Sticks and Stones: Further Thoughts on Mental Health, Labels & Stigmas

labelsSo I’ve been doing a little more thinking about the post on stigmas and labels when it comes to mental health and I’m finding myself somewhat divided.

Most anti-stigma campaigns target what I think everyone would agree are pejorative labels like “crazy,” “disturbed,” and “weird” when describing someone who may be dealing with depression, anxiety, bipolar or another other mental health issue. I think we all understand how calling someone disturbed can negatively impact them and cause them to withdraw. All it does is build up the walls that are already making them feel isolated, and making it harder to seek help or treatment. What about other types of stigmas though? Do we sometimes go to far identifying stigmas? Is it possible to be too politically correct in our use of labels? Do we leave ourselves in a position where having honest discussions about mental health is too difficult?

I’ll start with other types of labels and stigmas that are out there beyond the obviously pejorative. Let’s start by coming up with a working definition of stigma, and for this I’m comfortable with the one used by the mental health campaign No Stigmas:

Mental illnesses can be difficult to handle. Treatment and recovery requires time, effort, patience, and a lot of understanding and support. Unfortunately, those who suffer from mental illnesses often have to deal with much more than just their illness– they also often suffer from the effects of stigmas, negative representations or stereotypes that unfairly label people with mental illness. These ideas can be extremely harmful, and are evident in almost every aspect of society, from stigmatizing language in everyday conversation to inaccurate media portrayals of mental illnesses and the people who live with them.

Moving past negative representations let’s look at stereotypes, because I think these occupy an interesting space where there may be grains of truth to the labels and where they may not be used in an intentionally negative manner. One example that comes to mind is “emotional.” It seems fairly innocuous (after all, is there anyone who experiences emotions who isn’t emotional?) but where the context in which it’s used is crucial. For someone who may be dealing with depression they could present themselves as sad or irritable, and it’s easy to dismiss these things if you plaster over it with emotional, or, a word like “moody:”

“What’s going on with Paul, he seems kind of upset?”

“Oh Paul? He’s just kind of an moody guy, you know?”

Instead of saying, you’re right, let’s see if he’s OK, needs any help, etc., we classify Paul as moody we don’t offer help- we don’t think something could be wrong. It’s a soft form of stereotyping, but the result is to leave the person isolated.

How about some other labels that we apply to people with mental health issues? I’ve written about labeling someone as having “demons” before. Using metaphors, particularly metaphors that may have some element of supernatural or spiritual, are a two-pronged problem. First, and somewhat more innocently, it can gloss over the underlying issue, and second, it can negatively influence the person suffering to think that their mental health issues are somehow their own fault and that they’re to be blamed. Now all you’ve accomplished is to add guilt to their feelings of anxiety, depression, etc.

I think the solution is to deal with mental health issues in as open and factual manner as possible. I tend to look at it as a health issue, and so I don’t shy away from labels like “sick” or “ill” to describe myself. But there are plenty of people who aren’t comfortable with those labels either. I get it- when people are sick we do things like avoid physical contact with them, worry about contagions, and in extreme cases, we quarantine them. For someone who may already be feeling lonely the “sick” label may cause them to feel like they’re only isolating themselves more and more. The flip side of course, and the part of the label I embrace, is that often when you’re sick you have a chance to get better, to feel well again.

Having been born with a heart condition (or defect- how’s that for a label?) I grew up viewing and still to this day see being sick, or having a condition, as something treatable and manageable. I treat my mental health issues the same way- something that I can treat and manage in my life. Will I always be more susceptible than the average person to depressed moods or anxiety? Maybe, but I can treat both of those things and limit the negative effect they have on my life. I can lead a healthy lifestyle, regardless of whether my heart or my brain may not work exactly like most peoples’. So I have no problem being sick.

This brings me to the final type stigma I want to discuss- the idea of embracing a label. On my Twitter profile I describe myself as a “mad man with a blog,” a riff on Doctor Who being a “mad man with a box,” but there are other bloggers  out there (check out the blog roll on the right), particularly when it comes to mental health, who embrace labels like “madness,” and “drunk.” Are we taking the piss out of these labels by embracing them? Do we regain a sense of control over them? I can only answer for me, but yes, I think so. The other type of label you’ll see people embrace is something along the lines of “different,” as in, “There’s nothing wrong with being different!” A noble sentiment that I fear can border on denialism. Differences are of course the spice of life- a wide range of personality types and diversity of thought is awesome, but when it comes to mental health, there’s a distinction between being different and being unwell.

My depression and anxiety certainly made me different and unique from most people, but they also nearly killed me. They disrupted my social life and wreaked havoc on my career. It’s a difference that in many ways I want nothing to do with. I understand that it’s a part of my identity, and I’m not ashamed of it, but you’ll forgive me if it’s not a flag I’m proud to wave. I worry sometimes that the people who are cheerleaders for the “nothing wrong with you” movement in mental health are placing themselves in a position where they may not seek help for managing what can be a debilitating ailment. A secondary concern is that these folks are susceptible to a lot of crap (like the anti-psychiatry bunk peddled by the cult of Scientology), or worse, enablers of those pushing a twisted agenda. There’s a difference between embracing who you are and refusing to address a treatable problem.

When it comes to labels and stigmas I think the best thing we can do is deal with people as individuals. Let’s try and eliminate the blatantly negative stereotypes of mental illness and proceed thoughtfully when we talk about others who may be living with depression, anxiety or other issue. For me, being open and direct is a pretty good approach. I have no problem with the sick label, but that doesn’t mean others feel the same way. Labels and stigmas can further exacerbate someone’s negative mood, further isolate them or make it harder to seek help, so let’s tread carefully out there.

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