Do mental health labels hurt more than they help?

While labels sometimes bring assurance because they give a name to what individuals experience and make them feel like they are being validated, whether or not they are really inclusive and whether they help or hinder treatment is a questions that needs addressing

A mental health diagnosis, like any other diagnosis, would mean labelling a condition a person is dealing with. There exists, however, a debate over whether labels are helpful, or do more harm than good.

Mental health professionals commonly use the Diagnostic and Statistical Manual of Mental Disorders, an authoritative guide published by the the American Psychiatric Association, to categorise and diagnose mental health problems. The first DSM was published in 1952; the one currently in use is the DSM-5 TR.

A double-edged sword

Educators, researchers, and mental health professionals note that diagnoses are most accurately made when they align with the latest academic findings and the appropriate cultural context. A diagnosis, for instance, may label Patient A with bipolar disorder or Patient B with OCD. Every time the DSM is revised, more classifications are added, even for slightly different symptoms. While these labels sometimes bring assurance because they give a name to what individuals experience and make them feel like they are being validated and understood, whether or not they are really inclusive and whether they help or hinder treatment is a questions that needs addressing.

The fact that labels convert symptoms and concerns into a tangible reality and this facilitates treatment, remains a major justification for their use. However, some researchers have argued that psychiatric medication is generally prescribed based on individual symptom dimensions rather than official DSM diagnoses. This suggests that treatment based on symptoms may be more effective than strictly following diagnostic categories, especially when those categories fail to capture the complexity of a person’s experience.

Another problem with mental health labels as noted by researchers is that they have the effect of creating stereotypes, which in turn increase the stigma of psychiatric illnesses. In India, especially in rural areas, the stigma surrounding mental illnesses makes it hard for people to reach out for support as it could affect them socially and personally. The process of healing, therefore, could perhaps benefit from a better understanding of individual experiences rather than from categorisation into diagnoses.

From diagnosis to identity

Stigma doesn’t just come from society. When individuals begin to internalise society’s negative perceptions about their diagnosis, it can result in internalised stigma and self-stigma, which can give rise to negative emotional and behavioural reactions and contribute to shifts in personal identity. The diagnostic label doesn’t remain a clinical tool; it becomes a central part of one’s identity.

A misdiagnosis can have an even more damaging effect: it can lead to poor self-esteem and self-efficacy and also affect attitudes towards recovery, operations, and outcomes. Not to mention the wrong medication can harm an individual physiologically. Over time, such internalisation may influence behaviour negatively.

Even if an incorrect label is later revised, the initial diagnosis can leave a lasting impression. A provocative demonstration of this was was by David L. Rosenhan’s 1973 study in which ‘pseudopatients’, or individuals who were psychologically sound, admitted themselves to psychiatric hospitals. Soon, they were falsely diagnosed with schizophrenia. Despite showing no symptoms, they were treated in accordance with the label and were discharged as ‘in remission’ and not as ‘healthy’. This is an excellent example of how powerful labels can be in influencing perceptions and interactions: the labels can take precedence over any contradictory information.

Historical, cultural, societal forces

Just a quick look at the evolution of the DSM reveals how cultural, social, and political changes have affected our perception of mental well-being. For instance, in the DSM-I (1952), homosexuality is seen as a sociopathic personality disturbance; in the DSM-II, it is viewed as a sexual orientation disturbance, and finally, it was removed from the 1973 edition of the DSM. This was the result of activism, as opposed to any scientific evidence.

Labels, therefore, are not entirely objective: they may be based on what is believed to be true at a particular time, as well as what is believed to be normal or acceptable. What is normal or abnormal, however, can change based on who has the power to define it.

Bringing in nuance

The DSM is still one of the primary guides for practitioners in the field of psychiatry. However, it is essential to note that the categorisations in the DSM do not cover the whole spectrum of complexities within challenges that individuals face psychologically. While labelling may foster a collective identity and encourage people to seek assistance, it can also limit one’s perception of the individual.

A classification defined as true today could easily be defined differently tomorrow. We must begin to discuss why we classify conditions at all, rather than just how we classify them, as the way society perceives identity and mental health continues to change. After all, every individual diagnosed is an individual with a history, identity, and strength far beyond any definition in any book.

Authors: Ishani Kanchan, Undergraduate Student, FLAME University; Keerthana Bhashyam, Undergraduate Student, FLAME University; Sunayna Andrade, Undergraduate Student, FLAME University; and Prof. Moulika Mandal, Faculty of Psychology, FLAME University.