Labels, part 1

ADHD, agoraphobic, anorexic, antisocial, anxious, autistic, bipolar, borderline, bulimic, cyclothymic, delusional, depressed, dependent, dissociative, dysthymic,……..

We tackle the issue of diagnostic labels in a couple of different classes this semester. Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose various psychological problems. We are currently using the fourth version of the manual and the DSM-IV describes about 250 different psychological disorders. Many of the same labels have made their way into our everyday language. Due to the widespread use of labels, both in clinical settings and in everyday conversations, we should carefully consider their advantages and disadvantages.

Advantages:
Labels assist in communication. When clinicians around the world all use the same manual (and they do), the continuity of care for a client improves dramatically. If a person in Conway, AR is diagnosed with Bipolar II Disorder, he or she can go nearly anywhere else in the world and another clinician will have a pretty good idea of the client’s problems, just knowing the diagnosis alone. The DSM-IV labels improve the consistency of treatments between clinicians.

Labels sometimes make people feel better. Psychological problems can be scary – especially if a person feels lost about what is happening to them. Some people experience great relief just knowing that their condition has a name. Labels can make people feel safe. Naming a condition indicates we have some knowledge of and control over it.

Disadvantages:
Labels are limiting. While our labels may produce more efficient communication, they sometimes do so at the expense of accurate communication. Clients sometimes get “boxed in” by a label, and clinicians can miss important information because it doesn’t fit the diagnosis and they aren’t looking for it.

Labels are persistent. Once a person receives a diagnostic label, it tends to stick. Diagnoses are entered into client records that follow them for years if not a lifetime. Even someone whose symptoms have all but disappeared will likely retain the diagnosis for quite a long time. At best, past labels are documented in the past tense (e.g. “client has a history of Obsessive-Compulsive Disorder”). But the label is there nonetheless – it persists.

Labels create stereotypes and stigmas. Once others discover that a person has a particular diagnostic label, they will think of and treat that person differently. I sometimes illustrate this point in class by asking students what would happen if I were to disclose that I had been diagnosed with Schizophrenia several years ago. Nothing in my personality or behavior would change during those few minutes in class (nor in the following days, weeks, or months), but their perception of and interactions with me would immediately change nonetheless.

Labels become identifiers. People who receive diagnostic labels often begin to identify themselves in terms of those labels. In my work in community mental health clinics, I constantly met clients who identified themselves as their label: “I’m a Bipolar” or “I’m a Schizophrenic.” And I was constantly saying to them, “No, you are someone who struggles with Bipolar Disorder.” People think of themselves differently once they are diagnosed and so much of their identity can get wrapped up in their label.

I’m not suggesting we do away with diagnostic labels. I’m suggesting we use them cautiously and flexibly. More on labels coming tomorrow.