Some of these mental health models are: Urie Bronfenbrenner's bioecological model, positive psychology, and the related strengths model/strengths perspective .
An Inadequate Platform for Mental Health Treatment
This page has been edited and reviewed by psychologist R. Y. Langham, M.M.F.T., Ph.D.
"The result of the emphasis on DSMMD labeling is that people are now being defined as their mental disorders, rather than being perceived as having encountered certain obstacles in their lives with which they are struggling."
Kristin Madsen, MA, MSW (Medical Social Worker)
Labeling, based on the medical model of psychiatry, is a method and a theory, a basis or foundation for psychiatric treatment, and although widespread and the standard approach in psychiatry, it is not universally accepted in all professional communities, in part or in whole. There are other models of mental health which provide foundations which approach psychiatric disorders and mental health from a totally different angle, though not as popular, they are equally, or even more-viable, realistic, holistic and productive, than the medical model.
A psychiatric labeling parody featured on an episode of The Simpsons.
Labeling and drugging are convenient ways of treating mental health disorders,
primarily because it is profitable convenient for insurance
and pharmaceutical companies.
The medical model is convenient because it provides the practitioner with a clear-cut approach to handling individual situations, but most of all, it is commonly used in the psychiatric world to label and prescribe an array of psychiatric drugs. The medical model of mental health typically involves: identifying symptoms, assigning an appropriate label, and administering what is deemed appropriate drugs.
This practice, along with the stigmatization of individuals diagnosed with a mental health disorder and/or exhibiting symptoms of a mental health disorder, has come under the intense scrutiny and criticism within mental health professional circles for lacking a sound basis for treatment.
Pharmaceutical companies often use unethical methods (i.e. monetary incentives, kickbacks and/or "gifts”) to vigorously market
these drugs to physicians.
Pharmaceuticals have been enthusiastically marketed to physicians since the 1960s along with economic incentives. Though there has been resistance to the medical model and its implications with widespread use of pharmaceuticals as a first-line method of treatment, this practice has "sold" the medical model to the medical community over the decades until it has gained widespread acceptance.
Ethical boundaries are consistently approached and breeched;in fact, multi-million and billion dollar government and consumer lawsuits  have been launched and successfully pursued against pharmaceutical giants like Johnson & Johnson (Risperdal) , GlaxoSmithKline (Wellbutrin, Paxil), Abbott Laboratories (Depakote), Eli Lilly (Zyprexa), AstraZeneca (Seroquel), Bristol-Myers Squibb (Abilify).
According to Paul McHugh, M.D., professor of psychiatry and (2003) chairman of the department of psychiatry and behavioral sciences at John Hopkins University School of Medicine, the DSM label of borderline personality disorder, as an example, has lost its usefulness.
Dr. McHugh stated in Time Magazine that the DSM (i.e. the "bible" of psychiatric labeling) has "permitted groups of 'experts' with a bias to propose the existence of conditions without anything more than a definition and a checklist of symptoms. This is just how witches used to be identified." He cites multiple-personality disorder as an example of an "imagined diagnosis"; while much of the evidence supporting its existence has been debunked, multiple-personality disorder is still listed in the DSM, though today it's called "dissociative identity disorder." Diagnostics: How We Get Labeled, John Cloud. (2003). Time Magazine.
|Former chairman of John Hopkins University department of psychiatry and behavioral sciences compares the practice of psychiatric labeling (through use of the DSM IV (now DSM V)) to the practice of matching symptoms in an effort to come up with a label to identify witches in the Salem witch trials.
It is important to note that there are other mental health theories that provide a more practical, reasonable and accurate perspective towards mental health issues. These theories include: the bioecological model of mental health and Penn State University's positive psychology.
The Relationship between Labeling and Stigmatization in Psychiatric Practice
A study by the American Sociological Association on the theory of labeling in mental illness, found that "the likelihood of social rejection increases once others gain knowledge of an individual’s status as a mental patient." .
"When mental [health disorders] are used as labels, these labels hurt". SAMHSA
SAMHSA's, the U.S. government mental health association, provides "Before You Label People, Look at Their Contents" guidelines . In fact, according to SAMHSA, "when mental illnesses are used as labels - schizophrenic, manic and/or hyperactive - these labels hurt." In a public service announcement, Loree Sutton, Brigadier General of the United States and Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, stated that "a stigma is a toxic, deadly hazard that must be eliminated."
Psychiatric labels lead to stigma - Stigma leads to discrimination.
Loree Sutton, Brigadier General of the United States
"Labels lead to stigma - a term that refers to branding and shame and stigmas lead to discrimination. It is common knowledge that it is socially unacceptable to discriminate against people solely based on their race, religion, culture and/or appearance. Most people are unaware of the discrimination faced by people who have been diagnosed with a mental illness. Although such discrimination may not always be obvious, it exists and it hurts."
Another thought to consider with persons who have or who have had mental illness is that labels stick. Even after a person may have recovered from bouts with serious mental illness, the label may have a long-lasting impact on other's perception of him or her.
"My son is bipolar."
Labels can be damaging and hurt the one being labeled,
affecting their view of themselves.
If a person recovers from or is recovering from cancer, do we refer to him or her as "being the cancer?" No, we do not because we know that cancer is something that one can recover from and isn't necessarily permanent. In other words, there is a good possibility, with the majority of cancer prognoses, that the individual will eventually be cancer-free. What is more, the cancer does not define the individual's existence while battling with the disease or after recovery.
When someone with mental illness is labeled as "OCD" or "bipolar," we give the perception that being "bipolar" sums up his or her whole existence. In other words, we do not take into consideration the person's actions (good or bad) because in our minds we have based our perception on the label he or she has been given. Even worse, the individual who is labelled often internalizes the label to the point that they feel that their entire entity is summarized with it.
According to a mental health stigma study published in the American Journal of Psychiatry, one of the main reasons that mental illness stigmas continue to linger is that people tend to look at mental illness as something that never goes away. Bernice A. Pescosolido, researcher, states that "when you attach a feeling of permanence to this, it justifies, in some ways, a person's sense of 'otherness' or 'less-then-humanness.’"
In fact, Adolf Hitler not only utilized labeling and stigmatization to exterminate those with mental illnesses, he also labeled those who did not fit into his idealized schema as "untermensch," meaning "sub-human" or "under-man". Interestingly, the seeds of Nazi eugenics were propagated by the father of psychiatric labeling, German psychiatrist Emil Kraeplin. See article Emil Kraeplin, the Degenerative Theory and its Implications for Psychiatry and Stigma (on-site).
That same type of stigmatization can be applied to those with mental health disorders. It should be noted that some pre-med students, interns and residents received a bipolar disorder diagnosis before officially becoming medical doctors. Furthermore, there are schizophrenic lawyers and college professors that are active and productive members of respective professional groups.
Full Recovery from Mental Illness is Possible - NAMI article - (on-site).
Permanency in Psychiatric Labeling
Many schools today use white boards instead of the traditional blackboards. White boards have become more common because it allows you to use dry erase markers (which are easily wiped off with a rag or paper towel) instead of chalk. It is important to note that it can be quite difficult to erase the marks on a white board, if you use a permanent marker and allow it to set overnight. In addition, an underlying image may remain long after the marks have been erased.
This example illustrates how labeling and stigmatization affects those with mental illness . Psychiatric "markers" or labels tend to resemble permanent markers rather than erasable ones. Once a psychiatric label is applied to a person, it not only affects him or her in all aspects of his or her life, it also has the ability to be used as a weapon by those closest to him or her.
Although subsidiary, most U.S. psychiatrists operate under the medical model, which consists of identifying causes and symptoms, assigning labels, prescribing psychotropic medications and teaching clients more effective coping skills (self-help skills). Under this model, it is assumed that without psychiatric treatment and prescription medications, the client is not capable of helping himself or herself.
Some psychiatrists do not fully understand that labels are considered permanent, which is especially prevalent when it comes to severe mental illnesses. A typical response from a psychiatrist who follows the medical model may be "You will always have to be on medication." Under this model, the psychiatrist is not looking for a way to cure the disorder so the client can live a healthier and more productive life, rather he or she prescribes powerful psychotropic medications in order to manage, control or subdue the client’s "illness".
Moreover, if a non-medicated client no longer manifests symptoms of a mental illness, over an extended period of time, perhaps because he or she has addressed the underlying causes of the illness, a psychiatrist may determine that the disorder is in remission. This determination implies that the "illness" is not really cured and therefore can reappear again at a future date. In other words, the "illness" is only in remission for the time being, but there is always a chance that it will flare up again (unannounced and for no reason) like shingles or malaria, which lingers in your bloodstream.
The medical model tends to assign permanent labels for some severe psychiatric disorders. It is not really concerned with addressing the cause of the disorder or encouraging lifestyle changes as a possible solution. The focus is on labeling the individual and prescribing strong medications to control the "illness". The result is that anyone assigned with a psychiatric label under the medical model (which is usually applied while the client is in a formal psychiatric-based government or public school program) can be permanently labeled and face the prospect of taking strong and debilitating psychotropic medications for the rest of his or her life. For example, a teenager who exhibits risky behaviors and has been "labeled" with a psychiatric disorder may no longer display the signs of the disorder as he or she matures, yet may still be condemned to a lifetime of taking strong and debilitating psychotropic medications, simply because he or she was "labeled" during a difficult stage in his or her life.
For many, this life-long sentence is unacceptable, which is one of the main reasons why there are strong and sometimes vitriolic protests against the medical model and this type of psychiatry. Opponents of psychiatric labeling believe that this practice often abuses those who are the most vulnerable such as: foster children, children of immigrants in the U.S. (who do not speak English), and/or children whose parents are illiterate and/or incapacitated.
Controversy has surrounded the terms "mental illness" and "the mentally ill". In 1966, Thomas Scheff, professor emeritus in the Department of Sociology, University of California: Santa Barbara, former chair of American Sociological Association: Sociology of Emotions, president of the Pacific Sociological Association and author of the book Being Mentally Ill, challenged the common perception of mental illness by claiming that mental illnesses are manifested only as a result of societal influences. In other words, society establishes certain norms and anyone who deviates from those imaginary, societal-imposed norms, to a significant degree, is considered "mentally ill". Labeling terms like "mentally ill" and "mental illness" have the ability to lead to permanent stigmatization .
Scheff formed his theory by examining societal and cultural norms and analyzing how they are perceived and/or interpreted. Many times, in Western societies, when a person "sees things" that are not there and/or "hears voices," he or she is diagnosed as schizophrenic. On the other hand, some indigenous societies (i.e. some America Indian tribes) believe that seeing something that is not physically present (a "vision") is a right of passage for future leaders of the tribe. In other words, symptoms commonly associated with mental illness in the Western world are considered attributes in aboriginal societies. In fact, Crazy Horse, a popular Native American, experienced a "vision" as he passed from boyhood to manhood. His vivid "vision" not only extended beyond the physical realm and contributed to his life-course, it also guided him for decades. In many cultures, someone who "sees things" that aren't physically present and/or "hears voices" from the spirit realm is considered "gifted" and invited to become a "shaman" or religious, spiritual guide of the tribe.
In Judeo-Christian religious books, those who saw "visions" and "heard voices" from the spirit realm were treated with reverence and considered to be prophets. In modern psychiatry, an atheistic world-view forms the foundation of thinking, so that out-of-the-ordinary transcendental experiences are generally interpreted as a biologically-rooted mental illness.
Even though official psychiatric sources make room for religious interpretation of uncommon experiences as a part of the normal threshold of perception based on one's religious views, in general, psychiatrists typically do not make room for such interpretive perceptions, especially in regards to mental disorders . So while psychiatry is specifically concerned with how certain experiences negatively affect the life of an individual, there are other explanations and/or interpretations for supernatural, out-of-the-ordinary or transcendental experiences, which may not always be negative .
Psychiatrists and other mental health professionals (though often approaching transcendental experiences from an atheistic perspective) need to make room for religious interpretation of such out-of-the-ordinary experiences based on a person's religious background and belief system and not be so quick to fit those experiences into a symptomatic profile that leads to a psychiatric label.
Psychiatrists and other mental health professionals, then, though often approaching transcendental experiences from an atheistic perspective, need to make room for religious interpretation of such out-of-the-ordinary experiences based on a person's religious background and belief system and not be quick to fit such into a symptomatic profile that leads to a psychiatric label.
Recovery from Mental Health Disorders is Possible
----Mental Illness of Any Type Does not Need to be Permanent
If it can't be done, why try? History is filled with examples of those who accomplished what was previously thought to be impossible. The psychiatric label pretty much closes the door on the concept of full recovery.
In fact, labeling can have profound effects on your determination to overcome mental health disorders. If you believe that you can successfully overcome a disorder, you are more likely to work very hard to accomplish your goal. If you feel that the mountain cannot be climbed, you are less likely to even attempt to climb it.
This autism case highlights how you can successfully overcome your disorder. "Evan" suffered with autism for many years, which caused his mother to utilize a variety of resources and therapies to help him overcome his condition. She didn't give up. Within a few years, "Evan" had successfully recovered from his symptoms and no longer qualified for the label "autistic".
To sum it up: you can work through a mental health disorder and come out on the other side - label-free.
An Internet search on the keyword "xxxx self help," provides numerous references for depression self-help and ADHD self help, but there were comparatively few references for bipolar disorder self help. Why is that? Well, those that are labeled "bipolar," are often taught to resign themselves to being labeled and taking psychiatric medications for the rest of their lives as the primary "solution". Bipolar disorder, also known as manic depression, is often considered an incurable mental illness, which must be managed with a wide variety of medications. As a result, some labeled as "bipolar" may not take practical measures to help themselves. The label, in this case, ends up being a hindrance for those who have the ability to help themselves.
It is important to note that even disorders such as bipolar disorder, often treated as permanent, can be brought into remission, leading to a full recovery. See Dr. Liz Miller's story as an example of how lifestyle changes and vigorous self-help exercises led to full recovery from Bipolar Disorder I.
Treating bipolar disorder is a lot like treating a physical condition like gout or diabetes. In all cases, changing your diet and lifestyle can improve and/or "cure" your condition. If you are diagnosed with bipolar disorder then it is important that you take positive self- help steps to overcome your condition. In other words - take a positive approach to your recovery.
Don't let yourself be discouraged by labels. Try to help yourself and fight your way out of a self-imposed or doctor-imposed cocoon. Be pro-active--this will not only help you defeat any stigma associated with your condition, it will also help you become a more compassionate and understanding person who is better equipped to take on the next set of challenges that life presents.
References for Mental Illness Labeling
1. Aarti, R. Sekar K. (2006). Strengths Perspective in Mental Health (Evidence Based Case Study). Strengths Based Strategies 2006.
2. Before You Label People, Look At Their Contents. SAMHSA. (Retrieved June 30, 2009).
3. Healy, M. (2013, November 4). Johnson & Johnson to pay $2.2 billion to settle federal cases. Los Angeles Times.
4. Kroska, A. and Harkness, S. (2004, August 14). "Exploring the Modified Labeling Theory of Mental Illness Using Affect Control Theory Measures and Predictions". All Academic.com. Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA, Online. (May 26, 2009). American Sociological Association. http://www.asanet.org
5. Madsen, K., MA, MSW, Leech, P., MSW, LCSW. (2007). The Ethics of Labeling in Mental Health. Jefferson, NC: McFarland & Company.
6. Peteet, J. R., Lu, F. G., & Narrow, W. E. (2012). Religious and spiritual issues in psychiatric diagnosis: A research agenda for DSM-V. The American Journal of Psychiatry. Washington, DC: American Psychiatric Publishing. http://ajp.psychiatryonline.org/article.aspx?articleID=1109021
7. Rashed, M. A. (2010). Religious experience and psychiatry: Analysis of the conflict and proposal for a way forward. Philosophy, Psychiatry, & Psychology, 17(3). 185-204. John Hopkins University Press.
8. Scheff, Thomas, PhD. Professor Emeritus of Sociology, UCSB. (Retrieved November 17, 2010).
9. Wilson, D. (2010, October 2). Side Effects May Include Lawsuits. New York Times. http://www.nytimes.com/2010/10/03/business/03psych.html?pagewanted=all&_r=0
Dr. R. Y. Langham is a Family Psychologist out of Nashville, TN who works in abuse prevention and family counseling.
Pages Related to Psychiatric Labeling and Stigma
Child Psychiatric Labels, child psychiatrist Dr. Scott Shannon
Stigma and Mental Illness
Psychology History - Moral Management: Successful non-pharmaceutical holistic treatment for mental heath in the 1800's.
Positive Psychology Movement - Penn State University
Mental Health Treatment - A Closer Look at Psychopharmacology - Let the Buyer Beware! by Louis Kirby, MA
Appeal to Mental Health Professionals for professional non-pharmaceutical treatment options and clinical studies
Bioecological Model of mental health
NAMI - Mental Health Disorder Recovery
Articles Related to Psychiatric Labeling and Stigma (off-site)
Beyond The Brain, by Tanya Marie Luhrmann. Summer 2012. Wilson Quarterly. - In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure.
The Medical Model in Psychiatry: Pros and Cons. Dilemmas and Controversies of Traditional Psychiatry. By Stanislav Grof, M.D., Ph.D. Chapter 5 of the book, Beyond the Brain: Birth, Death and Transcendence in Psychotherapy.
I Had Asperger Syndrome. Briefly. (2012, January 31). Benjamin Nugent. NY Times.
Mental Illness and Work - Stigma. (2012, January 27). The Globe and Mail.
Espanaol - 19 prominent psychiatrists, psychologists and mental health professionals - (not an exhaustive list) - who disagree with the current medical model of mental health - Blog in Spanish
Talking Back To Prozac: What Doctors Aren't Telling You About Today's Most Controversial Drug by Peter Breggin -
"There is unquestionably a great deal of truth in what Breggin writes. Let the pill-swallower beware." --Los Angeles Times "Dr. Breggin is the conscience of American psychiatry." --Bertram P. Karon, Ph.D., author of Psychotherapy of Schizophrenia.
No Child Left Different, edited by Pennsylvania clinical psychologist and professor, Sharna Olfman -
A book on childhood mental health disorders, the media, and overprescribing of drugs, that is worth reading.
Blaming the Brain: The Truth About Drugs and Mental Health, by Elliot Valenstein
Detailed analysis (and proof) of how the pharmaceutical industry sold the medical field, over decades, on the idea of pharmaceutical treatment for psychiatric disorders. Valenstein provides ample logical reasoning on the idea that psychiatric disorders are not caused by a "chemical imbalance" and that the medical model, while convenient, is not accurate.