To Label, or Not to Label

hand marking checkboxes on checkboxesWhen you go to your doctor for some problem you are having, there is no question that you want an answer to what it is. Not only does it ease your mind because you have clarity, but it also means that there may be treatment for that problem/disease and you will hopefully get better.

It’s not quite so apparent when it comes to our mental health. You may have heard of the Diagnostic and Statistical Manual (DSM), which is like a bible of diagnoses for mental health. Originally compounded by psychiatrists (MDs), it reflected doctors’ beliefs that mental health issues are like diseases, and can be treated once diagnosed.

The most recent version of the DSM, put out in 2013, has been updated to reflect current research and practices. It is used to label mental health issues so that insurance companies know what and how to bill. But for many practitioners it is also a useful way to define a client’s condition. So, is it helpful or not?

On the plus side, there are times when having a label to your experiences gives you peace, as you have a name for it and don’t feel you are “just crazy”. It is also critical in determining medication interventions. If one is diagnosed with attention deficit issues (ADD) or bipolar, for instance, it is likely that the right medication(s) can greatly improve quality of life. Having such a diagnosis—and very clear criteria to make that diagnosis—aids therapists and clients in collaboratively identifying courses of treatment.

Labeling also often helps clients in explaining unexplainable behavior to their significant others. Imagine, for example, that your spouse is constantly late, procrastinates, forgets everything you tell him, and seems to space out a lot. Perhaps you are angry because he doesn’t seem to be trying to improve these problems.

If your partner is diagnosed with ADD, that gives a lens through which you can now understand your husband’s behavior, and it allows you to problem solve together, set realistic expectations for change, and, of course, get appropriate help in the form of therapy and/or medication.

On the down side, labeling can be highly stigmatizing and can even limit treatment options. Certain diagnoses come with all sorts of judgments—even on the part of therapists, who should be aware of these judgments, but aren’t always. Clients can become stuck on their diagnoses, instead of working on the solutions.

Most diagnoses don’t come with a clear and definite treatment, like a medical problem might. For instance, a diagnosis of depression might be treated with medication, cognitive behavioral therapy, hypnosis, mindfulness, or dozens of other options, depending on the client’s needs and the therapist’s skills. So some therapists prefer to look at the constellation of symptoms, and decide how to approach them without needing to put them in a box.

Having a label can be freeing, and can allow you and your therapist to come up with the right plan for you without adhering to strict labels. Another serious concern about labeling is that mistakes are made quite often! It could be the result of an unskilled therapist, or perhaps that clients share only selective information or inadvertently leave things out because they don’t know it’s important to share. Sometimes it takes years to piece together the whole picture and fully understand a person.

Whether you believe in labeling or not, it is always wise to do your own research, get a second opinion, ask lots of questions, and trust your gut!

© Copyright 2014 All rights reserved. Permission to publish granted by Lillian Rozin, LCSW, MFA, RYT, Aging and Geriatric Issues Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Ellen

    March 14th, 2014 at 3:50 AM

    While for you, the partner, having a label might make you feel better, but you also have to look at this from the other point of view and think about how this makes the one who has to then wear the label feel. Does this make him feel diminished? Like no one will ever think of him as anything other than just that one thing? If that is the case then one has to be very careful about how this diagnosis is assigned and then what you do with it. It is always good to seek out answers and subsequent treatment, but not to the extreme where it can end up making one feel worse than they did before.

  • jayme

    March 14th, 2014 at 1:24 PM

    When you go about it the right way then a label is not necessarily a negative thing. I know that there have probably been times when we have all seen it used in a way that is less than positive but believe me, when it gives you answers then it can also give you hope, and when you have struggled with something for a very long time than this is often all that you are searching for.

  • Noel

    March 15th, 2014 at 7:10 AM

    Every answer in general is going to come with some sort of a label.
    This is the nature of the best.
    If an insurance company is going to pay, then they want to have a clear cut diagnosis of what they are paying for.
    Anyone would.
    With that comes the necessity of a label.
    I don’t know if this is always going to be a good thing, I can see both sides of the issue, but we know that this is where the industry stands so this is where it is today.
    Have to make the best of it and be grateful for the answers and the progress that then comes from that.

  • Elaine Ellis

    March 16th, 2014 at 11:59 AM

    This is a difficult one, because I live in the UK, where we do not have to rely upon insurance to meet medical costs. We, do, however utilise both the DSM and the ICD as diagnostic tools in the field of mental illness. What worries me is that there is SO MUCH OVERLAP of symptoms in these manuals from one illness to another, that it could be argued they may make diagnosis MORE confusing. What one practitioner may see as “Reactive Depression” another may interpret as “Post Traumatic Stress” – simply because of the overlapping of symptoms. The point, then, becomes WHAT is the CORRECT diagnosis? Especially as diagnosis can affect treatment options, even here in the UK.

    To justify use of labels in the UK simply because this simplifies matters for insurance companies in a foreign country is simply NOT acceptable. Labels come with all sorts of associations attached, many of which (when referring to mental illness) can be significantly negative in nature. Use of labels implies a use of “shorthand” in which the patient often “becomes” the label. We all know the negative connotations associated with labels such as “schizophrenic”, “personality disordered” – labels that are easily adopted by the media, who wish to sell sensationalist stories that do not always reflect the true nature of mental illness, and patient experiences.

    Human beings – even those who are mentally ill – are complex creatures, FAR more than just labels. When we stoop to using labels as rote; rather than questioning why we are doing so, and what said labels actually mean; we do a disservice to humanity.

    For a LONG time, there has been a lack of parity between health care for physically ill people, and health care for mentally ill people, with those who are mentally ill being viewed in some way as “pariahs”. Though the days of “Asylums” and other such horrors are allegedly long gone, societally we still hold onto a view of mentally ill people that is stigmatizing and degrading. We assume lack of competence, lack of capability. We assume that they are “different” or “weird” – labels only add to this.

    We need to encourage a system that sees beyond such things, in more ways than one. We need to ensure that patients who need treatment and support are not forced to access it in ways that leave them open to stigma, and negative associations. We need to ensure that patients are seen first and foremost as HUMANS. For example… is Stephen Fry merely Bi-Polar, or something FAR beyond that? Bi-Polar does NOT in any way define his intellect, talent, creative ability, wit, determination…

    We must be aware that labels often STICK, and that once there – even if they prove to be inaccurate – they are hard to eradicate. Labels, even wrong labels, leave a legacy. They diminish people; in the case of those who are mentally ill, labels erase from view any good qualities the person may have, and supplant instead a whole host of negative stereotypes.

    Besides, to argue that labels are necessary in order to allow for the administration of medication is a fallacy. Much of the labelling that goes on in mental health care is as a result of trial and error treatment (see links to papers on this subject). Put simply, the patient who presents with “X” symptoms is put initially on “Y” medication to see if it works. If it does not relieve symptoms after a specific period of time, the patient then gets to try “Z” medication – and so forth until a medication is found that “suits” the symptoms. A “diagnosis” (i.e. label) may then be produced on the basis of medication that the patient responds to. HOW accurate is this? Recent research certainly shows a lack of evidence to validate the practice!

    It could also be argues that labels do not fully reflect the extent of patients’ experiences, nor do they encapsulate all that lead to the point at which the patient now finds him/herself. Many people who are abused in early life struggle to express what has happened to them; many never do. Instead, they may present as “mentally ill”, “disturbed” or similar. But ARE they? Do THEY really need medication? Do THEY really need a label? We REALLY ought to STOP and THINK about this one!

    The truth is that were any of us to be placed in a position where we were bullied or abused as youngsters; let down by those who ought to have provided nurturing, care and support; WE WOULD ALL REACT NEGATIVELY. This would be perfectly NATURAL. Each and every one of us is equipped with emotions, which help us to react to various situations. Emotions are a NATURAL part of being.

    Put bluntly… each and every one of us who has known BEREAVEMENT, has also known GRIEF, LOSS, MELANCHOLY, HURT, ANGER, DENIAL, FRUSTRATION… Each and every one of us who has experienced relationship breakup may have also known PAIN, LOSS, REMORSE, HURT, SELF-DOUBT… There is NOTHING “abnormal”, or “mental”, about this. So, there is NOTHING “abnormal”, or “mental” about the abused or traumatized (young) person who experiences RAGE, HURT, PAIN, UPSET, ANGER, FEAR, WITHDRAWAL, DENIAL, MISTRUST, CONFUSION…

    Did we all somehow leave Freud and Jung(amongst others)in the “basement”? Where is our understanding of “defensive mechanisms”? To act in a defensive manner with regard to past trauma does NOT automatically imply PATHOLOGY. We NEED to find a better, more appropriate, more sensitive way of looking at things.

    Yes, there may be mental illnesses with organic causes… but we do not yet possess the technology to fully look inside and fully understand the brain. So, diagnosis of such “diseases” remains speculative. A person presenting as “Bi-Polar” could just as easily be hiding a long back history of childhood abuse and neglect – and might, were this to be uncovered, benefit FAR more from “talking therapies” than from pills. They might also, therefore, benefit hugely from avoidance of being incorrectly labelled “Bi-Polar!

    Only HOLISTIC care can truly reflect the human. Labels are NOT holistic, they are REDUCTIVE in nature. If we are truly to provide care that has the BEST INTERESTS of patients at heart (as opposed to being influenced by budget, politics or “the system”) then we need first and foremost ALWAYS to see the HUMAN… and NOT the label.

  • Joanna

    March 17th, 2014 at 4:00 AM

    Medicine in general relies upon lables to provide patients with the most reliable and thorough care. I am not sure where there would be any harm in this?

  • DEan

    March 18th, 2014 at 4:04 AM

    Maybe not quite as dangerous as it was when insurance could deny you because of pre existing conditions

  • zach foster

    March 19th, 2014 at 3:58 PM

    When there is something that is good that comes out of it, then fine, I can handle it
    But what if there is nothing to gain from it?
    What if there is nothing more to it than just words?

    Labels can be hurtful
    but they can also help when done in the right way

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