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Beyond Labels: Getting Past Stigma With How We Think About Mental Health.

Diagnostic labels are helpful as a shorthand way of communicating what one is experiencing. But I wonder; might they also contribute to keeping us stuck and maintaining the larger societal stigma?

Here’s what I mean. Instead of focusing on labels, perhaps we need to encourage a language that speaks to the continuum of normal human psychology. When we understand a bit about the underlying system, which promotes mental health maintenance, we might begin focusing more effort on healing, relapse prevention, and building individual resilience; a bit less on symptom management.

Why We Turn to Labels

You may or may not have had a diagnosis in your lifetime. Nonetheless, almost all humans have experienced some period of angst, agitation, anxiety, or confusion and just plain brain fog, which makes coping more difficult.

The labels we give these periods of suffering have been helpful in some ways. These thumbnails of mental health create a valuable language around which clinicians can communicate and make treatment decisions.

Before we had this system, created for our Diagnostic and Statistical Manual, treatment for mental health was a crapshoot. Having a single word or term is helpful for clinicians because it narrows the focus of problem solving and limits ambiguity.

Getting a formal diagnosis can also bring a major sense of relief to the person being labeled. When you’ve been struggling in the darkness of internal distress, hearing a professional confidently ascribe it to a single term can feel reassuring that help is on the way!

The Problem With Labels

If you’ve struggled with a diagnosis for some period of time, you know, the label may give everybody a sense of reassurance, but does very little to effectively reduce your suffering! You are far more complex than a label.

I’ll be honest, I don’t care much for diagnostic labels. The problem with putting people into label boxes is, once you go in, it’s very hard to get out! When we talk about diagnostic labels for mood and anxiety disorders in particular, we’re just looking at the surface symptoms; five out of nine usually, for two weeks or more.

PAUSE: Put your hands out in front of you and overlap your thumbs. This is how much overlap there is potentially between two people with the same label. So, in truth, the label really doesn’t tell us much about what you’re experiencing as an individual.

So treatment decisions, and certainly social opinion, based on only the diagnostic label, is likely to be a bridge too far. Yet we cling to our mental shorthand.

The Medical Model of Mental Illness

According to the American Psychiatric Association, mental illness should be considered a medical disease, no different from heart disease or diabetes. I agree. Particularly in the case of severe and persistent mental illnesses, such as schizophrenia, severe bipolar, and autism. Where I differ is on the Western medicine’s allopathic (i.e. symptom management), one size fits all approach, to biological systems that are still not yet well understood.

Unlike physical diseases, the specific biological mechanisms of most mental illnesses is still largely a mystery. Even Thomas Insel MD, Director of NIMH, who believes strongly in the medical model of mental illness, has been cited as stating that the knowledge base is today where cardiology was 100 years ago.

Here’s my issue with this all-or-none stance. This medical model of mental illness suggests that “significant changes in thinking, emotion, and/or behavior” and “distress and/or problems in functioning,” indicate illness. This means something – you – is broken – and thus, needs to be ‘fixed.’ Could the ‘sick’ and ‘disease’ labels be perpetuating stigma?

Mental Illness as a Cue for ‘Disease Avoidance?’

Some researchers propose that stigma is triggered by the “disease-avoidance system,” which elicits emotions of disgust and fear in humans. Both visible signs of illness and verbal labels can trigger this evolutionary reaction. The emotion of disgust is a hardwired signal to ‘get away’ and ‘this thing could hurt you.’

So we’re left with a quagmire: Diagnoses help to explain, communicate, and put a circle around a cluster of difficulties. But this disease label approach to mental functioning may be provoking exactly the kind of stigmatization response we are trying to reduce.

We’re All In It Together: Changing The Way We Think, And Speak, About Mental Health

The solution to this double bind may lay in how tightly we hold to a divided notion of health and illness. What if rather than pushing one agenda (mental illness is a disease) or the other (mental health is constantly changing along a continuum), we focused the discussion and education on the holistic components we all share?

We can, and should, educate the public on how to overcome the human predisposition to react with fear and disgust towards those suffering from mental illness. In particular, we should target misconceptions about people with mental illness being ‘dangerous’ and ‘unpredictable.”

What I’m wondering is this. What if together with increasing awareness and tolerance, we shift the conversation from one about disease and illness to one of our universal humanity? The interactive system of emotions, thoughts and actions, which underlie mental health and illness, apply to all of us!

So perhaps a more helpful way of reducing stigma, is not just in trying to get people to override their natural reactions to disease so much, and begin helping people to see mental health and illness in a more holistic way. What we see on the surface (i.e. diagnoses, personalities, overall functioning) are simply the different kinds of flowers in an ever-dynamic human garden. We all share the same soil!

When we become more informed about the processes, which apply to everyone, we can start dismantling the stigmatizing you-me, sick-healthy, crazy-sane divide, which propagates the stigma of mental health. With this information, we set the foundation for an agenda aimed more at the promotion of mental health maintenance, relapse prevention, and building individual resilience.

 

This blog was inspired by Dr. Fielding’s upcoming book: Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grownup. To learn more helpful skills for Mastering Adulthood, sign up for the Mindful-Mastery SKILL WEEKLY newsletter, or follow me on Facebook, Twitter, or Instagram. Or YouTube for skills videos!

 

 

 

Beyond Labels: Getting Past Stigma With How We Think About Mental Health.

Lara Fielding

Lara Fielding is a licensed Clinical Psychologist, who teaches, supervises, and specializes in the Mindfulness-based Cognitive Behavioral Therapies (CBT). Her private practice is in Los Angeles, where she is also an adjunct professor at Pepperdine University, Graduate School of Education and Psychology, and a Supervisor Psychologist at the UCLA Department of Psychology Clinic. Dr. Fielding teaches clients how to master the auto-pilot tendencies of the mind-body emotional system with mindfulness and self-care skills. As a behavioral psychologist, she works with clients to empower their skillfulness in managing stress and regulating difficult emotions. The skills she teaches are based on her research at UCLA, Harvard, and Peperdine, to incorporate the psycho-physiology of stress, emotion and cognition. Dr. Fielding has exhaustively studied the Mindfulness-Based CBT treatments (DBT, ACT, MBSR, MBCT) and their application for problems with Emotion Dysregulation. From this study, she derived a set of therapist guidelines for evidence-based practice. Dr. Fielding’s work is further informed by her research experience at UCLA and Harvard. Her research there explored the relationship between health behavior and the psycho-physiological effects of stress on cognition and emotion. Dr. Fielding is trained and experienced working with groups and individuals suffering from the effects of traumatic experiences, anxiety, and mood disorders. She has taught hundreds of clients concrete skills to better manage difficult emotions in the face of stressful life situations. With these cognitive and emotional skills in place, clients are guided towards personal values consistent behavioral change, in order to achieve their life goals.


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APA Reference
Fielding, L. (2018). Beyond Labels: Getting Past Stigma With How We Think About Mental Health.. Psych Central. Retrieved on May 24, 2018, from https://blogs.psychcentral.com/mindful-mastery/2018/02/beyond-labels-getting-past-stigma-with-how-we-think-about-mental-health/

 

Last updated: 1 Feb 2018
Last reviewed: By John M. Grohol, Psy.D. on 1 Feb 2018
Published on PsychCentral.com. All rights reserved.