I have anxiety. She is bipolar. He’s ADD. These are examples of some of the comments heard at my office, and I think these types of remarks deserve a closer look at the impact they have on overall mental health.
With physical injuries and illness, the condition is often something that can be measured, counted, and seen by the naked eye. For example, it is relatively easy for a physician to detect a broken arm by X-ray, or a dentist to identify a tooth cavity under magnification. Countless additional body ailments are measured through blood draws and other similar methods. What cannot be accurately measured and counted, however, are mental illnesses including depression, anxiety, and attention-deficit disorder. In cases of mental illness, clinicians use self-reports, direct observation, and DSM checklists to identify how many symptoms a person displays. The process of identifying mental illness is much more abstract, compared to physical ailments that are more observable and easier to identify. This all leads to the big question of the impact of mental health labels being used with people who have no way to “see” when their condition actually improves. Without witnessing any progress, there is a greater likelihood the individual may feel as though he is doomed, and destined to have his disorder for the rest of his life — when in fact he can in all likelihood improve upon his condition if he didn’t think he was forever helpless to his situation. Mental health labels have the potential to create a pessimistic long-term view for future improvement, especially when people feel as though they “have” (absolute messaging) a condition that is genetic and has no chance to improve.
Why we use labels
It is understandable why we use labels in mental health, as they are designed to provide a common language people can use to identify, categorize, and apply to specific situations. Even if the labeling system in mental health is far from perfect, efforts to categorize mental illness symptoms are better than talking in general terms and saying things like “she has something going on.” The problem may have less to do with psychiatric diagnosis and more to do with mental health messaging, both at the macro- and micro-levels in America today. For example, mental health clinicians on the front line who assign psychological disorders to people need to do so in ways where the client fully understands the ambiguities with mental health diagnostics, as well as the potential to improve upon mental health conditions with proper treatment and self-care. On the national (macro) level, public service messaging should explain the nuance involved in mental health diagnostics, specifically as this applies to how inexact of a science it is to label a person with mental illness — and the related concerns as they apply to client optimism related to overcoming a mental disorder.
The danger of self-fulfilling prophecies
A self-fulfilling prophecy is defined as is the phenomenon of someone “predicting” or expecting something, and the expectation comes true simply because the person believed or anticipated it would. Clinical psychologists and other mental health professionals know that there is great risk for clients to assume and expect their mental health condition to define them, and often clients can act out symptoms (sometimes unknowingly) simply because they expected to feel a certain way after receiving their mental health diagnosis and label. From my own personal experience, I have found that cutting through labels and self-fulfilling prophecies is often more challenging than treating the actual mental health condition — especially with clients who are convinced they are helpless to a genetic condition they will invariably live with the rest of their life.
Unlike physical health issues that can often be measured by X-rays, white blood counts, and MRI’s, mental illness is not measured in any objective manner. What this means, practically speaking, is that mental health disorders are the product of subjective opinions made by mental health professionals that can sometimes be wrong. Additionally, when mental health diagnoses are made it is vitally important that clients fully understand how the diagnosis was made, a general timetable for improvement, and specific plans designed to meet treatment goals and objectives. Clients should also be made aware that for the vast number of psychiatric disorders clients can and do improve, and that only a small percentage of people fail to improve upon their situations.