To the Heart of the Matter:  Stigma, Labeling, and the Delicate Search for the Common Good

James Schroeder, PhD
70
256

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!

70 COMMENTS

  1. 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.

    • 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.

  2. 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.

  3. 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.’

  4. 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

    • 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

      • 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.

        • 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

          • 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.

  5. 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?

    • 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?

  6. 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.

    • 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.

  7. 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.

  8. 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.

  9. 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

    • 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?

  10. 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

        • 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

    • 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.

  11. 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?

  12. 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.

    • 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

      • 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.

        • 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.

          • 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

          • 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.

          • “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.

          • 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…

          • 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.’

  13. 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.

    • 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…

      • 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.

        • 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.

  14. 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.

  15. 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

  16. 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

  17. 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.