure out how to adapt to their unique personalities and needs.
I would also acknowledge that there are people who are disabled severely by their “mental health” problems and who need extended care and who will not succeed in society without ongoing support. Those people may, indeed, be appropriately considered disabled by their mental/emotional condition, but I still don’t see that lumping them together under one vague and subjective rubric does anything but confuse the issue. As with my kids, each and every one of them deserves a full and individualized analysis of what is troubling them physically and emotionally and an individualized plan of action that takes their unique needs and perspectives into account and is driven by their own goals and preferences. DSM labels, in particular, appear to me to impede any efforts to make this kind of thing happen.
I am sure we would agree on many things, but I don’t agree that the fact that people naturally deviate from norms means they should be assumed to be malfunctioning, if only because it makes it way too easy for those in power to dismiss legitimate concerns (like a rigid teacher or a boring classroom or a gifted child) as “mental health problems,” as is occurring to millions of people across the country today. Again, disagreeing with DSM labeling doesn’t mean that kids and adults don’t have different needs or that they don’t suffer from emotional pain and behavioral dislocation. It just means that it doesn’t help to lump people together that really have very little in common with each other besides a bunch of behaviors (of potentially widely diverse causes) that the powerful don’t want to have to deal with.
— Steve
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I think this again is an issue of language and terminology. Language using labels like ADHD and bipolar, even if there is a basis in biological temperament, is inherently stigmatizing and I plies a medical condition needing medical treatment…namely meds.
While in traditional societies, the language of temperaments and constitutions was not perjorative.
For example, In Indian medicine, someone born with a Vata temperament might be excitable and restless and prone to anxiety, but also sharp minded, clever and bright. Diet and lifestyle is geared to making sure this type does not fall into imbalance.
Traditional medicine cross culturally takes into account these temperamental differences, and also acknowledges the potential for falling out of balance and distress. But traditional systems of healing from throughout the world emphasize nourishment, not drug intervention.
The language of modern DSM labels implies disease, permanence and drug intervention. DSM language is about 70 years old. The language of traditional medicines are thousands of years old.
We have been led astray.
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Hi Steve,
The more we write, the more I do realize that we share a similar vision in many ways. The vision you share for your boys echoes so much of what we share for ours, too (and our girl, of course). I do see their temperaments eventually develop in many ways as they interact with their environment, and like you, we want to do everything possible both in teaching them and addressing their environment that will make them successful. Beyond anything else, it is what truly matters.
I will just let it go at that because I think that remains the most important thing. In the end, you and I desire a system that allow people (as I indicated before) to live up to their highest capacity (whatever that may be in the context of the experiences they have had) and in communion with others. We may not fully agree on the all aspects of how this would occur, but we do agree clearly on one thing – that is, if anyone works with our children who does not embrace this idea, then not only do I have no desire for my child to be connected with them, but I will do everything possible to make sure the issue is rectified even though I understand that I may not be successful.
I realize that many people are not afforded this luxury from an early age and at later times. It does make me sad. Because once the trust is broken, it is hard to repair and leaves many scars; but if the trust is honored, it creates a lifetime of potential.
Thanks to all of the time spent to you and others weighing in on this topic. I hope that it provides not only great insight for me, but many others as I hope to return to this issue down the road in different ways. And I hope that everyone has a great weekend.
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James, I disagree with your again creating a parallel with “stigmatizing” medical conditions for several reasons:
1) You are mentioning illnesses that despite the social judgments applied to them, all have a biologically determinable cause or origin;
2) NONE of those illnesses or “labels” calls into question whether the person labeled as such is competent to function on their own behalf;
3) Once a “mental illness” label/diagnosis is applied, causes for the suffering are less likely to be sought and addressed because drug management becomes the focus; and
4) Anyone so labeled is easily dismissed, incarcerated, infantilized, discounted and otherwise treated as a not fully formed adult human being with civil rights.
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Wow, Steve, well said. You covered all the bases in any comment I would have made about this. Thank you.
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Once you slap a psychiatric label on someone you don’t have to do any more work. Even though each person is a unique individual the psychiatric label trumps all this and specifies that there is only one way to see what’s going on and there’s one and one only solution to the problems. The solution of course is the psychiatric drugs.
This is why the issue of trauma is discounted by so many psychiatrists. They already know what the person’s problem is, they obviously have a broken brain. Trauma, if anything, is only secondary to all this and doesn’t have to be taken into account because it’s the person’s broken brain that is the problem. All that has to be done is to make sure that they get put on the toxic drugs for life and forget about dealing with the trauma, it’s not important.
Once you label you have all the supposed “answers” and you don’t have to look any further or struggle to understand the person. It’s a one size fits all cookie cutter solution to very complex situations, experiences, and problems.
The argument for labeling is that everyone will be on the same page when talking about the individual but the simple fact is that the people being labeled are never as simple as the label that is slapped on them for the convenience of the medical model system. This labeling is not done for the good of the so-called “patient”. It’s for the good of the people that will be dealing with them in the system.
The certified peer specialist training that I received does not allow me to use the medical language of the medical model nor the labels since the medical model is totally deficit based and not strengths based. It only emphasizes what is wrong and doesn’t recognize the strengths, abilities, gifts, and unique talents found in each and every so-called “patient’. It’s a challenge to find new ways of speaking about the issues and difficulties that people struggle with but the effort is worth it as far as I’m concerned.
I always wonder why there is a tendency in me to label someone who is different from me? I don’t label those who are my friends or who agree with me; no, I am tempted to label those who are different from me or who act different from me and those whose behaviors make me uncomfortable. What profit or worth is there in this? It only makes me feel better so that I can go ahead and discount those people and I don’t have to feel badly about what I’m doing. It justifies my thoughts and actions against them because after all, they are not like me! And of course, when it’s psychiatrists doing the labeling they’re doing it for the good of that poor person, aren’t they?
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The main issue I have with labeling is that by and large the terms are social constructs that are simply ways for insurance companies to reimburse providers and for drug companies to niche market drugs. Psychiatry and Big Pharma learned the strong advantages of labeling long ago.
And yes there are realms where labeling can be important. You start out with autism…which is a permanent condition…and then morph to anxiety disorders and bipolar, which are far more murky. While the first one can be helpful and not necessarily tied to Big Pharma/psychiatry, the next ones are.
The language that we use is deeply important. In older times, traditional societies might point to constitutional differences- choleric or sanguine in Greek medicine, pitta, vata, kapha in Indian medicine. But these labels would point to tendencies that could be modified by diet and lifestyle. These were not disease labels, but ways of describing personality and health characteristics as ways to guide healing when someone fell out of balance.
Today we have created a panoply of labs that imply disease and permanence. While autism may fit as a permanent label, labels like ADHD, bipolar II, borderline and histrionic personality disorder often appear to be no more than shorthand for the marketing and prescribing of drugs.
Labels also tend to pigeon hole vast swaths of people into one size fits all categories, while human complexity is far greater. I have never met two people labeled with schizophrenia alike, but they tend to all be treated the same way- neuroleptics. Again, traditional systems of seeing imbalance describe a wide variety of emotional suffering but tend to imply that the condition need not be permanent and that tailored healing approaches for unique people are key.
So yes I get that some folks feel happy to have a label, as a way of externalizing experience, reducing shame, etc. But the language of labeling has morphed from traditional holistic conceptions to reductionistic, medical jargon tied to drug regimens. Deeply problematic.
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I agree that labels can be comforting, but that doesn’t make them valid scientifically or fully descriptive of reality. For instance, I kind of like the Myers-Briggs system. It creates labels, but they are soft labels with acknowledged fuzzy edges, and each label carries with it both important strengths and assets as well as challenges and frustrations. It is not particularly stigmatizing to be an INTJ (that’s my “label”) because INTJs are acknowledged to be important contributing members of society, and their characteristics are recognized as necessary to the functioning of a team or group. Whereas “ADHD”-labeled people are generally considered deficient, annoying, impossible to care for, and likely to grow up to be criminals without “treatment.” There is no recognition of the redeeming strengths of such a personality, which include persistence, creativity, divergent problem solving, high energy, courage, and willingness to challenge authority, all of which can have great value if properly channeled.
So it’s not the label itself, but the pejorative implications that are most disturbing to me. These labels are inherently stigma-producing in the collective, even if some individuals may find them temporarily or permanently reassuring. And there is science backing that up – people who believe in the biological model implied by the DSM system have been shown to have less empathy for and more fear of the “mentally ill” than those who understand mental illness as an understandable human response to excessive stress.
Words do have power, and choosing words that isolate and exclude people as contributing members of society can be very dangerous indeed.
—- Steve
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Interestingly, the Meyers-Briggs system (ENTJ here) came from Jung, who borrowed from the ancient Greek system of constitutional assessment and healing (choleric, sanguine, phlegmatic, melancholic). Like you said, The Meyers Briggs system points out sensitivities but also points our strengths and capabilities.
At core the whole battle is over language. The language of health and distress created by our ancestors has been marginalized in place of a language that is reductionist and based in pathology instead of potential strengths.
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Stigma is so much more than about language–it’s about mindset, attitude, and perspective. It’s an energy, a habit of thinking, that creates a negative environment, and especially a negative, defeating perception for individuals.
The moment you say any condition is permanent, for example, you are stigmatizing, because there is no way anyone can know that to be true, regardless of whatever experience anyone else has had. This stigma is particularly dangerous, because you are assigning artificial limitations to a person and a skewed self-perception, and that affects us at the core more than anything. Our beliefs about ourselves influence our reality more than anything else.
This is beyond mere ‘tolerance’ and ‘acceptance.’ It is seriously about respect, as anyone has a right to expect.
The only way to understand this is to go through it. It’s a feeling like no other, to be the target of stigma which writes you off as second class (aka non-deserving). I came out of that period with an entirely different attitude than I had previously embodied, really grew me in all ways.
It was transformative to my entire perspective to have gone through this. It’s quite humbling and more enriching than I can possibly say. One thing for sure–going through the experience of blatant stigma, which is the most oppressive experience I’ve had in life, broadens one’s perspective a great deal about the experience of humanity. It is truly an eye-opener.
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You are correct, as usual, Alex. The problem is not the labels themselves but the inherent disrespect that lies behind them. It gives people, including your own clinicians who are supposed to be helping you, total cover for dismissive and disrespectful attitudes. Those diagnosed as “mentally ill” are treated in undignified ways that no one would consider acceptable with so-called “normal” people.
Thanks for articulating that important point so clearly!
—- Steve
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yes…stigma comes because the modern DSM psychiatric language implies permanence, disease and the need for medical drug based intervention.
Consider it this way. your child is bright, quick, interests in many things, sometimes can’t focus and is deeply curious….or your child has ADHD.
From perjorative language, stigma springs.
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“Those diagnosed as “mentally ill” are treated in undignified ways that no one would consider acceptable with so-called “normal” people.”
That’s right, exactly. The solution? Well, you can imagine the shock of the system when I took a corrupt and blatantly stigmatizing and discriminating voc rehab agency to legal task–and won. That wasn’t supposed to happen, no one was supposed to believe me! Well, the EEOC did believe me. I was so fortunate that the mediator listened to reason, rather than some fabricated social prejudice.
The craziest thing ever is that THEY actually believe the stigma they project. In essence, that is delusion.
For clients, the important thing is to not self-identify as that which others project onto them. That would be the personal growth, in boundaries and self-perception.
I had to even correct my family, they had bought the “mental health system party line” hook, line, and sinker. They’re awake now, I took care of that, between the film and LOTS of dialogue.
The more people awaken to not believing the stigma and getting away from stigmatizing (discriminating) environments, the more they will heal. It is this stigma that distorts reality, so no healing can really occur, only more illusion and enabling. Stigma is the social ill which is the precursor to marginalization, oppression, discrimination, prolonged disability, and human suffering.
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Oh, and just to show contrast, the Civil Rights Office DID employ blatant stigma when I filed a grievance against Dept of Rehabilitation citing discrimination. I sent evidence, including an email from a job developer which DOR assigned me, which stated very clearly to me: “You just use ADA law when you don’t get your way.” HA! Shaming me for standing up for my rights legally?? I don’t think so! I cited other actions which were consistent with this attitude. But the OCR never interviewed me, asked for follow up, nothing. I just got a letter in the mail stating that my grievance was dismissed because I had a psychiatric file with this issue and that issue. That was their evidence against ME.
That’s what a closed system looks like–as you say, Steve, people of different CLASSES are treated differently, and there is no place to turn in that system which does not operate by the same stigma.
I was fortunate in my employment discrimination case against the voc rehab, I found a public employment attorney who had nothing to do with the mental health system. The “mental health” legal advocates to whom I had turned were just as bad as the employers within the system–incredibly discriminating.
So I’ve had both experiences–one where reason and justice overpowered stigma, and one where the stigma was more influential than justice. In essence, this informed my path, so it’s all good. What a world…
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Jonathan, one could even say absolutely nothing about this and the attitude would still translate. Stigma is felt by whether or not people are heard and listened to, how we engage with others, the quality of our responses.
I believe it’s in the quality of the engagement where stigma can be perceived on the most subtle level. Do you engage with a client with the same attitude with which you engage with a colleague, and is that the same quality of engagement as with your boss? More than likely, it is not. That is the essence of ‘discrimination.’
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To the heart of the matter, from the voices of direct experience:
https://www.youtube.com/watch?v=AtDGxJWmj5w
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“One could even say absolutely nothing about this and the attitude would still translate. Stigma is felt by whether or not people are heard and listened to, how we engage with others, the quality of our responses. I believe it’s in the quality of the engagement where stigma can be perceived on the most subtle level. Do you engage with a client with the same attitude with which you engage with a colleague, and is that the same quality of engagement as with your boss? More than likely, it is not. That is the essence of ‘discrimination.”
Alex, I think this IS the heart of the matter, and this ultimately is where stigma begins and ends. Although I agree much of what many have said about the power of labels/diagnoses, I really think that stigma comes back to the way in which you treat the person across from you, regardless of diagnosis or any other factor. Do you treat them as you would want to be treated? Do you value them as a human being as much as yourself and anyone else? Do your recognize that their worth to society is not determined by who they are, what they do, or how we describe them, but by the fact that they, like all, are a human being deserving of deep respect, care, and love.
All of us come with some biases, certainly of a different nature, intensity, and degree. If we think we don’t, then we are lying to ourselves. But, when it comes time to treating another human being, regardless of the roles we perceive ourselves in, we repeatedly make decisions about how we do this. And when we devalue others, and use labels as a justification to do this, then as you said discrimination and stigma rise up.
When we were growing up, all of us (and many of us were subject to this at times) saw how our classmates were often stigmatized (i.e., called nerd, geek, retarded, etc…) and degraded. Often this occurred not because they had a formal diagnosis (or that we knew of), but because it was rationalized that they were doing things different or looked a different way. And so they were harassed. Regardless, what is clear is that stigmatization and discrimination long existed before any formal label was used, and will long exist even after labels are gone.
What I find interesting, though (and for better or worse), is that many of these same derogatory terms – nerd, geek, wimpy, etc.. – are increasingly showing up in a different way in the public domain, often in ways of solidarity, as an attempt to neutralize and counteract was previously only held in a negative way (e.g., Geek squad, “Diary of a Wimpy Kid, etc…). In many ways, the label is being flipped upside down, and for some, has almost become a sense of pride (again for better or worse). Maybe there is something to learn from this.
As you said, though, the conversation around this topic has been wonderful, and it has inspired me to follow-up this initial article with more discussions. We will see what comes.
jim
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One thing is kids evolving, growing, and learning as they become social. Hopefully, there are sound, guiding, and nurturing adults around to teach them (by example) how to not judge others, and to know themselves on their own merit, not by comparison, which distorts reality.
Another thing, however, is systemic stigma which leads to oppression and abuse on a grand scale, whether blatant or subtle (gaslighting, double-binding, etc.).
When a system treats its clients with lack of regard and respect because they have this inherent belief that their clients are less than (deficient, disordered, chronically ill), then, indeed, label or no label, that will be damaging for the client.
However, realistically speaking, that DSM label sure does bring a lot of false assumptions, mainly because no one seems to understand how these specious diagnoses actually relate to being a human being, other than to put them in a category that implies something which is not true.
I think that’s where the trouble with these labels come in. It’s not at all an accurate picture of the person, EVER, for a variety of reasons. Too much assumed, too much relevant info left out, too much categorizing, too much comparison, too much based on research (as opposed to that person’s unique experience). All of this undermines the human experience and limits individuals, by implication. That can’t ever be a good thing.
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Which is kind of what I was originally saying. The label does not cause the bias, but it builds on existing bias and allows biased people to feel OK about continuing to categorize and other-ize people who aren’t like them. Whereas real healing happens when we start to find the SIMILARITIES between us and the “other,” and can truly empathize with their experiences, which are unique for every person and defy easy categorization.
Thanks for your articulate passion. I always enjoy reading your posts!
—- Steve
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Thanks, Steve, likewise for sure.
I totally agree with your analysis of how these labels do harm by being a justified and ‘legal’ form of discrimination based on stigma–which I see as an extension of social ills which only embed a person’s poor and self-limiting self-image. It’s crazy-making to know this is standard procedure.
I sat for a moment with what you wrote, and this came to me:
I believe that, universally, we are all similar, if not equal, in our craving for love, respect, nourishment, and safety. Without these, we get cranky, to say the least–really, it goes from despondent to enraged. Different people react differently to not getting their core needs met, aka acting out. Some are quite clever in how they go about getting their needs met, others are more direct.
We can also totally detach from our feelings altogether, as a response to a toxic environment, so as not to feel the lack which we perceive. A lot of walled up and totally dissociated people walking around the planet these days, because the emotional intensity of life is just too much. Survival tactic, of course, but that can only lead to chaos when one is detached from their authentic emotional responses. In short, denial. This is where stigmatizing projections so easily occur, and more than likely will–when we don’t own our stuff.
So our differences amount to how we react/respond when we do not get what we not only crave, but that to which is really our birthright. At least I believe this. Everyone deserves love, respect, nourishment, and safety.
People who lack self-love, self-respect, and are sabotaging or depriving to themselves did not get what they needed, and they have yet to learn how to be a cooperative component in their own manifestation. Were we to see this beyond our fears and judgment of differences, then we’d feel compassion for those that are acting out violently or somehow sabotaging. I work on this myself all the time, for deeper understanding of humanity.
I’ve heard over and over people say, in the wake of violence as a reaction to injustice, “I wouldn’t act like that!” But then again, until one walks a mile in blatantly stigmatized shoes, and that has been a generational reality, it’s really impossible to know how we would behave under the thumb of social oppression at every turn. I’m sure some people would be shocked at their impulses under such circumstances.
I’m not saying it’s a good thing, but I think it’s easy to understand, if one understands the effects of blatant discrimination on one’s nervous system and emotions. It’s quite infuriating, to say the very least, when a person is trying to get reasonable needs met, and reason ceases to be while manipulative control based on degradation and dehumanization begins, where lies are told repeatedly. Then it’s just a big ol’ mess after that, lose/lose.
One thing for sure–we can’t force compassion on others, so we have to discern what is comfortable for each of us, that’s our own responsibility. And when we are sent outside that comfort zone, as life so often does this to us, then that’s the signal that healing, growth, and personal evolution is happening. That’s a good thing, not something to condemn!
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That last is probably the biggest lesson I’ve learned in my adult life – while everyone has been hurt and their acting out comes from hurt, there are some who choose to pass their hurt on and choose not to empathize as a protection. Such people are dangerous in that they continue to dramatize what was done to them and pass their pain on to another generation. So while I remain as compassionate as I can, there are times when I have to set boundaries to stop the damage of myself or others, and that’s OK.
Compassion can’t be taught – it has to be felt, and it comes from being willing to deal with our own pain and to feel it rather than passing it on. Only a small percentage of folks are really able to do that. Most of the rest harm mostly themselves, but there are enough of those others to do a lot of damage. And sadly, a disproportionate number of trhem seem to become psychiatrists!
— Steve
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Setting boundaries with compassion is an art in and of itself! That’s where I feel I learn the most. Always a delicate balance…
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Oh very dear.
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I really like the continuing discussion. And what a story Alex1
Interestingly, I was helping a client who thought he was “retarded” because he couldn’t do math. I said no it’s a learning disability called dyscalculia. I knew it because I have it. I looked it up and low and behold was a new label called Gertsmann Syndrome which is a cluster of learning disabilities – a lot of dyses – and one other unique aspect that I share with it in a small but significant way. Also under the Rare Disease category.Two major medical institutions and too many “helping professionals” were unable to put it all together and all it took was for me to Wiki it with 5 minutes of readingS So Now
I have the “right” label. And it would only be good for – if my parents were still alive – going out for dinner and celebrating my self diagnosis.
Otherwise it doesn’t change a thing for me. I might have even suffered more stigma as a child if I did have that venerable label. This way I ended up being accepted into a PHD program and passing the research methodology and stats classes required.
Labels can limit and often do.
Also SES , culture, and race is so important to label and stigma issues. My client was of a different race than me and different SES. Much easier to throw a kids into the “special section” when there are no advocates or watchdogs.
But in a strange way many of the upper strata have bought into the labeling for their own children. Again there are alll sorts of levels of otherness in our society accepted and not accepted.
But the whole Mental Health experience goes beyond everything.
In museums that I frequent back in the eighties and early nineties there were exhibits that explained disabilities in multiple modalities and provided interactive experiences as well.Wheelchairs, blind folds, ear plugs, ect were all accessible to use for folks to understand in a small way what disability is. At our regional site center staff are trained in the experience of visual impairment.
The one overarching theme and tenant in the Mental Health field is the refusal of professionals not labeled themselves to undergo in any way, shape or form the experience of a mental health disability or whatever word should be used for that.
There are no John Howard Griffths in the field willing, brave, and strong enough to experience the unthinkable and horrible and return to tell the truth.
Until there is a change of heart and mindset in that matter I sometimes think our voices are just blowing in the wind. Unless psychiatrists, psychologists, nurses, and therapists along with psych unit folks start wearing body cameras?
That too might change the cultural in a critical way.
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So eloquent, and clearly stated, CatNight. Don’t you think we qualify as JH Griffiths? That’s exactly how it felt to me, sound like your experience, too, from what I’ve read in your posts.
It’s amazing how we can intellectually know something–that we are not these projections– and still, it gets under our skin and in our bones. Certainly affects the quality of one’s life.
Being stigmatized, and ‘othered’ as a result, by an entire culture is nothing short of traumatic. I suffered from “stigma post traumatic stress’ for a while, until I figured it out, called it out, and then re-claimed my sense of self.
I think that’s really what heals all of this–when we have a strong sense of self and hold to it, then we can stand alone in any environment and not lose our way. Takes good, hardy inner work, but it’s well worth the effort, in my experience. Really clears the mind and heart to know who we are, above and beyond the stigma. Then, we can find what is supportive to our goals and well-being, rather than sabotaging to them. To stigmatize is to sabotage.
Now, if those who perpetuate blatant stigma and discrimination can only find THEIR “sense of self,” that would greatly alleviate the issue, all around…
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Btw, I was staff when I called out the voc rehab agency, my first job since having become temporarily disabled by medication withdrawal. I was doing great, too, got a wonderful 3 month evaluation and high marks with clients, partners, all around. Then, I got in trouble (and ‘written up’) for challenging management when I saw they were blatantly discriminating against a client. That’s when it started happening to me, they were not happy that I was not ‘going along.’ They spent 2 months torturing me (that’s how my co-workers put it), as I tried to transition to another agency, because I so desperately wanted to work and was really enjoying it–it was my training and I was thrilled to be back hands on with clients, and they were doing great, placing people well who were succeeding.
But what really mattered was that I advocated for clients rather than for management. That’s where I went “wrong.” Although, I’d do it exactly the same way, all over again, were I ever to be in that position–which will never happen, because I’m over it! This was not fun in the slightest, but it worked. So, I lost my job, but found my freedom, which allowed me to create a great life, on my terms. Helluva learning process.
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I mean–can you imagine, getting fired from a VOCATIONAL REHABILITATION agency, whose program I took and completed, as my own rehabilitation, I wanted to work. They are the ones that asked if I wanted to apply for the position of voc rehab counselor that was open, they recruited me. Then, they did this turnaround, like, oops, just kidding, when they saw my loyalty was with clients.
So their (incredibly dubious) claim was that I could not be rehabilitated, after they had worked with me for a year, given me high marks and encouragement, kudos, and then recruiting me. (You should have seen the incredibly transparent lies they added to my file–which I requested–and which no one believed, they were outrageous and had nothing to do with me, obviously).
What were they thinking??? Honestly, not terribly bright, wouldn’t you say? They no longer exist, lost their funding. Too bad.
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CatNight, one last thing, I LOVED these sentences, so spot on:
“Labels can limit and often do.”
“Also SES , culture, and race is so important to label and stigma issues. My client was of a different race than me and different SES. Much easier to throw a kids into the “special section” when there are no advocates or watchdogs.”
Indeed, I also feel this is vital information and awareness. We falter here a great deal, omitting important factors in what makes us US.
Apologies for all the successive posts, I’m actually supposed to be on vacation from all of this for a couple of months while I turn my attention elsewhere temporarily, but this topic is hot and also most near and dear to my heart, and to my work, so I took couldn’t resist participating enthusiastically.
Thanks James, for instigating a wonderful and enlightening discussion, and I believe most relevant. Very appreciative to all who have commented and have given me much food for thought regarding where we are with these issues.
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James,
I think your piece is balanced and thoughtful. Psychiatric diagnoses should only be used as a guide, and can be useful both with colleagues and patients to aid communication and at times to relieve guilt and anxiety. The issue is more with how society and the mental health industry has misused diagnoses to the detriment of the population. Many institutions, including the NIMH in the U.S. and the CMHA in Canada, as well as many government bodies tend to spend much needed funds on marketing campaigns to “de-stigmatize” mental illness rather than addressing causes of emotional distress. It makes no sense to try to stick a label on everyone who suffers emotionally, to not try to help prevent emotional distress ,and then to focus on de-stigmatizing, mostly to show to the public that you are “concerned”. A welcome relief from the mental illness and stigma advertising has been ads put out by longlivekids.ca which focus on emotional wellness and common factors that can cause emotional distress. We need more emotional wellness promotion, less labelling, and more concern about conditions in our society that can lead to emotional distress. We shouldn’t want to get rid of diagnoses as a guide, but to start training practitioners to understand the possible benefits and limitations of diagnoses. Let’s all work towards a world where diversity is appreciated, labels are irrelevant, but that good descriptions and words that promote understanding are valued
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Hi James,
> I know many who have received a diagnosis, and have seen it as an empowering, freeing idea (again, > for better or worse), in that they no longer feel solely responsible for their deficiencies or struggles.
I think it’s pointing out how bad the “worse” alternative above is. I sometimes hang out at a web site where you can find many, many people who proudly have signature lines listing, for instance:
Bi-Polar I / GAD / Panic Attack Disorder / ADHD
Medications:
– Welbutrin XL 150mg
– Latuda 20mg
– Adderall 20mg 2x day
– Nuvigil 150mg
Xanax as needed
And who discuss among each other what is the best “cocktail” for their particular diagnoses.
Part of the dishonesty of diagnoses like that is a fake specificity that gives a false impression that it’s a scientific answer. I don’t really object to someone saying “you are depressed”, but if someone tells you that you have
“Bi-Polar I / GAD / Panic Attack Disorder / ADHD”
they are just lying to you and pretending to know things that they do not know.
As usual, The Onion says it best: “GATORADE SCIENTISTS DISCOVER FOUR NEW KINDS OF THIRST”.
– Saul
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Hi Saul,
I hear what you are saying, and I agree with much of it. I think the ultimate demise of the DSM will be largely associated with the fact that it got carried away with dissecting human functioning into too many parts. I cringe when I see reports of a 10-year-old come to me with four psychiatric diagnoses, and also cringe when diagnoses/medications become a point of almost bragging and/or a justification for every behavior or thought that a person can possibly have. That too, does a person little good, and relegates them to being completely defined by the label(s) they have been given.
Your Onion headline was classic, and it reminds me that I need to get back to reading them more like I used too. Sometimes, good satire conveys more inherent truth than the reported truthful reports we often read.
Thanks for weighing in.
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LOL!!!!
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James, while I would agree that, looking at the issue is far more complicated then to just point towards people labeling someone with a diagnosis. I however, do think that it can play a big role. The reason, being it was designed to point to something wrong, lacking, or abnormal about them. I get that it is supposed to be helpful, for them to receive help for those experiencing difficulties. I however dissagree that the best way is a diagnosis. In fact, I’m not sure the label would, make someone anymore compassionate who would otherwise stigmatize someone. If you described their specific situation, it could, but then aren’t they just empathising, or sympathing like they would to any person who’s ever struggled, because they know that nobodies perfect including the self?
Another thing I want to bring up, is these people who are in need of help, are probably well aware that they are not meeting expectatations, or noticeably struggling. I don’t really think that’s the time to put an official name to it. They’re probably the last people who need a name for their struggles. They need hear, what’s positive about them, and their strengths. Other people need to hear this to. There of course should be help in ways they need it. However, while focussing mainly strengths , so people really want to help. I know this person struggles with blank, but you know what it doesn’t even matter because they are one of the people I know who can do blank. If you get to know them, you won’t regret it, they’re one the best friends I have.
Also you really have to get to know someone on an individual level, with all the variations, and overlap. I know for some people it can be helpful, in certain aspects, but isn’t that more from an individual description. I still think general things people struggle with is ok to note. In fact what I’m studying mentions it, but focusses more on strath, and I want to reiterate people seeking, or being tested probably need that the most. That’s why I think they should feel empowered, is because what’s good about them. I think compassion, and realizing their not alone in certain struggles is good, but don’t think they need to much reminders that they have them.
Lastly I want to just say although I disagree with a lot of specifics, but glad you brought it up, and think you have some really good points. There needs to be discussion, before saying without mental health there will be stigma, or without there would be no stigma. Similarly to the idea, people either have to be completely unsympathetic, to someone’s struggles, or believes it caused by an illness. There has to be a more honest discussion, that takes everything into account, tries to avoid confirmation bias, and looks for a solution.
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