Weighing Psychiatric Labels
This guide explores the benefits and risks of using psychiatric labels to describe a person’s challenges. Labels are words, and words have power. Considering if, how, and when you use a label can help you avoid the pitfalls.
Where Do Psychiatric Labels Come From?
Sixty plus years ago, the American Psychiatric Association developed a system to help clinicians across mental health fields make consistent diagnoses. The system provides diagnostic criteria for mental disorders by organizing clusters of symptoms that tend to occur together into categories. All this is presented in the Diagnostic and Statistical Manual of Mental Disorders or “DSM” (the current version is “DSM 5”, the fifth edition).
This pathology-based system can be deceiving, because labels don’t correspond with known, measurable biological processes. Unlike diabetes, for example, which can be diagnosed by measuring insulin levels, mental “disorders”, such as ADHD, Autism and Anxiety, are determined by what amounts to a symptom checklist.
Although the DSM provides standardized guidelines, there is still room for subjective interpretation. A child may have symptoms from more than one category, but a clinician will determine which category (or categories) fits best. Since diagnosing is as much an art as it is a science, it’s crucial to find a qualified practitioner whom you trust.
Positive Aspects of Labels
Diagnostic labels are a verbal shorthand way of characterizing a particular disorder, giving parents, teachers, and clinicians some idea of what to expect. Professionals including practitioners, researchers, advocates, and insurance companies use labels to simplify communication in describing problems and needs, making decisions, discussing practices and interpreting outcomes.
Can be empowering
For many parents, diagnostic labels help define the problems their children face and allow for greater understanding. Having a name for the condition means parents can acquire knowledge, seek help, and take action to improve the situation.
Provide something to blame
Having learning, behavioral or emotional problems can impact a child’s self-image. By having a label to blame, kids can create some distance between themselves and the problem. The phrase “it’s not me, it’s my ADHD” demonstrates how diagnostic labels allow some children to reattribute their difficulties to the diagnosis rather than blaming themselves. Diagnostic labels can also help defuse charges of laziness or stupidity leveled by teachers, parents, or peers.
Satisfy the “system”
A diagnosis is required for a child to qualify for certain special education services, and a diagnostic code is required for insurance coverage.
The Negative Aspects of Labels
People see the diagnosis first
A diagnostic label may cause people to focus on the expected problems while overlooking other, positive personal attributes. People may selectively attend to information that confirms the label, rather than seeing the whole person.
Don’t explain enough
Labelling of differences tend to be all or nothing. An individual is viewed as either having a specific disorder or not. In reality, all mental health conditions land on a spectrum. Measures such as severity, pervasiveness, chronicity, and degree to which the cause is environmental or internal are not readily conveyed by a label.
People have different interpretations and experiences related to labels. There’s a saying that “if you’ve met one child with autism, you’ve met one child with autism.” This holds true for any diagnosis. Two kids might have the same label, but seem to have little in common. Using a label to describe a person can leave more misunderstanding than not.
Can create limiting expectations
Diagnostic labels can create a set of limiting expectations, not only for the adults who are trying to help, but for the child as well. When we lead with a label, our kids might hear “you have a disability, a disorder, a deficit”, which sends messages that can be internalized as “you are broken…you have less potential than others…you will be trouble…here’s your excuse for not trying.” None of these messages are constructive. As Ned Hallowell notes: “Using our pathology-based model, when we diagnose and treat these kids we often, inadvertently, instill the most dangerous ... disabilities (which) are fear, shame, loss of hope, broken confidence, shattered dreams, and a feeling of being less-than. Those are the disablers.”
a suggestion: “People-First” Language
The language we use to describe our children shapes other people’s perceptions about their abilities, as well as their own self-concept. Words are powerful. The People-First approach emphasizes the person, rather than the disability. For example, rather than referring to someone as a “(diagnostic label) kid”, one would say this is “a kid who is affected by / living with (diagnostic label) -- and also happens to have xyz strengths and interests.” As the Arc explains: “By placing the person first, the disability is no longer the defining characteristic of an individual, but one of several aspects of the whole person.”
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