Psychological Diagnosis: Dangerous, Desirable, or Both?
How do labels hurt and how can they be helpful?
Posted Feb 03, 2012
A client of mine, let's call him Gary, once said something that struck me as startlingly insightful. Gary had had a recurrence of his soon-to-be-fatal cancer. Yet he was informing almost none of his friends of his regrettable medical reality.
"As soon as I tell anyone that I have cancer, all they see when they are with me is CANCER. They no longer see me, Gary, with all my foibles and virtues. All they see is CANCER."
Gary understood that words have the power to define what we see, potentially blocking us from seeing aspects that differ from the label.
Calling yourself an anxious person, for instance, can put you at risk for ignoring the many times that you feel relaxed, playful, and loving. Label your friend a narcissist and you risk losing sight of the generosity, creativity, and insightfulness that used to draw you toward him.
In addition to screening non-confirmatory data from our view, using a label heightens our awareness of confirmatory data. Label yourself an anxious person and you will be more likely to notice the many times that you feel a flutter of nervousness that in the past you might have ignored.
Here's another subtle yet potent labeling danger. Calling yourself by a diagnostic label can increase the likelihood that you will continue to act in that manner. Saying that you are depressed increases the likelihood that you will stay home instead of socializing, or give you permission to nibble, putting on pounds instead of pushing yourself to go out for your usual exercise regime.
Labeling yourself or others with the potent labels of psychological diagnostic categories also can convey a blanket negative feeling. Old-fashioned character slurs like selfish or lazy had that impact. Similarly, psychological character diagnostic labels like narcissistic convey distinctly pejorative connotations. To most people, narcissistic is a fancy word for selfish.
Once you've begun thinking of a friend with the negative label like narcissistic, for instance, you become at risk for interpreting everything he or she does in a negative light. If a friend you have labeled narcissistic brings you chicken soup when you're ill, instead of appreciating the generous gesture you may think to yourself, "She's just trying to make herself look good."
Perhaps the biggest problem with labels occurs when pathologizing emotional reactions leads to pills.
Depression, for instance, is a negative emotional state that merits attention. Talk therapies of various types including insight-oriented, cognitive-behavioral, energy psychology (EFT, TFT, Emotion Code), conflict-resolution visualizations and couple therapy all have strong track records of helping people alleviate depression's dark cloud. They help by addressing the life problems provoking the negative emotional state.
Unfortunately though most people who are troubled by a depressed emotional state ask their physician rather than a psychotherapy professional what to do. To a man with a hammer, as the saying goes, the world's a nail. Doctors give pills.
The downside of pills for emotions is their potentially detrimental side effects. Anti-anxietiy drugs can be addictive. While anti-depressants do help some people to see sunshine again, they can cause mental cloudiness, dampen feelings of joy, increase appetite which leads to weight gain, decrease sexual interest which can cause marital difficulties, and lead to drug dependence.
Drug dependence means that if people try to stop taking the medication, especially if they wean themselves too abruptly, the sudden removal of the medication's contributions to their body chemistry can trigger a serious depressive episode. Not realizing that the culprit was the drug, not a lurking depression that the drug had been preventing, people then feel locked into to continuing to take the medication forever. The drug companies benefit, to the detriment of a person who now has been wrongly labeled as having a lifelong underlying depression.
The benefits of psychological diagnoses.
Diagnostic labels are helpful though when they lead to more empathetic understanding and more effective responses.
Labeling a child ADHD, for instance, may give you more patience with his high energy. It also can enable you to give him a medication that may be life-changing. Now that he can focus and settle down in school, he will be learning more successfully, which is likely to enable him to build the foundations in knowledge and self-esteem on which he will be more likely to enjoy successes throughout his adult life. [note: One reader wrote to remind me that Ritalin can also be dangerous: see http://www.ritalindeath.com]
Receiving an accurate diagnostic label for a spouse's difficult behavior can prove similarly life-changing. In one of my current couples, for instance, the wife became increasingly verbally abusive to her husband, emotionally erratic, and certain that everyone and everything was out to get her. Her husband kept trying to keep his head above water and their children safe from his wife's anger outbursts. Finally he gave up on trying to handle the situation himself and brought his wife for professional help.
The wife's emergency room diagnosis was amphetamine addiction and drug-induced paranoid psychosis. A month of hospital care plus extensive therapy that included both spouses resulted from this accurate diagnosis, and proved life-saving for them all.
Accurately labeling yourself diagnostically can be helpful as well.
Labeling a jittery feeling state anxious can propel you to pause, identify the dilemma that is triggering the anxious feelings, and focus in on figuring out what to do about the problem.
One morning for instance my client Jan felt anxious. Jan used to get mad at herself for her nervousness. By clinically labeling her feeling anxiety, she was able to use her new knowledge of what to do in the face of specific emotions.
"The best antidote for anxiety," Jan reminded herself, "is information." She paused to track down the cause of the anxious feeling and realized that too many projects at work were competing simultaneously for her attention. Thinking further, Jan scheduled specific times for addressing some of the projects, removed others from her current day's To Do list, and picked one as a primary foreground to get started on right away. Now Jan could move forward with a clear, relaxed and productive focus.
What can enable you to keep your uses of psychological terminology beneficial?
Here's three principles that can help.
1.Use labels for emotional states as signs that point to a pathway to alleviate the problem.
Anger signals that there's something you want and are not getting or a harm that needs rectification. If you feel angry, find ways to be more effective, preferably by acting in a way that's collaborative or clever rather than coercive.
Anxiety signifies that there's a problem ahead that you need to address. Look at it squarely, gather information, and map a plan of action. The anxiety is likely to diminish.
Sadness means there's been a loss. Acknowledge the loss, allow the sadness to well up like a wave and it's likely afterwards to abate.
Depression means you experienced a loss of power. Identify the triggering moment. Visualize yourself as big. Then, from a subjective state of feeling bigger, figure out new options. If for instance you feel depressed over the way a friend has treated you, figure out a strategy that will enable you to handle that situation in a new way in the future.
2.Use personality disorder labels to handle yourself and others more effectively in the future.
If someone has told you that you are behaving narcissistically, study up on what that means. One common factor in narcissistic functioning, for instance, is unwillingness to listen to others. Insisting too often on your perspective instead of being open to absorbing others' viewpoints is a habit that you could decide to modify.
Similarly, if you have decided that someone in your life, say your boss, is distinctly narcissistic, use that information to stop taking his self-focus personally, that is, as a rejection of you. When he does not listen to your ideas, calmly hold your ground and patiently give him a second or third chance to digest their import.
3.Pick diagnostic labels that are as positive as possible.
Eight year old Jerry hated school. He was refusing to go, and when he did he would often react sullenly to his teachers. His teacher sent a note home describing him as an oppositional child. The note conveyed her thorough-going annoyance with him.
Jerry's Mom and his psychologist arranged a meeting with his teacher. They labeled Jerry a highly sensitive child who felt overwhelmed by the classroom's behavior modification structure. The teacher had a system of points rewarding children for good behavior, and would take away points to punish children who behaved badly. The threat of losing points was causing Jerry to withdraw altogether.
Once the teacher began thinking of Jerry as emotionally sensitive instead of as oppositional, she switched her attention to focusing on and rewarding his every positive behavior. She also decided for a period of time to ignore his occasional negative slip-ups.
The change in Jerry's emotional state was both immediate and long-lasting. He became an enthusiastic student and his insistence on staying home evaporated.
In sum, there's enormous power in naming things. Like fire, gasoline, money, and fists, all power can be utilized for good or for harm. Use your power to label yourself and others with psychological diagnoses cautiously and for the best.
Susan Heitler, Ph.D., a Denver clinical psychologist, is the author of From Conflict to Resolution on psychotherapy and The Power of Two on the secrets to marriage success. A graduate of Harvard and NYU, Dr. Heitler's latest projects are the online marriage-skills program PowerOfTwoMarriage and her book on self-help techniques for alleviating negative emotions, Prescriptions Without Pills: For Relief From Depression, Anger, Anxiety and More.