Psychiatric Labeling | Mental Health Disorders | Labeling People | Stigma

An Inadequate Platform for Mental Health Treatment

Labeling, based on the medical model of psychiatry, is a method and a theory, a basis or foundation for psychiatric treatment, and although widespread and the standard approach in psychiatry, it is not universally accepted in all professional communities, in part or in whole.

There are other models of mental health which provide foundations which approach psychiatric disorders and mental health from a totally different angle, though not as popular, they are equally, or even more-viable, realistic, holistic and productive, than the medical model.

Some of these models are, Urie Bronfenbrenner's Bioecological Model of mental health, Positive Psychology, and the related Strengths Model or Strengths Perspective of mental health. (See references).

Labeling and drugging is a convenient way of treating mental health disorders,
and is profitable for insurance and pharmaceutical companies.

p/> The medical model is convenient, it provides the practicioner with a clear-cut approach to handling individual situations, but most of all, it has been used by the psychiatric world in a way that leads to labeling and subsequent prescribing of psychiatric drugs. The typical procedure for the medical model of mental health involves, identifying symptoms, assigning an appropriate label, and administering what is deemed appropriate drugs.

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This practice, along with the stigmatization of individuals who have mental health disorders, or who exhibit symptoms of such disorders, has come under the most scrutiny and criticism as lacking sound basis in professional circles in the field of mental health.

Pharmaceuticals are vigorously marketed to physicians, many times
with incentives.

Paul R. McHugh, M.D. is (2003)professor of psychiatry at John Hopkins University of Medicine and chief psychiatrist at John Hopkins hospital in Baltimore.

Paul McHugh, M.D., professor of psychiatry, John Hopkins University, who chaired (2003), the department of psychiatry and behavioral sciences at Johs Hopkins University School of Medicine feels that the DSM label of Borderline Personality Disorder, has lost its usefulness. He is quoted in Time Magazine as stating that the DSM ("bible" of psychiatry labeling), has "permitted groups of 'experts' with a bias to propose the existence of conditions without anything more than a definition and a checklist of symptoms. This is just how witches used to be identified," cites multiple-personality disorder as an example of an "imagined diagnosis"; while much of the evidence supporting its existence has been debunked, multiple-personality disorder is still listed in the DSM, though today it's called "dissociative identity disorder."

Diagnostics: How We Get Labeled, John Cloud. (Jan. 20, 2003). Time Magazine.

There are other mental health theories which provide a more practical, reasonable and accurate consideration of mental health issues such as the bioecological model of mental health, and positive psychology from Penn State University.

How Labeling and Stigma in Psychiatric Practice are Related

In a study by the American Sociological Association, of the theory of labeling in mental illness, the conclusion was reached that, "consistently support the prediction that the likelihood of social rejection increases after others gain knowledge of an individuals status as a mental patient."'

"When mental [health disorders] are used as labels, these labels hurt". SAMHSA

SAMHSA's, the US Government mental health association, gives this guideline, Before You Label People, Look At Their Contents. SAMHSA states, "When mental illnesses are used as labels - schizophrenic, manic, or hyperactive - these labels hurt."

The Brigadier General of the United States, and Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury,
Loree Sutton, stated concerning many forms of mental illness, "Stigma is a toxic, deadly hazard, which must be eliminated," in a public service announcement.

Psychiatric labels lead to stigma - Stigma leads to discrimination.
Loree Sutton, Brigadier General of the United States

"Labels lead to stigma -- a word that means branding and shame. And stigma leads to discrimination. Everyone knows why it is wrong to discriminate against people because of their race, religion, culture, or appearance. They are less aware of how people with mental illnesses are discriminated against. Although such discrimination may not always be obvious, it exists-and it hurts."

Another thought to consider with persons who have or who have had mental illness is that labels stick. Even after a person may have recovered from bouts with serious mental illness, the label may have a long-lasting impact on other's perception of him or her.

"My son is bipolar."
Labels can be damaging and hurt the one being labeled,
affecting their view of themselves.

If a person recovers from cancer, do we refer to him or her as "being cancer," or he or her "is cancer". No, because we know that cancer is something that we can recover from and be cancer-free. With mental illness, labels are made, "he is OCD," "she is bipolar," as if to say, the word "bipolar" sums up one's whole existence, we don't need to take that person's actions good or bad too seriously, because it all comes down to the fact that he or she "is" this or that label.

In a study published in the American Journal of Psychiatry concerning the subject of stigma, the studies author Bernice A. Pescosolido notes that despite greater insights into mental health disorders in recent decades, one of the reasons for stigma surrounding mental illness lingers is that people tend to look at mental illness as something that never goes away. "When you attach a feeling of permanence to this, then it justifies, in some ways, a person's sense of 'otherness' or 'less-then-humanness'". Hitler took that idea of labeling and stigmatizing to the extreme, as we know, exterminating those with mental illness, but also labeling those who did not fit into his idealized schema as "untermensch," meaning "sub-human" or "under-man".

That same type of stigmatizing can occur when considering those with mental health disorders as well. It should be noted that there are medical doctors who, before becoming doctors, started medical school after receiving a diagnosis of bipolar disorder. There are lawyers and college professors with schizophrenia, who are active, productive members of the respective groups, no less than any other professional.

Full Recovery from Mental Illness is Possible - NAMI article - (on-site page)

Permanency in Psychiatric Labeling

Many schools today no longer have blackboards, but white boards. The advantage is, no more need for chalk, only dry erase markers, which can be wiped off with a rag or paper towel. However, if you write on the white board with a permanent marker, and let it set overnight, it can be very difficult to erase the marks, and there can be an underlying image long after the mark was cleaned up.

This illustrates the issue of stigma in psychiatric. Psychiatric "markers" or labels, have a tendency to be more like a permanent marker than an erasable one. The label sticks, and sometimes that label can be used as a weapon by those who are close to the one suffering with a mental health disorder.

Psychiatric labels for some serious disorders have a tendency to stick. Because psychiatry’s primary occupation, in the medical model under which most U.S. psychiatrists operate, is identifying symptoms and assigning a label, second, prescribing appropriate medication that address those symptoms or that correspond with that label, causes and developing coping skills or self-help skills, is often only subsidiary. It is assumed that without the prescribed treatment, the client is not capable of helping himself, that they can only succeed with the full-range of psychiatric services in their particular program.

For some serious disorders, especially in cases where the psychiatric profession does not fully understand, labels are considered to be permanent. "You will always have to be on medication," might be a typical response from a psychiatrist who follows the medical model. The psychiatrist is not looking for a way to cure the disorder, so the client can go on living a normal life once he or she is cured, but rather, the "illness" can only b controlled or subdued with the help of the psychiatrist and the use of powerful drugs.

If a client, without drugs, no longer manifests symptoms of the diagnosed disorder over an extended period of time, perhaps because a client has addressed the underlying causes of the symptoms, a psychiatrist might say, "the disorder is in remission, since this or that date." This seems to imply that, the cure isn’t final, the "illness" can come up again at any time, it is merely in remission for the time being, but there is always the suspicion that it will flare up again, unannounced and for no reason, like shingles or malaria, which is still lingering in your bloodstream.

Because the medical model more or less assigns a permanent label for some serious disorders, and isn't so concerned with addressing causes and lifestyle changes as a solution, the result is that anyone assigned with certain psychiatric labels under the medical model, which is usually the case in formal psychiatric programs, such as government funded programs of any type, including psychiatry based in the public schools, this means that a teenager who is labeled will be consigned to a lifetime of taking strong and debilitating psychiatric medications. This is a very serious prospect, it is like putting a young person in the warehouse for life.

For many, this is unacceptable, and this is one of the reasons why there are strong, sometimes vitriolic protests, in literature, against this practice, and the abuses that are often associated with it, especially against those who are vulnerable, such as foster children, children of immigrants in the U.S. who do not speak English, or whose parent is illiterate or incapacitated themselves. But it also has broader implication for anyone who has had a serious mental health disorder.

There has been controversy over the term "mental illness," or "mentally ill" as well. In 1966 Thomas Scheff, Professor, Emeritus of the Department of Sociology, University of California, Santa Barbara, and former Chair of the section on the Sociology of Emotions, American Sociological Association, and President of the Pacific Sociological Association, published the book, Being Mentally Ill. Being Mentally Ill challenged the common perception of mental illness, and claimed that mental illness was manifested only as a result of societal influence. In other words, society established certain norms and anyone who deviated from those imaginary, societal-imposed norms, to a significant degree, was considered to be "mentally ill". The term "mentally ill," then, or "mental illness" itself was part of the psychiatric labeling jargon, and potentially a cause for stigma.

That there is some basis for Scheff's theory can be discerned by looking closely at societal and cultural norms and how they are perceived or interpreted. In Western society, in psychiatric terms, anyone who "sees things" that are not there, hears voices, is considered to be schizophrenic in one nuance or another. In some indigenous societies, such certain America Indian tribes, seeking "a vision" of something which is not physically there, is a "right of passage" for would be future leaders of the tribe. Crazy Horse sought a vision as he passed from boyhood to manhood, which he received, and that vivid vision, beyond the physical realm, contributed to his life-course and provided him direction for decades.

In many cultures, someone who sees things who is not there or hears voices from the spirit realm is considered to be gifted and becomes the "shaman" or religious, spiritual guide of the tribe.

In Judeo-Christian religious books, those who saw visions and heard voices from the spirit realm were treated with reverence and considered to be prophets. In modern psychiatry, an atheistic world-view forms the foundation of thinking, so that out-of-the-ordinary transcendental experiences, are generally interpreted in terms of a biologically-rooted mental illness.

So while psychiatry is specifically concerned with such experiences in terms of how it negatively affects the life of the individual, there are other explanations or interpretations for supernatural, out-of-the-ordinary or transcendent experiences.

Recovery from Mental Health Disorders is Possible
----Mental Illness of Any Type Does not Need to be Permanent

If it can't be done, why try? History is replete with examples of those who accomplished what was previously believed to be impossible. The psychiatric label pretty much closes the door on the thought of full recovery.

Labeling can have profound effects on the level of will with which you exert yourself to try to overcome mental health disorders. If you believe you can overcome a disorder, you are more likely to work very hard to do so. If you feel that the mountain cannot be climbed, then for sure, you will never try to climb it.

One encouraging account in relation to autism can be of help to persons with mental illness. In one well-known example of a boy, "Evan" who had suffered with autism, his mother utilized a tremendous amount of resources and therapy for her son's help, she didn't give up. Within a few years, the boy no longer qualified for the label, "autistic," he had sufficiently recovered from his symptoms.

You can work through a mental health disorder and come out on the other side, label-free.

An Internet search on the key words, self help, provides numerous references for depression self help and ADHD self help, but comparatively few for bipolar disorder self help. Why? Because many who are labeled bipolar disorder, as one example, are often taught to resign themselves to the label with a lifetime of taking psychiatric drugs in view. It is often thought of as an incurable disorder which must be managed with medication. Many who are labeled bipolar, then, may not take practical measures to help themselves. The label, in this case, can be a hindrance for many to take steps to help themselves.

Symptoms associated with bipolar disorder, however, in this example, can be brought into remission and full recovery is possible.

If you have the gout, as an example, you will no doubt be encouraged to change your diet. If you have diabetes, a diet free of excess sugar can be of much benefit. If you are diagnosed with bipolar disorder, then by all means, take positive self help steps to overcome the disorder. Take a positive approach to recovery.

Don't let yourself be put down by the label. Try to help yourself and fight your way out of the cocoon. If you do, you will gain a victory over stigma, and come out of it a more compassionate and understanding person, better able to take on the next set of challenges life presents.

References for Mental Illness Labeling

1. Before You Label People, Look At Their Contents. (Retrieved June 30, 2009). http://mentalhealth.samhsa.gov/publications/allpubs/SMA96-3118/default.asp

2. Kroska, A. and Harkness, S. , 2004-08-14 "Exploring the Modified Labeling Theory of Mental Illness Using Affect Control Theory Measures and Predictions" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA, Online <.PDF>. 2009-05-26 from http://www.allacademic.com/meta/p110021_index.html
American Sociological Association. http://www.asanet.org

3. Scheff, Thomas, PhD. Professor Emeritus of Sociology, UCSB. (Retrieved November 17, 2010). 4. Strengths Perspective in Mental Health (Evidence Based Case Study), (2006). Rangan Aarti, Sekar K.

5. The Ethics of Labeling in Mental Health, (2007). Kristie Madsen, MA, MSW, Peter Leech, MSW, LCSW.

Pages Related to Psychiatric Labeling and Stigma

Child Psychiatric Labels, child psychiatrist Dr. Scott Shannon

Stigma and Mental Illness

Psychology History - Moral Management: Successful non-pharmaceutical holistic treatment for mental heath in the 1800's.

Positive Psychology Movement - Penn State University

Mental Health Treatment - A Closer Look at Psychopharmacology - Let the Buyer Beware! by Louis Kirby, MA

Appeal to Mental Health Professionals for professional non-pharmaceutical treatment options and clinical studies

Bioecological Model of mental health

NAMI - Mental Health Disorder Recovery

Articles Related to Psychiatric Labeling and Stigma (off-site)

Beyond The Brain, by Tanya Marie Luhrmann. Summer 2012. Wilson Quarterly. - In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure.

The Medical Model in Psychiatry: Pros and Cons. Dilemmas and Controversies of Traditional Psychiatry. By Stanislav Grof, M.D., Ph.D. Chapter 5 of the book, Beyond the Brain: Birth, Death and Transcendence in Psychotherapy.

I Had Asperger Syndrome. Briefly, (January 31, 2012). by Benjamin Nugent, NY Times.

Mental Illness and Work - Stigma. January 27, 2012. The Globe and Mail.

Espanaol - 19 prominent psychiatrists, psychologists and mental health professionals - (not an exhaustive list) - who disagree with the current medical model of mental health - Blog in Spanish

Talking Back To Prozac: What Doctors Aren't Telling You About Today's Most Controversial Drug by Peter Breggin - "There is unquestionably a great deal of truth in what Breggin writes. Let the pill-swallower beware." --Los Angeles Times "Dr. Breggin is the conscience of American psychiatry." --Bertram P. Karon, Ph.D., author of Psychotherapy of Schizophrenia.

No Child Left Different, edited by Pennsylvania clinical psychologist and professor, Sharna Olfman - A book on childhood mental health disorders, the media, and overprescribing of drugs, that is worth reading.

Blaming the Brain: The Truth About Drugs and Mental Health by Elliot Valenstein
Detailed analysis (and proof) of how the pharmaceutical industry sold the medical field, over decades, on the idea of pharmaceutical treatment for psychiatric disorders. Valenstein provides ample logical reasoning on the idea that psychiatric disorders are not caused by a "chemical imbalance" and that the medical model, while convenient, is not accurate.