Do the following names mean anything to you?
Brother of a plant lover
…Well, they did to the brother of psychiatrist Emil Kraepelin, the father of modern mental health labels. Kraepelin’s brother was a botanist (plant scientist) Maybe this contributed to his eagerness to classify human suffering into neat categories.
According to renowned Clinical Psychologist and author Dr Richard Bentall, “Kraepelin’s overarching ambition was to discover a workable diagnostic system that would allow his fellow psychiatrists to describe and make sense of the myriad problems they encountered in their clinics”.
A universal language
From that perspective this makes sense, as before psychiatrist Emil Kraepelin there were no agreed classifications, and therefore communication between psychiatrists would have been very difficult. Classification seemed to solve this issue.
Dr Bentall explains that “communication between researchers in different clinics was almost impossible. How was a psychiatrist working in say, Edinburgh to know he was studying the same kind of patients as his rival in Boston”?
From lab to pub
I wonder if Emil Kraepelin, who died in 1929, would ever have imagined that his framework would have left the research laboratory and grown such strong legs among the general public.
Nowadays you’ll often here people referring to themselves as being “A bit OCD” or explaining their actions in the context of “My personality disorder” and describing how their ‘Social Anxiety’ makes them feel uncomfortable in crowds.
An unintended consequence
Whilst these labels serve a purpose between mental health professionals and researchers, are they causing us to miss the woods for the trees when it comes to the real world? Does a focus on labels distract us from the person struggling beneath that label? Their unique experience might be missed.
Different to physical diagnosis
A diagnosis of type 2 Diabetes is based on biological markers, a prognosis of how the illness with proceed, and a suitable medication to match the diagnosis. But in the world of mental health things are very different…
For starters, there are no biological markers for common everyday mental health problems like anxiety and depression. There’s no blood test, saliva test, urine sample or brain scan that pinpoints them.
Prognosis is also very unreliable when it comes to mental health labels, as is finding a treatment that works as reliably as insulin would for type 1 Diabetes. When it comes to diagnosis, the worlds of physical and mental health are very different.
Psychiatrist Dr Robert Spitzer, who chaired the creation of the 3rd DSM (Diagnostic and statistical manual of mental disorders) said “there are very few disorders whose definition was a result of specific research data”. Suggesting that many new labels are as a result of consensus, not science.
In his book Cracked, Medical Anthropologist, Dr James Davies discusses an experiment used to explore the reliability of the current labelling classifications, which asked the following question: “Would two different psychiatrists diagnose the same patient in the same way”.
Dr Davies explains how the researchers sent the same group of patients to different psychiatrists in different locations to see if they would all get the same diagnosis...
He summarises their surprising results by saying, “This meant that the diagnosis you could be assigned not only depended on who your psychiatrist was, but on where your psychiatrist was located”. Pointing out the fact that diagnoses for the same people varied wildly across different psychiatrists and different places.
Not the same as physical illness
If we compare this to a physical illness such as Diabetes, its highly likely you will get the same diagnosis regardless of who or where is diagnosing you, due to the uniform nature of the illness, and the biological tests used to accurately determine it.
Do we give labels too much weight?
I personally think we do. It almost appears that nowadays a conversation about mental health isn’t complete without labels thrown in. Its not enough to talk of our distress without sealing it with a medical sounding label, as though that makes it more real, a stamp of authenticity if you like.
But distress is real whether it has a label slapped on or not. And when we focus overly on labels it leads to generalisations. Generalisations of what the distress means, and more importantly how to resolve it. But 20 people diagnosed with major depressive disorder or Anxiety, could be 20 people with completely different experiences. Labels ignore that fact.
"Go for a run mate"
And when somebody has come through Depression for example, and exercise was the thing that helped them, this can lead to lazy advice giving, such as “go to the gym”, or “try meditation”, as though what works for one will work for all.
These are the problems that arise from overuse of labels, they don’t leave any space for individual differences, as they're based on generalisations.
Ideas not things
Most people who use mental health labels don’t realise that they’re concepts rather than objective things. They don’t realise that the lingo they’re using was created to help clinicians and researchers share a common language, rather than for media reporters and the general public to adopt them.
Not to mention the fact that the current psychiatric classification system we use is just one approach. There are others such as the ICD (International Classification of Disease), The Feighner Criteria, The PTM (Power Threat Meaning) Framework, and psychological formulation to name a handful.
A shining light
American Clinical Psychologist, Paula Caplan says that "Mental disorders are nothing more than constellations”. She refers to how many millennia ago ancient civilisations looked up and attempted to make sense of the night sky.
We know that when we look out into the sky at night-time there is chaos there, but civilisations were able to make sense of the chaos by imposing patterns to the clusters of starts and giving them names. This process enabled them to have a mutual way of discussing that ocean of chaos.
An oversimplified map
Professor Caplan describes how the same thing happened with mental health classifications, in that years ago psychiatrists wanted to make sense of the types of distress symptoms people experience, and decided to cluster them together in groups of those which commonly occurred together, and give those symptom clusters names, such as Depression and Anxiety, rather than ‘Sirius’, and ‘Big Bear’.
Symptoms such as low mood, diminished interest/pleasure in activities, loss of energy, difficulty thinking or concentrating, dark thoughts etc, were grouped together under the constellation of ‘Depression’.
Obviously, we know that when we look up at the night sky, there’s no Orion’s belt there, or no Big Bear, but those concepts make it far easier for us to discuss the same thing, as do labels for mental health clinicians and researchers.
So what does this mean for the rest of us?
It seems that for the time being, mental health labels are here to stay as far as public discourse is concerned. And despite the fact that people feel they’re talking about real objective things, rather than concepts, we have to work from where we are, and promote the importance of staying focused on what’s truly important…the person beneath the label.
When we focus on people with problems, rather than people with labels we stand a much greater chance of the person moving forwards. A label doesn’t say very much about that person as an individual, and can cause us to miss the woods for the trees. As I said earlier, 20 depressed people probably have for more differences than similarities.
Somewhere within each person might be the key to unlocking their situation, and by focusing on empowering them and exploring that, we have a far greater chance of them getting unstuck than we do if we focus purely on diagnostic labels.
Let’s take a word of advice from Swiss Psychiatrist Adolph Meyer who wisely suggested we should give up trying to classify people like plants…
Jonathan Pittam Mental Health Educator