Labels

Reading the blogs Not So Big Society and Being Here over the last few days, both have spoken about perceptions of various mental health problems (Dementia/Alzheimer's and OCD) and it has got me thinking about the labels we put on things and what they come to mean. It is a fact that humans like to label things and throughout our language development (especially in the English language) we have been relentless in our pursuit of finding more and more names to call more and more things. This progression has reached its height with modern branding techniques, where a carefully chosen name can be the different between financial success of failure. Similarly in the medical field, as more viruses, syndromes, ailments and bacteria have been discovered, so too has the language used to describe them. Sometimes a name change reflects a progression in the understanding of a disease, for example when someone is exhibiting extreme and unusual behaviour we no longer say that someone has been possessed by demons or evil spirits, but more likely describe it as a form psychosis or perhaps a virus which targets the central nervous system. At other times a name change has been as simple as a shortening of a term, for example from influenza to flu, or a more specific description of a similar virus from "common" flu to H1N1. 

However any name change, no matter how seemingly small and insignificant carries a burden of meaning and perception for those who read and use it. In the example of flu, to my untrained medical brain it sounds considerably less serious and life threatening than something as horrific as INFLUENZA! Of course this is completely illogical and flies in the face of the facts: that they are one and the same disease, however I cannot deny the feeling that bubbles up inside me when people refer to influenza rather than flu. The longer, more archaic term carries with it a more serious connotation and so my perception is changed. Tell me you have influenza and I might fear for your life, tell me you have flu and I'll send you to bed with a cup of hot cocoa. The point is that these name games are risky (people die from "just flu" every year) and constantly muddy the waters of the process of accurately "labelling" things.

So what does this have to do with mental health? Well with mental health we have a real issue of definition. Our understanding of the human brain is still far from complete and thus any ailments associated with it must therefore also lack a degree of understanding. Doctors and researchers try and pin a label to behaviours they observe but these labels have extreme and potentially dangerous limits. As was the case when demons plagued the mind, a case of mis-labelling can lead to a subsequent misdiagnosis. An exorcism of a non-existent evil spirit will certainly never cure a psychotic episode, though it might do permanent damage to the individual suffering from it. 

Applying this logic to a modern situation, trying to pin a label on a behaviour which has an element of compulsion and an element of obsession and calling it a disorder, doesn't necessarily help us to help the individual with the observed characteristics. By applying a definition of OCD you automatically apply a character to that person, you lose the individual and replace them with a medical term, an acronym and a set of "symptoms". Indeed as Being Here reveals, she has experience of a number of people who have a label of OCD but who clearly do not actually fit what she recognises to be the "real" definition. Outside severe mental health diagnoses but on a similar track from my own experience, one of my students has a diagnosis of ADHD and does indeed have a lot of energy and can't concentrate for a long time. He is a handful to teach but I was told from the outset not to really bother or try to control his behaviour because "his parents say he has a diagnosis of ADHD". However lo and behold, when his father came to watch a class he was a perfect student. Now it could be argued he was just trying hard and successfully fighting any urges to run about and be his normal hyperactive self on this particular occasion, however this hour of complete serenity seems to cast some doubt on the prudence of "not bothering". Whether he was trying hard or not, he was able to improve and we had a good class as a result, thus the label of ADHD did a lot to pass the buck of responsibility for improving his behaviour, but did little to actually help the poor kid learn some English!

Seemingly the need to find a label is often an excuse finding process, as much as it is a naming process, which is clearly misguided and unhelpful to the individual. As Ermintrude2 argues in a post about Dementia:

"the importance is the ability of services – as with all mental illness – to respond to the person and not to the diagnosis."

Thus, society has a duty to focus on the individual and not get caught up in definitions. A label, no matter how well intentioned, shapes the object in our minds and when that "object" is a person, this really changes that person too, potentially unfairly. It also changes the way we respond to that person and try to help them. Grouping, or often more accurately "lumping" similar but always different people together under one diagnosis umbrella, might be very neat and tidy from a spreadsheet perspective, but from a people perspective it can be downright useless. Labels are helpful, but they must be used with caution.