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I am advocating that we rethink the whole field of psychology. As we embark on rethinking what we mean by normal, what we mean by mental health, and what we mean by psychotherapy, a first step is removing the labels that we give to people who look for help with their "mental health problems" or who are sent for help for those "problems."
All "mental health disorder" labels ought to be rethought. They flow from a specious, incoherent definition of "mental disorder" and amount to little more than the affixing of fancy-sounding disorder labels to bundles of putative "symptoms." In addition-and the subject of this article-the very naming of the person who walks into the office of a "mental health provider" ought to be rethought. Is that person really a "patient"?
Right now those people are known as either "patients" or "clients." I'll tackle the problems associated with the word "client" in a separate article. Here, let's look at the problems associated with the word "patient." What happens when, as you cross the threshold of an office, the label "patient" is immediately affixed to your forehead?
Many experiments have confirmed that, when confronted by a "patient" or a "prospective patient," mental health professionals are less likely to diagnose actual disorders and are more likely to express unfounded opinions that match their training and that serve their pocketbook. An excellent experiment run by Ellen Langer and Robert Abelson of Yale and published in the Journal of Consulting and Clinical Psychology illustrates this point.
The experimenters wanted to gauge what therapists would say about a subject who for one set of therapists was called a "job applicant" and who for a second set of therapists was called a "patient." Would the latter label bias their opinions?
Did it ever!
Therapists who thought that the subject was a job applicant used words like "candid," "upstanding," "innovative," and "ingenious" to describe him. Therapists who thought that the subject was a patient used words and phrases like "tight," "defensive," "frightened of his own aggressive impulses," "conflicted over homosexuality," and "passive dependent type" to describe him.
The experimenters concluded, "Once an individual enters a therapist's office for consultation, he has labeled himself 'patient' ... The therapist's negative expectations in turn may affect the patient's own view of the situation, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy."
May, indeed!
If all it takes to render a person's ordinary behaviors symptoms of pathology is to label him a patient, our eyes should be opened to a fundamental truth about diagnostic labels. The system is designed to turn ordinary human experience into categories of disorder, trapping any real disorders in with the concocted ones. This bad science couples intellectual shoddiness with venality to produce tens of millions of "patients" annually.
If there is a genuine illness present and it is your job to treat illnesses, it is fair to call the person a patient when he walks into your office. It is even fair to call that person a patient when he is not suffering from an illness, if your office is truly a medical office and you can actually distinguish between health and illness. "Ah, no," you say, "you aren't ill, the new prescription for your glasses is way off and that's why you're getting headaches!" If that is the sort of transaction that is occurring in your office, it is fair for the person who enters your office to be called a patient.
But what if the transaction is more of the following sort? Say that you enter and share that you are worried about your son's drinking, the impending loss of your job, and your mate's infidelity, and that these pressures and the many other pressures that you are under are making you unhappy. If, after I hear this, I say to you that you are ill with the mental disorder of depression, I have illegitimately turned you into a patient. You complained of certain human problems and certain normal feelings and I labeled you with a mental disorder.
Whether your office carries the shingle of general practitioner, psychiatrist, psychologist, clinical social worker, family therapist, licensed counselor, or some other name sanctioned by the state, that does not give you the right to make a patient out of the person who walks into your office just by virtue of some illegitimate naming game. It would be as if you walked into an accountant's office, told him of your financial troubles, and he replied, "You have the illness of bad debt! And since it is an illness, I can accept your medical insurance!"
The label of "patient" should be used appropriately, as by its very nature it increases the power of the provider and weakens the person who is suffering. If there is an illness present, it is fair (though still problematic) to call that person a patient. If there are life problems present, it is not. One of the reasons that we must demand that psychology start over is that practitioners refuse to honor this distinction, the distinction between illness and life problem. It is a fundamental distinction. If you refuse to honor it you are on the road to blithely and automatically turning every human being into a patient.
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Eric Maisel, Ph.D., is a psychotherapist, bestselling author of 40 books, and widely regarded as America's foremost creativity coach. His latest book is Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning (New World Library, February, 2012). He is the founder of noimetic psychology, the new psychology of meaning. Please visit Dr. Maisel at http://www.ericmaisel.com or contact him at ericmaisel@hotmail.com
