A new study published in the Journal of Health and Social Behavior addresses the long debate on the consequences of self-labeling – the process of adopting psychiatric language such as “mental illness” to describe one’s own distress.
There have been many debates amongst the public, researchers, and mental health providers about whether adopting a mental illness label is empowering and helpful for mental health recovery or actually harmful to psychological well-being.
Sociologists Lexi Harari, Sharon S. Oselin, and Bruce G. Link draw on several sociological theories to investigate the impact of self-labeling on youth experiencing mental health problems. Drawing from longitudinal data involving middle school students in Texas, their study suggests that identifying with a mental illness label is harmful to youth self-esteem.
“While a medicalized ‘insight’ perspective emphasizes the importance of self-labeling for psychological well-being and recovery, a sociologically informed ‘outsight’ perspective draws from modified labeling, self-labeling, and stigma resistance theories to suggest that self-labeling can generate negative consequences for self-esteem,” the authors write.
According to the medical model, understanding oneself in psychiatric terms is essential because it provides “insight” into one’s illness or allows one to make sense of their distress by accepting a mental illness diagnosis. This acceptance is believed to promote help-seeking and contribute to successful treatment outcomes. Based on the “insight” perspective, self-labeling with a mental illness should improve self-esteem.
However, this perspective is critiqued because when someone chooses to reject a self-label, they are often seen as not fully understanding their illness or are accused of refusing treatment. Sometimes, refusing to self-label is even considered a symptom of mental illness that prompts additional medical treatment.
In contrast, the sociological “outsight” perspective critically considers the negative social consequences associated with self-labeling. For instance, this perspective uses modified labeling theory to consider the judgment and negative treatment people often experience after being labeled with a mental illness in a clinical setting.
It also draws on self-labeling theory to examine the adverse consequences labels have on psychological well-being.
Lastly, it applies stigma resistance theory to suggest that people often choose to reject self-labels to avoid negative stereotypes commonly associated with mental illness. According to this perspective, it is expected that labeling oneself with a mental health diagnosis will harm self-esteem.
Drawing on these conflicting perspectives, the researchers created a test to investigate whether self-labeling leads to better or worse self-esteem for youth ages 11-14. To do so, a school intervention was done in Texas to educate students about mental health and reduce negative beliefs about people who experience mental illness.
During this time, data was collected to see if the youth self-label or agreed with the statement: “I have a mental illness.” Over two years, the researchers followed up with students about their personal experiences with self-labeling to track whether youth (1) adopted a self-label, (2) consistently maintained a self-label, (3) dropped a self-label, or (4) never self-labeled. Using this information, they tested whether having a self-label improved or harmed self-esteem over time.
Findings support the sociological “outsight” perspective because self-labeling was shown to be harmful to youth self-esteem. More specifically, the authors emphasize the following:
“It is the adoption of a self-label that is particularly detrimental to self-esteem in both the short- and long-term.”
Their findings reveal that youth who stopped self-labeling had improvements in their self-esteem which shows “additional support for the outsight perspective, signaling that self-labels are generally harmful to youth self-esteem, and by extension, shedding them can yield positive effects.” The researchers found no differences in self-esteem outcomes based on participant race, ethnicity, or socioeconomic status.
Since this study took place in one Texas school district and focused explicitly on a middle school age group (ages 11-14), these findings do not represent youth experiences nationwide.
Despite the limitations of this study, these findings are of utmost importance because of the exponential increase in mental health screening and the overdiagnosis of mental health conditions in children and youth. Awareness of the harms of self-labeling is also crucial because providers in treatment settings often assume that self-labels facilitate the mental health treatment process and improve psychological well-being.
However, psychiatric survivors who have personally navigated the mental healthcare system share that mental illness labels led to feelings of hopelessness and trapped them in a system that overmedicated their suffering.
Practitioners and the mental healthcare system must consider the complex ways that the recognition, adoption, and acceptance of mental illness diagnoses can harm psychological well-being and self-esteem, especially for youth in a critical stage of identity development.
Harari, L., Oselin, S. S., & Link, B. G. (2023). The Power of Self-Labels: Examining Self-Esteem Consequences for Youth with Mental Health Problems. Journal of Health and Social Behavior, 002214652311759. https://doi.org/10.1177/00221465231175936 (Link)