It is an interesting facet of humans that, while we seem to draw a clear distinction between those with mental health conditions and those without, and personally identify as either one or the other, we also often hear of symptoms associated to specific mental health conditions and say “oh, I do that” even despite endeavouring to personally disassociate from the “crazy”. Does this tell us that we are all actually mad? Does it tell us that while people do not want to identify with a specific label, they are comfortable identifying with symptoms?
I think what it tells us is that we in fact all lie on a spectrum of madness, wherein all symptoms exist, all of which are individually experienced to varying degrees by each person, and that it is those who experience several of these symptoms to inhibiting extremes that are then diagnosed with specific mental health conditions, depending on their specific cluster of symptoms. What I want to question is whether we should label those clusters as specific mental health conditions, or remove the labels altogether and focus instead on the individual symptoms.
There are a few arguments for why we should remove labels and instead focus on just symptoms. The first is that if you look at each individual mental health condition and their symptoms, you will notice that many of those symptoms overlap. There are many behavioural and mental traits symptomatic of schizophrenia that are also symptomatic of bipolar disorder and borderline personality disorder. Not only this, but it is also the case that not everyone diagnosed with schizophrenia, for example, will exhibit or experience all the potential symptoms of that condition. So it seems to be the case that we inadvertently suggesting people have a whole bunch of symptoms that they in fact may not have at all by lumbering them with a label, and, more worryingly, treating the label and not the specific symptoms.
The second argument for removing labels is the taboo factor and the fact that people will be less willing to talk to specialists about specific symptoms they may experience. I personally do not believe that there should be anything taboo about having a specific mental health condition, but we seem to live in a world, as suggested above, in which people are more willing to identify with symptoms rather than conditions. If we were to remove all mental health labels and instead focus on the array of symptoms, perhaps people would feel less boxed into madness. The reason for this brings me to the third argument for why we should remove labels…
As mentioned above, we all seem to experience or exhibit or identify with all the symptoms to some degree or other. Take emotions. All of us feel emotions. Some of us feel emotions to stronger extremes than others. Some people feel virtually no emotions. Others experience emotions to inhibiting extremes and end up being labeled with a condition like bipolar disorder or borderline personality disorder, dependent on which other symptoms they also have along with those emotional extremes. Another common one is obsessive compulsive disorder. We all, to varying degrees, need or want to have things just so. We are all quite specific and obsessive in our own ways about different things in life and need to have things done in certain ways to feel comfortable or in control. On one end of the spectrum are those who are very chilled out and not remotely bothered if things in their life are out of their control or not done their preferred way, and on the other end of the extreme are those who cannot function due to their anxiety levels if their way is not adhered to. The key word here is “inhibiting”; when those symptoms reach a point on that spectrum where they become inhibiting, …….. to leading a happy functional life, we consider them to be mental health issues. I know people who would never consider themselves to have any specific mental health condition, but yet do live daily with quite inhibiting symptoms that they find hard to control alone. If mental health focused on symptoms rather than conditions, perhaps more people would get some help in controlling and diminishing them.
So rather than looking at humans and separating the sane from the insane, what this model does is look at everyone as existing on a spectrum of madness, just to varying degrees. It removes potential isolation, it increases understanding and empathy, it unifies us and stops the taboo.
My final argument against labels is that they make people potentially complacent in overcoming their symptoms because they over identify with the label. Some people consciously, or subconsciously, fall into the habit of justifying their behaviour, even when antisocial, inhibiting or destructive, by pointing to their label and saying “I can’t help it”.
All this said, there is one powerful argument for why labels do help people: it is a quick and efficient way to explain antisocial, inhibiting or misunderstood behavioural and mental traits to someone without having to go into a long and seemingly disconnected list of symptoms. When it comes to people with several if not all the symptoms associated to a specific mental health condition, the label is sometimes a very useful tool for the sufferer because it helps them understand and come to terms with their symptoms in a neat and concise way. With the label comes the “why”; the explanation for all the chaos in their minds and a lot of reading material and other sufferers to relate to who bring not only understanding but effective tools and treatments to help them live with the condition. Yes, they could also do this by focusing just on each symptom, but when lots of the symptoms on the madness spectrum are experienced to inhibiting extremes and very much identifiable with a specific condition, it is just so much easier to use the label than run through each symptom. I, for example, have almost every symptom of borderline personality disorder and it is way easier to explain certain aspects of myself by alluding to the label than going through each individual symptom. It helps not only the sufferer understand themselves, but also helps other people understand the sufferer. Caution, however, as said above, must be taken to not over identify with the condition and thereby become complacent with treatment.
In conclusion, we are all humans, we all have neurological stuff happening in our brains to varying degrees and we all exist on the same spectrum. Maybe if more people saw it this way, as opposed to the black/white view of mental health as either mad or not, the world would have an increasing empathy towards people who struggle at the extremes of the spectrum of madness.