Resisting Labeling and Defining People by Their Mental Health Diagnosis:
“I’ve been labeled with ADHD, obsessive compulsive disorder, addictive personality disorder and poly-substance abuser,” describes Nick Carveth, a social work student at Ryerson University.
Growing up with a psychoanalyst as a father, Nick quickly learnt that he was an uncommonly anxious child. Beginning at the age of 16, during the most extreme period of his addiction, Nick completed psycho-educational testing and scored in the 98th percentile for anxiety, meaning that only two percent of the population tested had more severe symptoms.
“Much of the need for this test resulted from my parent’s dismay at my apparent disinterest in getting an education or job because I had become hopeless about the prospect of graduating high school, preferring instead to keep my anxiety at bay by chasing cocaine highs all day” explains Nick, “I tried a few different therapists and addiction treatment programs and mostly felt manipulated and patronized in environments that were abstinence based.”
Although psychiatric treatment programs can reduce individual’s symptoms dramatically, the official labeling that accompanies this treatment can affect individuals negatively. For those struggling with mental health problems, recovery often involves overcoming stigma, particularly perceptions of dangerousness and incompetency.
The stigma associated with mental illness presents a serious obstacle both for individuals looking for mental health treatment and for diagnosed individuals in the community. When individuals are officially recognized to have a mental illness, they are placed into a cultural category that damages their social and psychological well-being.
The effects of a person being labeled with a mental illness are translated into actual behaviours. Discrimination against people with mental illness in the workplace, when seeking housing, or when applying for loans or insurance has been well documented, as has rejection by acquaintances, friends, and family.
These negative consequences of psychiatric treatment are rooted in cultural definitions of the ‘mentally ill’. When an individual is diagnosed with a mental illness, cultural ideas about the ‘mentally ill’ (e.g., incompetent, dangerous) become personally relevant and are transformed into expectations that others will devalue and discriminate against that person.
In the case of diagnosing mental illness, the power to label is a significant one and is entrusted in the psychiatrist. Once an individual has been diagnosed as mentally ill, labeling theory would assert that the patient becomes stripped of their old identity and a new one is ascribed to them. A process which usually leads to the labeled person internalizing this new identity and social status and taking on the role of the psychiatric patient with all its associated set of role expectations.
Nick states that, “at some points I have definitely internalized some of the stigma about madness and substance use, thinking myself to be incompetent to perform certain tasks safely, which of course creates a vicious cycle of symptomatology for a person experiencing severe anxiety.”
Stigmatization is another aspect that follows, which has the effect of excluding the labeled ‘psychiatric patient’ from normal interactions. Nick describes moments when he recognizes stigma in the way that others perceive him. One example of this happened after being expelled from an alternative school for his substance use in grade 12. The principle told his parents “let him hit the streets, if he survives he might learn his lesson.”
Another common incident where Nick is aware of his stigmatization by others is in his interactions with police officers. “I am often perceived to be dealing drugs or pan-handling when I am just walking along the street.”
A big change in Nick’s life occurred when he entered the Recovery and Education for Adolescents Choosing Health (REACH) program at Centre for Addiction and Mental Health (CAMH) located in Toronto. The program works to make both treatment and education more manageable for youth ages 15-21 in mental health treatment and specializes in addressing concurrent disorders.
“I entered REACH and learned they practice from a harm-reduction philosophy, I was amazed when I found out that I could still use substances and attend the program as long as I didn’t come to groups high or bring drugs on the property,” Nick reflects on his first impression of the REACH program at CAMH.
“It was so unlike the negative rehab experiences I’d had in the past. It was liberating to be able to set my own goals with regards to my substance use and to work on them at my own pace, in a setting where relapse was viewed as just another part of the recovery process.”
Nick graduated high school through the REACH program where he was also inspired to enter the social work program at Ryerson University. Knowing that agencies are looking for more people with personal experience to work in the field, motivated Nick to continue on his journey towards recovery, where he has now abstained from cocaine, crack, and other similar drugs for nearly four years.
Having completed his third year in the undergraduate social work program, Nick argues that he continues to struggle with being taken seriously within an academic context because of his identification with the drug culture. Although he also explains, “there are two sides to this, because even though I feel I am not taken seriously in some settings, social work courses at Ryerson do provide me with a space in which my lived experiences are valued.”
Recent reviews suggest that attitudes are actually worsening when it comes to society’s views on mental illness, which is why it is important to take on new approaches to reduce or possibly eliminate the negative outcomes of diagnostic labeling.
Several studies have examined the impact of education on public attitudes about severe mental illness based on the finding that people who seem to be knowledgeable about mental illness are less likely to endorse stigma and discrimination. Education, which seeks to replace stigmatizing attitudes with accurate conceptions about the disorders is one strategy that social psychologists suggest can be done to reduce negative outcomes.
A second strategy to assist in changing public attitudes about mental illness is to facilitate interactions between people and persons with mental health issues.
Nick suggests that imposed labels and stigma can be resisted through altering the words used to describe the ‘deviant’ behaviour. He explains that in written text “I like to use the post-conventional technique of bracketing certain phrases to break down binaries such as use and abuse or normal and abnormal.”
Examples of these phrases can be written like substance (ab)use, (dis)ability, or (ab)normality. “In this way a synthesis is created from two seemingly opposing discourses which leaves an open question that allows for true self-identification.”
Another suggestion to break down stigma with regards to written text is the concept of the person-first language movement, which began some 20 years ago to promote the concept that a person should not be defined by a diagnosis. By literally putting the “person” first in the language, what was once a label becomes a mere characteristic. No longer are there “mentally ill people,” instead there are “people with mental health issues.”
By suggesting that a diagnosis is a person’s most important characteristic reinforces the all-too-common opinion that people with mental health issues have limited potential and society should expect nothing from them.
Nick also argues an important piece of the puzzle for activists and advocates is to “get the word out there that these labels are merely social constructs, basically the opinions of a committee of psychiatrics who get together and vote about what they believe constitutes so-called ‘normal’ and ‘deviant’ behaviors and cognition.”
Nick suggests, “another way people can resist labels is through the reclamation of the terms that have been used against us, adding our own emancipatory connotations.”
For instance a term with growing popularity is “madness”, which is an umbrella term for those who identify as ‘crazy, mentally ill, insane, psychiatric survivor, users, consumers, or inmates.’
In the past “madness” was used as a way to belittle people who had psychiatric experiences but these days “madness” is a word that has been reclaimed and re-possessed by the people it originally hurt.
Historically there has been a dependence on identifying Mad people with only psychiatric diagnosis, which assumes that all Mad experiences are about biology as if there wasn’t a whole wide world out there of Mad people with a wide range of experiences, stories, history, meanings, codes and ways of being with each other.
Overall there are three main approaches for changing stigmatizing attitudes: education, which seeks to replace stigmatizing attitudes with accurate conceptions; contact, which challenges public attitudes about mental illness through direct interactions; and protest, which suppresses stigmatizing attitudes toward mental illness and behaviours that promote these attitudes.
Alannah Sheridan is currently a fourth year social work student at Ryerson University with an interest in the field of mental health.
This article’s focus is to provide the reader with a counter hegemonic perspective of diagnostic labeling and the importance of resisting imposed labels. By interviewing Nick Carveth, Alannah was able to place knowledge back into the hands of a person with lived experiences and values a perspective, which is not often heard or seen in the media.
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