THere are frequent initiatives by the mental health system aimed at reducing stigma around psychological issues. It’s felt that people will ask for and accept help if there’s less stigma. However, the mental health system itself is responsible for much of the stigma. It’s responsible for highlighting our differences and labeling some as abnormal. Instead of increasing understanding of our differences, the mental health system contributes to the marginalization of people it classifies as mentally ill.
The marginalization of people has always been and continues to be a social problem. People try to push aside others that they don’t understand, don’t agree with, or those who in some way bother them. They may try to isolate and ostracize. Sometimes they label. “That person” is crazy, manipulative, untrustworthy, etc.
What is the point of such labels? Do they not discredit? Are they not saying to people, “listen to me, discount what ‘that person’ says”? If such marginalization sticks and if others decide the labels are correct, what do we expect the impact to be? Unfortunately, it can lead to an automatic dismissal of information, viewpoints, and feelings expressed by the marginalized person.
Those who have given such labels have succeeded in isolating and ostracizing the targeted person. I’ve heard people say we should ostracize “that person” as punishment. Clearly, we know such treatment hurts people. So why do we have a mental health system (the stated goal of which is to improve people’s emotional wellbeing) labeling those who came to them as diseased or fundamentally and permanently flawed?
It’s hard to understand viewpoints that come from a place that you’ve never been in. It’s easier to label people as mentally ill and dismiss them. But such a practice adds to anger, increases conflict, and makes a path to recovery, already quite difficult, less possible.
I experienced a severe psychological problem because of a serious relationship conflict, which I’ve described in previous blogs on Mad in America. In my effort to recover from it, I dug deep into how my psychological problem developed. I use what I learned not just to understand myself, but to increase my understanding of others. For it was only through a greater understanding of why others’ viewpoints and interactions were different from my own that I could heal.
I looked at the many ways my psychological problem changed me. It didn’t just affect my mood, it affected how I view society, people, and relationships. It affected not just how I interacted, but how I could interact. Through it all, I discovered that how deep a psychological injury is, and the nature of the injury, creates viewpoints and behavior that differ, but in a way that is ultimately understandable.
Why do I think understanding these differences is important? Because I don’t think we can reduce conflict or help people struggling to heal without it. If what we do is support only those who are similar to ourselves in their emotional state and viewpoints, while pathologizing those who are different, then our differences and the conflicts around them will continue to grow.
What’s the harm in labeling?
- First, labeling discredits people’s viewpoints and opens people up to dismissal.
I worked as a caseworker for 30 years in the area of child protection, adult protection, and domestic violence. In that capacity, I heard the way that clients’ expressions of the problems they were struggling with were mocked and dismissed as excuses. I have said, “I think your client is being honest about her struggle, as I experienced similar difficulty.” One response I received is, “If you have had similar problems, you aren’t credible either.”
When legitimate struggles are rebuffed as excuses, those struggling have no choice but to hold in their thoughts and feelings. Of course, doing so adds to and aggravates their emotional distress.
As part of my work, I needed to engage families in service plans designed to resolve issues the family was struggling with. Often there was one person in the family who was seen as the problem. I didn’t have a problem engaging the person who had been labeled as the problem and marginalized, as long as I kept the plan within the framework of what they agreed they could do. However, it was very hard to get the person who wasn’t seen as the primary problem to budge on the complete satisfaction of their demands. They wouldn’t accept that those labeled “the problem” might have any limitations.
Sometimes a person isn’t meeting a demand because a limitation of the psychological problem prevents it. Not consulting, and not taking seriously what can or can’t be done, makes resolution impossible. With children in particular, the goal tends to be to just make them behave as desired.
I hear people who are struggling say to their helpers that their “help” is making them worse, not better. I hear them get a response that they are “unappreciative,” along with a complete dismissal of the complaint.
Theal of the complaints of those who are struggling means actions that dismiss the problem go unrectified. In addition, others see the person trying to help as the one deserving support. Plans are made on how to deal with the person labeled “the problem” without involving the labeled person. This isolates the person who is labeled, creates issues, and diminishes their options to vent issues in an appropriate way.
- Second, labeling is dismissive of environmental factors.
I developed extreme social anxiety after I experienced my psychological problem. But it wasn’t because of the initial conflict. It developed afterwards because the people I had to be around attacked me because of the psychological problem itself. My strongest critics were a few people who seemed to have a deep wound of their own. A close second to them were people who didn’t understand the symptoms a severe psychological problem creates. People often label their opposites as the problem, encourage others to view them as the problem, discourage any understanding or accommodation, and criticize.
So how should one respond when the attacker is at work, school, and home? My response to such a problem at work was to request a transfer. However, the therapist I saw didn’t see that as necessary. Clearly, there are many who find themselves in such a situation. Frequently, the response by the mental health system is to give a psychiatric diagnosis and offer some medication instead of allowing the person to escape a harmful situation.
This practice is easier than understanding and addressing the problem. But it doesn’t allow for recovery and is dismissive of the stress such a situation creates.
- Third, labeling fosters a belief that feelings aren’t legitimate but just a symptom of a psychiatric problem.
During a social work training session, an instructor once told me that one of the symptoms of a borderline personality disorder is those who have it feel like no one cares about them.
If you experience an emotional injury from a traumatic event, if you’re critiqued, criticized, and attacked for it, if the mental health system pathologizes you based on your symptoms… If you are seen as the problem and as causing problems for others… if the precipitating traumatic event is dismissed as being irrelevant because it’s in the past… The belief that no one cares isn’t irrational. It makes sense when the focus of concern isn’t for the person suffering or what happened that placed them there, it’s about the difficulty the person’s symptoms cause others.
Consequences of labels that marginalize
Those who are labeled become isolated and feel marginalized. The extreme hurt and anger the person is feeling can generalize, becoming anger towards humanity. Potentially, it can lead to a person who wants to hurt others. It can push them into groups of those who they sympathize with and protect while they attack others outside their circle. Groups that sometimes protect their members even when they commit crimes against others.
Of course, people are responsible for their actions. However, I think it’s important to look at the conditions in society and the mental health system that feed these problems.
People heal when they feel cared for and understood. They heal when the difficulty of their struggle is respected, and the effort they’re putting into recovery is supported. They heal when their viewpoint is listened to and the legitimacy in it is seen. They heal when they feel valued and of value. The current practice in the helping profession of pathologizing our differences, targeting some people as the problem, and attempting to force change takes away what’s needed for healing from people who are struggling.
The medical model has created an emphasis on medication and reduced the search for environmental causes and efforts to address them. Most therapies just focus on coping skills and mood regulation. Again, there is a failure to look for environmental causes and address them.
For this to change, people struggling with psychological problems need to be listened to. However, the mental health field has established a system of labeling people as mentally ill that sets them up for automatic dismissal of their feelings, viewpoints, and the information they can provide.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.