To Label or Not to Label, that is the question: Whether it’s nobler in the mind to suffer the taunts and stigma of same-age bullies, or by defying the label given by the insensitive society, and not taking a pill, end it!

My earlier post, on Autism and ADHD being the price one pays for Intelligence and Creativity, in evolutionary terms, has struck a raw nerve with some of the readers, whereby there seems to be a raging debate in the comments section, concerning whether it makes any sense labelling a child and also whether drugging, and consequent passivity that sometimes accompanies it, is the only treatment option available.

I believe there are two issues involved here. One is that of labelling non-neurotypical (NT) children/adult amongst us, as suffering from a mental disorder and disease – this labelling aids in diagnoses, treatment and research but also leads to stigmatisation that is normally associated with mental illness - if the difference is biological these guys’ brains are somewhat wired badly - perhaps for life - with little hope for cure; and if it’s a result of psychological issues, maybe they are deficient in character- not able to exert control over themselves or had a messed up upbringing. No matter whether the mental illness/disease/disorder is seen as biological or psychological in origin- it’s usually accompanied with unacceptable and harrowing stigma. It’s a classic case of heads I win, tails you lose. No matter whether the current paradigm favours a psychological or a biological explanation- the stigma doesn’t go.

The other issue is that of treatment/adjustment options - do the differences in neurodiverse children/ people require more of a treatment approach shaped by a medical disease model – either drugging or therapy to remedy some supposed underlying defect/ deficit; or does it require adjustments/ accommodations in the school/home environment and society /workplace in general - to harness the special talents/ sensitivities such children bring to the table. The latter approach is more in line with the positive psychology movement that focuses on strengths of people and the resources and reserves they have, rather than being driven solely by where one is lacking or what one doesn’t have.

The way I have framed the above issues, I’m sure you know by now, which way my sympathies lie.  To make it explicit, I do not like labelling children / adult who have slightly differently wired brains, or who are temporarily thrown off-track due to acute stressors and circumstances beyond their control, with mental disease/illness labels – I believe the stigmatisation that accompanies such a labelling does more harm than good.  This does not mean labelling per se is bad- we do need to label differences amongst us, both to harness properly the special abilities that such a diverse population presents, and to help them overcome whatever shortcomings they have by providing adequate and tailored societal support to accommodate such differences. Labelling becomes bad and counterproductive when the label is seen as permanent and innate (even a ‘gifted’ label is counterproductive if such giftedness is seen as innate and non-malleable), and has a negative, stigmatising and disability connotation.

If we were to see Autistic kids as not just disabled or isolated, but sensitive souls having islands of exceptional ability and intelligence; If we saw ADHD kids as not just difficult and uncontrollable, but rather as creative and curious children then I would love those kids to wear those labels on their sleeves- my initial post on positive aspects of such differences was a step in such a direction – to counter the stigma and replace the disease model with a differences and strengths model. But I’m sure we are not there yet.

Till that time that these differences lose their negative connotations, I would say that labelling is a necessary evil- to help in proper diagnosis, research and accommodations, but to also to be restricted to those needing the label – the psychiatrist/ doctor making the diagnosis, the research scientists studying the condition and teachers/ parents needing the label to make proper accommodations/ adjustments to their teaching/ parenting style.  Does the label have to be told to peers who may use that to bully the affected person – absolutely no - there is no reason for the neurodiverse child to be visibility differentiated/treated specially in class, by giving him a label, rather the accommodation/ adjustments should be made tactfully and silently, sans the labels.   

Does it mean I’m anti-psychiatry? Does it mean drugs should never be used? Not at all. In extreme cases, we do need to apply the technology that is available to date and has not proven more harmful than good, be it drugs or psychotherapy; however that should be the last resort - when accommodations have not proved fruitful – not the first line of defence where instead of taking a relook at ones teaching style/ parenting style and seeing how one can modify ones style to accommodate the child’s differences/ special abilities,  one is more driven by immediate pressing need to quieten the hyperactive/difficult child or to treat the symptoms that are difficult for the teacher/ parent, rather than what  actually benefits the child. More often than not, the drugging is to the benefit of the teacher/ parent rather than benefiting the child - especially when the long term side effects are unknown or unpleasant and undesirable. This issue becomes especially acute given the immaturity of the child to make an informed decision. Just like the name given to him by his parents, he also has to live with the label given by his doctor/ teacher/parent/ society and he has little say in the matter.

I’m sure there are bound to be other opinions and perspectives, but for now I see labelling as a necessary evil, we can’t advance the field without proper labelling and classification- the only service we can do while labelling is to focus equally, or more, on the positive aspects and strengths, so as to reduce the stigma associated with being different; and to emphasise the dimensional nature of such differences – be it autism or psychosis or ADHD all of these differences lie on a spectrum and are marginally separable from normality- the difference is a matter of degree rather than kind- and the move of DSM-V towards dimensionality rather than categorical classification is a move in the right direction.

The other issue of drugging as the first line of defence is highly questionable and probably easily avoidable. It would require great efforts on the part of teachers, parents and therapists/ doctors, but that is sorely needed, given the side effects and  risks associated with long-term use of drugs, especially during developmentally critical periods. It’s not that drugs are never useful, they are but they also should not come at the cost of making active, curious kids passive and dulled.  We simply cannot design for a society in which only the passive survive.

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