Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

With diagnostic categories on the incline I find it increasingly important to qualitatively research how a person who has received a mental health diagnosis in their culture is affected throughout their life. I will attempt to examine this in the following piece through the work of several scholars in the field, some of which contribute to this very site.

Diagnostic Process

The word ‘diagnosis’ stems from the Greek verb ‘diagignoskein,’ which means ‘to discern’ or ‘to distinguish,’ as well as ‘to know thoroughly’ (Harper, 2011). In several handbooks on psychotherapy it is listed that making an accurate diagnosis is crucial to the therapeutic process. Psychiatric classification is thereby seen as a prerequisite for good psychological treatment, but Vanheule (2012) cites several qualitative issues he has with the current DSM system of classification. Vanheule’s critiques revolve around the exclusion of the lived experience of symptoms and complaints, leaving the individual’s subjective interpretation of his own condition out of consideration, neglecting the context of complaints in the individual’s memories, relationships, life narratives, existential events, as well as social and cultural situations, and ignoring the variability in the experience of symptoms and complaints both in one individual and between individuals. He is careful to conclude that he is not against the DSM per se, but believes that the current system of diagnosis through the manual is not workable for psychotherapy.

Labeling Theory

Labeling theory predicts that psychotic patients who accept the label of mental illness from the DSM system will have worse functioning than those who reject their diagnosis, while accepted psychotherapeutic theory suggests the exact opposite (Warner et al., 1989). Scheff (1966) believes that labeling and stigma causes subjects to see themselves as damaged and deviant and impairs their self-control, which in turn leads to a pattern of long-term abnormal behavior. In a 1989 study by Warner et al., fifty-four psychotic patients were asked to complete several questionnaires filled with various adjectives they would use to describe themselves. The goal was to measure the degree to which the individual accepted their diagnosis, the individual’s perception of themselves, and the individual’s self-esteem. The findings concluded that participants who accepted the label of mental disorder exhibited lower self-esteem if they perceived high levels of stigma attached to mental illness and that those who accepted a mental disorder diagnosis may assume that they lack mastery over their lives. It also found those who rejected the label had higher self-esteem.

The Third Domain

Link (1982) believes there are three domains of possible consequences associated with labeling someone with a psychiatric diagnosis: 1) the label creates the deviant behavior, 2) the label maintains or stabilizes the deviant behavior, and 3) the consequences stem to other areas of a person’s life including jobs, friendships, family relations, and mate selection. Critics of the labeling theory have addressed the first and second domains, but have underemphasized his third domain. This lack of emphasis provides an appropriate segue into the examination of how individuals who are given mental disorder labels are viewed by the population around them. Phillips (1966) interviewed several individuals on their willingness to associate with five hypothetical ex-mental patients who fell under the categories of paranoid schizophrenic, simple schizophrenic, depressed-neurotic, phobic-compulsive, and normal individual. The associations ranged from having the ex-patient as a neighbor to allowing their children to marry. The lowest scores were found in both of the schizophrenic categories where none of the interviewees felt comfortable allowing their children to be married to an ex-patient in either of these hypothetical cases.

In an American study, citizens reported more comfort with individuals who are deaf or have facial disfigurement than people with mental disorders (Hinshaw, 2007). Additionally, people expressed disgust when shown images of individuals who are homeless or abusing substance—behaviors that are often associated with active symptoms of mental disorder (Harris & Fiske, 2006). Media portrayals about persons with mental illness often emphasize a heightened potential for violence, which leads to the stereotype that these individuals are dangerous (Wahl, 1995). In a study aiming to assess the humanity associated with individuals who had received mental disorder labels, participants in an experimental condition were asked to form impressions of a hypothetical target with a mental illness while a controlled condition was asked to form impressions of a hypothetical target with a physical illness. Both participants were given a set of words associated with animality (i.e. wild, beast, untamed) and humanity (i.e. human, citizen, person). The mental illness label triggered decreased ascribed humanity as well as a greater perceived threat by the participants (Martinez et. al, 2011).

Stigma

Goffman (1963) adopted the term stigma from the Greeks who defined it as a mark meant to publicly represent immoral status. He noted that some stigmas might be readily apparent (i.e. skin color, body size) or hidden (i.e. religious affiliation, sexual orientation), but that both types often lead to prejudice if observed by a majority group member. Hidden stigmas can be self-promoted, given by others or ascertained based on association; for example, observation of someone leaving a psychiatric clinic might lead to the assumption that the person is mentally ill (Corrigan, 2007). Findings from the National Comorbidity Survey identified several stigmatizing beliefs that might sway people from treatment including concerns about what others might think and the desire to solve one’s own problems (Kessler et al., 2001).

Personal Accounts

Studies surrounding mental health can give us some idea of the stigmas associated with these labels, but it is important to look at the experience of a patient who has been labeled mentally ill in their culture first-hand. Judi Chamberlin, an American author and activist, recounts her experience as a patient diagnosed with a mental illness:

Eleven years ago, I spent about five months as a patient in six mental hospitals. The experience totally demoralized me. I had never thought of myself as a particularly strong person, but after hospitalization, I was convinced of my own worthlessness. I had been told that I could not exist outside an institution. I was terrified that people would find out that I was an ex-patient and look down on me as much as I looked down on myself (Chamberlin, 1978, p. 6).

Prateeksha Sharma, a musician and mental health research in India, details her experience with being diagnosed with bipolar disorder in her particular culture:

This is a story of my personal journey with Bipolar illness over the last 19 years. For a large part of this time I have wondered if this story is also one of a person with some weakness, for I have often felt like that due to the seeming lack there is within me. I was made to believe that I need to look up at suitable “outsiders” for support, guidance, and inputs at all times to live my life in a “proper” and “balanced” way. Those “outsiders” have been variously pointed out to me as medicines, doctors, analysts, jobs, and relationships in which I should find an anchor for myself and structure my life around, for a life apart from these is not meaningful or entirely feasible for one such as me. There is also the distant presence of my psychologist with whom I have been redefining the narrative structures that have been handed down to me by a system, which sees the psychiatrically ill woman as a “poor girl” or someone to feel sorry for (Sharma, 2011, pp. 3-4).

Overcoming the label

If not pills, though, what is the solution to overcome being labeled mentally ill? In 1796 a man named William Tuke established the York Retreat in England. It was a Quaker-operated religious hospice that is considered to be the birthplace of an approach called moral treatment. Tuke focused on the healing powers of benevolence and charity. Patients were understood to have an innate capacity to heal, empathetic listening was practiced, and the environment was structured to reduce stress and strain in order to promote the patient’s recovery. Centers that began practicing moral treatment in its time saw astounding results with over half of the patients leaving “cured,” “improved,” or “recovered” in all reported cases (Olfman & Robbins, 2012).

Results of a study including 70 mental health consumers were presented at the eighteenth annual Mental Health Services conference in Auckland, New Zealand. The study aimed to assess if the process of being diagnosed with a mental illness was helpful. The results indicated that people had expected the diagnosis to provide hope and an opportunity for recovery, but instead found that being diagnosed opened the door to stigma and discrimination, altered family and other relationships, prejudiced their work and employment possibilities, and reduced their lifestyle opportunities. Some participants found it helpful to get statistics on individuals who had gone through the same experience as them and find out what they went on to do afterwards. The participants agreed what was best for them was a holistic treatment plan developed over time including factors such as talk therapies, physical and creative pursuits, alternative remedies, and spiritual paths (Zoeller, 2008).

The accounts of Chamberlin and Sharma also give us some insight on how patients labeled mentally ill are able to overcome the perceived stigma. Chamberlin found comfort in group settings:

Gradually I had to recognize that I was not the fragile shell I believed myself to be. It was a long process. I had to fight the crippling belief in my inferiority, a belief that I had been given by the people I once trusted as healers. It was years before I allowed myself to feel anger at a system that had locked me up, denied me warm and meaningful contact with other human beings, drugged me, and so thoroughly confused me that I thought of this treatment as helpful. Of enormous help in digging through the layers of mystification has been my involvement, for the past six years, in a number of mental patients’ liberation groups, in which ex-patients have come together to validate our own pain and anger (Chamberlin, 1978, p.7).

Sharma formed deep relationships with her music and immediate family members:

I have repeatedly, and with a good measure of obstinacy, refused the labeling and have forever been constructing my own reality—one in which the mainstay of my life is not medicine, but music; where the deepest relationship I have is not with another but my own self. I owe immensely the women in my immediate family a great deal, for all those times that I found myself slipping into the societal traps of psychiatric nomenclature, they have repeatedly pulled me out to remind me of these alternate and less conventional ways of looking at situations (Sharma, 2011, p. 4).

References

Chamberlin, J. (1978). On our own: patient-controlled alternatives to the mental health system. New York: Hawthorn Books.

Corrigan, P. W. (2007). How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness. Social Work, 52(1), 31-39.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.

Harper, D. (2011). Online etymological dictionary. Retrieved from http://www.etymonline.com/index.php?search=diagnosis

Harris, L. T., & Fiske, S. T. (2006). Dehumanizing the lowest of the low: Neuroimaging responses to extreme out-groups. Psychological Science, 17, 847-853.

Hinshaw, S.P. (2007). The mark of shame: Stigma of mental illness and an agenda for change. New York: Oxford University Press.

Kessler, R. C , Berglund, P A., Bruce, M. L., Koch, J. R ., Laska, E.M., Leaf, P.J., Manderscheid, R.W, Rosenheck, R. A., Walters, E. E., & Wang, P S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987-1007.

Link, B. (1982). Mental Patient Status, Work, and Income: An Examination of the Effects of a Psychiatric Label. American Sociological Review, 47(2), 202-215.

Martinez, A. G., Piff, P. K., Mendoza-Denton, R., & Hinshaw, S. P. (2011). The Power of a Label: Mental Illness Diagnoses, Ascribed Humanity, and Social Rejection. Journal of Social and Clinical Psychology, 30(1), 1-23.

Olfman, S., & Robbins, B. (2012). Drugging our children: how profiteers are pushing antipsychotics on our youngest, and what we can do to stop it. Santa Barbara, Calif.: Praeger.

Phillips, D. L. (1966). Public identification and acceptance of the mentally ill.. American Journal of Public Health and the Nations Health, 56(5), 755-763.

Scheff, T. J. (1966). Being mentally ill: A sociological theory. Chicago: Aldine

Sharma, P. (2012). Mending the Broken Frame: Self-Narration in a Constructionist Framework. Psychological Studies, 57(2), 189-194.

Vanheule, S. (2012). Diagnosis in the field of psychotherapy: A plea for an alternative to the DSM-5.x. Psychology and Psychotherapy: Theory, Research and Practice, 85(2), 128-142.

Wahl, O. F. (1995). Media madness: Public images of mental illness. New Brunswick, NJ: Rutgers University Press.

Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance Of The Mental

Illness Label By Psychotic Patients. American Journal of Orthopsychiatry, 59(3), 398-409.

Zoeller, R. (2008). Mental Health Diagnosis A Label. Austrailian Nursing Journal, 16(4), 47.

Chloe Detrick

About Chloe Detrick

Chloe Detrick works for the Society for Humanistic Psychology and manages the Global Summit on Diagnostic Alternatives site. She is a summa cum laude graduate of West Virginia University's P.I. Reed School of Journalism, where she received a Bachelor of Science in Journalism with a major in public relations and a minor in english.