Labels and language

Bipolar disorder is “just a label”.

Not to me.

I know mental illness is culturally and personally complicated. A faction, a rather large vocal faction, don’t believe in the existence of mental illness. There’s another debate about this over at Mental Nurse. I stayed out of it.

It’s fair enough to hold your own opinion but to me, it’s insulting when people refer to bipolar disorder as a label. The same is true of schizophrenia, some people refer to it as a label, but, more often than not, there’s a little get out clause stating that “oh, but schizophrenia, that’s an illness” because it is more obviously destructive and indiscriminating than bipolar disorder. “Learned” types don’t make this distinction but the laymen do.

One of the problems is that bipolar disorder is seen as a middle-class illness. Its famous sufferers are by and large educated, artistic people. Schizophrenia, on the other hand, is an illness that is known for affecting people from working class backgrounds. Its very image is of the mad bag lady, or the unwashed black man gibbering on the bus. This is a stereotype, not from me but from society as a whole. Schizophrenia is the poor man’s disorder, and manic depression is the rich man’s disorder. Because manic depression tends to be publicised as an artistic disease, it’s easy to see it as a label that auguments this image, rather than an illness like schizophrenia.

I can see why some people prefer to see mental illness as a label.

Mental illness, particularly schizophrenia and personality disorders, come with stigma attached to it. The public’s perception of schizophrenia isn’t a sympathetic one. It’s wrongly associated with violence, and people fear those affected by schizophrenia.

Because of the stigma attached to mental illness, it’s better to see it as just a psychiatric label with no real meaning to the individual. Being “a schizophrenic” or being “a manic depressive” says something about you, something that might be seen as negative. Labels you can get rid of. Labels are interchangeable and unreal. The causes of mental illness are unknown, so maybe it isn’t worthy of being called illness at all, and sometimes diagnosis can vary from person to person. There’s no way of proving that somebody has a mental illness. A label that says, “Something is wrong with you” is insulting and unnecessary. Lots of people believe that psychiatric labels are just imposed on someone because society doesn’t know how to cope with them. In my own experiences, some people have considered me to be arrogant because I explained that I had manic depression. Implying that I have a real problem, and am not just a contrary, melodramatic woman.

I see this as real. As real as any other illness.

I think seeing mental illness as being as real as physical illnesses is the way forward in reducing stigma. A lot of people don’t agree with me, though. If mental illness is real, then your diagnosis does mean something. And you can be defined by it. And people are defined by mental illness, far moreso than they are by physical illnesses, because a mental illness lives in your control tower, pulling the switches that make you who you are. But if mental illness is real, then it’s not the fault of the person who has it. They didn’t do anything to make this happen to them.

But if people just dismiss mental illness as a label, it devalues those problems. It implies that any suffering the person is experiencing is not real. It’s all part of a disposable label. If someone kills themselves over a label, well, that’s just stupid. Mental illness can be treated. (Although the actual wanting to be treated for it is another problem altogether). And, although there’s no real scientific evidence of yet that shows that mental illness is hardwired into the brain, there are a lot of physical illness that cause symptoms of mental illness. Dementia, epilepsy, MS. So there is something in the mind that causes hallucinations and mania. People suffering from hallucinations that have been triggered by a physical cause aren’t fashioning coping methods, so why are people with mental illness supposedly doing just that?

I don’t think that I’d be “free” if I thought of manic depression as a label rather than an illness. I don’t think I’d be liberated from all that manic depression implies. This feels like an illness to me. It feels like an infection. It swept through my body eleven years ago, it weighed down my bones and dissolved its sickness through my body and mind. This feels absolutely physical to me. I don’t just become depressed sometimes and manic at others. It’s not an isolated syndrome. It affects everything and it is not a case of “letting it”, no more than a person with cancer can “let” their cancer destroy their body. My energy is affected by it. My perceptions and my abilities are affected by it. Days I can’t sleep, and days I can’t wake, and days I can barely walk more than a few yards, and days when my hands shake so badly that I can’t hold a cigarette, and ash is confetti. It isn’t “all in my head” because it’s not confined to my mind. It’s in my body, too.

There is a theory that people develop mental illness to cope with unbearable stresses in life. There is one illness in which I support this theory: Dissociative Identity Disorder, because, overwhelmingly in those who suffer from it, there has been a massively traumatic event that has happened to them, and I can see and understand why someone would want “alters” in order to escape, in order to cope.

I don’t believe that other mental illnesses are caused by stresses in life. Certainly worsened by them, as any human emotion is affected by the life around them. In my case, I’ve had those traumatic events. A lot of my life was a nightmare. But, in a way, I deal with that well, just like I’m good at dealing with emergencies, I get on with it, and I always have. Nothing “triggered” my first episode, the same way that nothing has triggered all my episodes since. And I did not just “become” manic depressive when I was twelve. I can see its roots stretched back as far as my childhood, which makes me believe even more so that this is just an illness that I was born with.

If mental illness is real, then the people who suffer from it are not just burdens on society who got there on their own volition by being fucked up and reckless. It just happened to them, like cancer happens to other people. Because a lot of people with mental illness drink and do drugs to cope with it, well, the image of mental illness is unfavourable because we’re all alcoholics and druggies, on the bottom rung of society. They didn’t do anything for this to happen to them. It’s not their fault.

If mental illness is real, it can be treated. Maybe one day cured. If I saw this as a label, a label that was destroying my life, not because I let it (believe me, I try, very hard, every single day, to not let it do anything), I’d have no hope. I probably wouldn’t have accepted the diagnosis in the first, probably wouldn’t be treated for it, probably wouldn’t have a CPN, probably would never have spoken to Rob about it, probably never would have started this blog, probably would have killed myself the second I left hospital.

I don’t believe in the “Big Pharma”. All huge businesses are corrupt, and a lot of people shouldn’t be on psychiatric medications. But some people should, and for some people, it does help. Of course, because it’s a label, psychosis, mania, depression, it’s all good, it’s all someone “experiencing” stuff. But those experiences can be so destructive. And sometimes, people need a drug to pull them out of the depths and heights of these experiences. It’s not coercion (although I do agree with detractors that in the past, “inconvenient” people were put into hospitals), there is a need for antipsychotics and hospitals to help stop someone ruining their lives, or taking their lives. Of course people should be allowed to, but it’s unlikely that once you help someone ease back into a more rational frame of mind that they’d want to.

Another thing is that being “ill” grants you a “victim” status that those who espouse the label theory don’t like. I’ve written before about the survivor/victim mentality so I’ll just let you read that instead.

And there is, of course, the language of mental illness. Words that you are not supposed to use, lest you be a “victim”:

  • Mental illness, as opposed to mental disorder/mental distress/fantastic thing that makes me so unique
  • “Suffering”. You’re not allowed to “suffer” from mental illness because if you do, you’re a victim
  • “Medication can be helpful”, no, medication is EVIL.

I understand the reason people refer to mental illness as a label. But it is insulting to me. And it’s insulting to me when people comment here and tell me to take a bit more exercise and eat my greens and do a bit of yoga and I’ll be fine, as if I did this to myself by sitting around, did this to myself by not eating enough leafy vegetables. Over eleven years, I have done all the good stuff, done the exercise, got my vitamins, had a “positive attitude” and it didn’t help. I did not do this to myself. If I did this to myself, I would undo it to myself. Oh, yeah, and if you want to be in my bad books forever, do come here and tell me three things:

1) Pull yourself together, I did, it’s just a label, think positively, your diagnosis doesn’t mean anything, etc etc

2) DIET and EXERCISE? Oh, and YOGA and REIKI and other bollocks? It worked FOR ME. You don’t need ANY OTHER TREATMENT AT ALL. In fact if the above doesn’t work for you, YOU’RE WEAK, AND BEING CONTROLLED BY THE BIG PHARMA!

3) Your illness is an EXCUSE for you not to live a NORMAL LIFE because obviously due to your EXCUSE you must not ever tell anyone that you LOVE them or PLAY WITH YOUR KITTENS or ANYTHING since you spend ALL DAY just being MANIC DEPRESSIVE.

4) How dare you use the words SUFFERING and MENTAL ILLNESS. It is “MENTAL DISTRESS” and saying that people SUFFER from it makes it sound BAD.

For those people, I can use other words, like “fuck” and “off”.

The only thing that my illness is an “excuse” for is for my slurring my words occasionally on medication. I’m not defined by my illness, even if I don’t consider it a label. It’s part of me. Part. It does hold the reigns on my life, but hey, whatcanyoudoaboutit. Not much more than I am doing, really. I think therapeutic exercises like yoga and whatsit are important as supplements to actual medical treatment (indeed, I am getting a prescription to exercise to help my energy), but not the be-all, end-all. I don’t like to be made to feel like a failure just because I’m in psychiatric treatment, and just because, so far, I’m not better yet.

It doesn’t mean that I define myself as “manic depressive”. I don’t. I think of myself as someone with manic depression.

I still don’t feel very well so that may account for the tone of this post, and the fact that it doesn’t make that much sense. Although at least I managed to get out of bed before 4pm today.

32 Responses

  1. lables, now thats interesting no one would call someone cancerous if they had cancer so I cant stnd being refered to as manic depressive. On the other hand i suppose the illness is far more than a lable because it does change your everyday life,the way you do things and think things and the way you react to different situations. Without mental health problems i am sure that i would be far less intrested in mental health infomation. This illness shapes our life for better and worse.
    “It’s part of me. Part. It does hold the reigns on my life, but hey, whatcanyoudoaboutit”- i really agree with this, it does shape us, but can you picture life without it? i certainly cannot pictre a balanced life, for me it just sounds like monotony, day to day existance and dullness

  2. ‘labels’ are always used as a way of somebody being able to pigeon hole the ‘labelled’ as a nice, neat type – whereas a diagnosis tells you what you’re up against from a personal POV (although i guess you could say that was a ‘label’ for whatever’s wrong with you?). Maybe the only difference between the 2 is what somebody does with it?
    It’s funny though, the one thing you NEVER get in psychotherapy is any sort of name put to what you’re going through, but you DO get lots of suggestions of things you can do to stop having the thoughts/feelings and experiences that you’re battling – like “try taking a few minutes out from those thoughts” Doh! I think being able to say what you’re suffering from is “this” or “that” makes a difference. Like the difference between knowing you’re suffering from asthma and just wondering why you’re fighting for breath all the time for no apparent reason.

  3. I don’t really get the difference between a label and a diagnosis, to be honest and I’m not sure that most of the people who like to call psychiatric diagnoses labels do either. There’s really no distinction between ‘manic depressive’ and ‘person with manic depression’ – to me they mean exactly the same thing.

    colouredmind: Cancerous applies to the disease not the person (it comes from the Greek for ‘crab-like’, which refers to the way some tumours look). Consider instead diabetic and asthmatic. These are used to describe people with those conditions and very few people object to this. Being referred to as a manic depressive in contexts that have nothing to do with your illness is probably annoying, but it’s not at all the same thing as calling someone cancerous, which is to compare them to a disease, rather than referring to them as someone who has that disease.

    I just had a look at your blog and I note that you’re 17. I’m not bringing that up because I think it diminishes your opinion. But I felt the same way about a balanced like bringing ‘monotony, day to day existence and dullness’. I think most people do. These things have a lot to recommend them, particularly as the consequences of an unbalanced life make themselves ever more clear.

  4. They imply different things, though. “Manic depressive” implies a type of person, and “person with manic depression” just is a person with an illness, not a type of person.

  5. I am not disordered, I know that much, I know this is an illness. I am both manic depressive and a person with manic depression, when I am recovered I will just be a person with manic depression.

  6. When I was a little girl there was an illness that people could not pronounce it’s name. Whenever they referred to this disease, which prognosis was so bad and there was so little knowledge about treatment and fully comprehension of the disease itself, they use to say “-You know that Tom has …….. .” ,
    To fill the blanks they used to look at each other with a dark face as if death was around. It seemed that if you pronounced the name you were also contaminated by this disease. Some people filled the blank with a low voice saying “crab”.
    Now I’m 49 years old and I can say aloud: “-Tom has cancer.”
    People still look at each other with fear because although there was some improvement in treatment it’s far from having a real cure.

  7. “A faction, a rather large faction, from politicians to psychiatrists, don’t believe in the existence of mental illness.”
    What makes you say the faction is a large one? If anything, the vast majority of people “know” that mental illness is real.


  8. Okay then, a very *vocal* faction- a lot of people who espouse Szazz, the anti-psychiatry movement and such.

  9. I know mental illness is culturally and personally complicated. A faction, a rather large faction, from politicians to psychiatrists, don’t believe in the existence of mental illness. There’s another debate about this over at Mental Nurse. I stayed out of it.

    I don’t blame you for staying out of it. I’m the moderator of that site, and even I (mostly) stayed out of it. My God, that Ted has no concept of when he’s losing an argument.

    I’m actually surprised at myself for when I did join in by how much I was willing to defend the medical model, given how in practice I’m really not a medical model-oriented kind of a nurse. Although that’s mainly to do with the kind of clients I see and the work I do with them.

    Overall, I think any model you care to use (medical, cognitive-behavioural, humanistic, psychodynamic, psychosocial, social constructivist) is true to some extent or other. Some models will be more valid/relevant to certain people and at certain times than others.

    As for labels, they’re only as good/bad as the way they’re used/abused.

  10. I don’t understand why you keep stressing the “mental illness is a real physical illness” – it is. I believe that, you believe that. Hell, the medical journals believe that.

    There’s always going to be people who will not be convinced. Certainly not by this blog – that isn’t to say your blog isn’t great – your blog is AMAZING – but these people only start to change when either something happens to them or those close to them or they start to get to grips with the science.

    There are people out there who think women should be seen and not heard, the black people shouldn’t have rights, that immigrants should be deported etc etc – a lot of that comes from ignorance. You can try and reason with these people, but at the end of the day you’re getting wound up over something that you can’t change.

    • Tbh, it’s better to say something, than to say nothing. Some people will come here, read this, with a new perspective. Maybe not a lot, but some will.

  11. As I said a few days ago I don’t mind what they label me with, I am past caring so long as I get the help I want and need to finally start to recover and understand why I am so screwed. Whilst I am not scared to be labelled or diagnosed, I am still scared and slightly ashamed of talking to close family about it… I seem to be unable to get over that stigma.

  12. Hiya, yeah we’ve all found our way over here now. Looks like Ted has too! Anyway I love this post. Especially the stuff about yoga and reiki. I’m sick of hearing that too.

    Your post prompted me to repost on my lj an email I sent to folks I work with back in Jaunary as a kind of manic-depression 101, where I explained that yoga/reiki/chilling out was NOT going to fix anything. (I’d been planning to do that for a while – the repost, not reiki).

    But yes, I agree 100%. I hate being told I have “mental distress”. It makes me sound like I didn’t get what I wanted for my birthday.

    I think some people who talk about “labels” are talking about the very specific case of unipolar depression v. bipolar disorder – ie there’s a spectrum with arbitrary dividing lines and the points along the spectrum could be called “labels”, but against a background of bipolar spectrum disorder. This is one particular point of view though and not one that is expressed by the “mental distress” crowd.

  13. @ Zarathustra

    “My God, that Ted has no concept of when he’s losing an argument.”

    If you define losing an argument by popular vote, then there was never any chance I would win, nor did I ever believe any different. I just find it strange when people (taking the Mental Nurse blog as a collective) blindly assert blatant falsehoods and fail to back them up when questioned, either thinking they are somehow beyond reproach, believing they occupy the moral high ground, or simply having no real knowledge of the subject of discussion. Some of the folks there have been well worth talking to, and some less so. As for your admission of defending the medical model while simultaneously not being that way inclined…

  14. Ted…

    Fuck off

  15. Sorry, that was a bit of a brusque response, and I think I should elaborate on that.

    Ted, regarding your point:

    As for your admission of defending the medical model while simultaneously not being that way inclined…

    I never said that I reject the medical model as being wrong. I merely said that my current clinical practice doesn’t make it as important as others. This has a lot to do with the kind of psychosocial influences that are important when doing child and adolescent mental health work.

    I have previously worked with people with acquired brain injuries. With such people the medical model is much more important than with, say, a child who has been sexually abused.

    There are many important nuances about the different models and how they interact. Feel free to ignore these nuances and come to a ridiculously simplistic conclusion that satisfies neither professional nor patient. You will anyway.

  16. @ Zarathustra

    “Fuck off”
    I was merely being honest. To be fair, you were one of the more interesting contributors.

    “There are many important nuances about the different models and how they interact.”
    There surely are, and I never said this wasn’t the case. Still, if the medical model is used where there is no medical illness, something is surely going wrong.

    “Feel free to ignore these nuances and come to a ridiculously simplistic conclusion that satisfies neither professional nor patient.”
    The model of coercive care cannot, by simple logic, satisfy the patient. If the patient were satisfied, he would not require coercing.

  17. Oh Gawd. Leave the debate where it started – There’s a reason MLA said she’s staying out of it – so please don’t bring it here.

    Labels: I hate them. Not because MI doesn’t exist – but because they are used as ‘throw away’ lines; like once the diagnoses is put on – that’s it; job done. We just go thru the ‘ clinical pathways’ now and it becomes so depersonalised.
    I’m happy for someone to tell me they have MPD or BPD or Schiz – but, without wanting to sound all ‘textbook nursey’, I also like to know what it means to them as each is unique.

    Coping mechanism: I totally agree Mand; DID is a coping mechanism; but major psychoses are a response to some brain screw up. I view it as akin to tearing a muscle – it takes some serious stress/strain to do that and then, once done, there is forever a weakenss. I subscribe to the ‘trigger’ factor tho that trigger may be 20 years of slow, low key grind on the brain. I don’t think I’ve ever met someone who just suddenly became mentally ill.

    MI exists: Yes, of course. But I debate the context in which people put it and agree that people have the illness – they are not “the illness”. I recently looked at a website displaying art and literature – each item had descriptors of the ‘artists’ next to it “male – paranoid schizophrenia” “female – manic depressive with personality disorder” – It made me want to scream for the public representation it does.

    Hope you’re going ok there Mandy.

  18. oops I got the wrong blogger



  19. Does this mean I can tell Ted to fuck off too?

  20. They imply different things, though. “Manic depressive” implies a type of person, and “person with manic depression” just is a person with an illness, not a type of person.

    Surely ‘person with manic depression’ is a type of person (ie. a manic depressive)? Just as ‘person with diabetes’ is a type of person (ie. a diabetic)? Saying ‘diabetic’ doesn’t imply that all people with diabetes are the same except in the respect that they don’t have enough insulin and have problems regulating their glucose levels. Similarly, ‘manic depressive’ doesn’t imply to me that all people with ‘manic depression’ are the the same, except for the fact they’re likely to be manic or hypomanic sometimes and depressed sometimes.

    To me, ‘I have manic depression’, ‘I am manic depressive’ and ‘I am a manic depressive’ all mean the same thing. It’s the context they’re used in that counts. (Incidentally, have you looked at the subtitle of your blog recently?)

    I’m happy for someone to tell me they have MPD or BPD or Schiz – but, without wanting to sound all ‘textbook nursey’, I also like to know what it means to them as each is unique.

    Just as a data point, I find this kind of thing inordinately annoying whenever it’s done to me. I tend to use technical language because it’s my natural way of thinking. And it’s irritating having to constantly explain what I mean by words that actually have a precise and widely understood meaning. I may not be the typical mental health patient, though.

  21. Labels are given way too much power, in my opinion. A label is nothing more than a shortcut expression, a descriptive way of compressing a number of different things into a few words or less. Labels aren’t always accurate, often change with time and circumstance, and are only reliable in the most general of ways; yet some people live and die by how they’re labeled.

    What my doctor and therapist choose to label me with is their decision – it doesn’t change the symptoms I experience, and it doesn’t change who I am as a person. What it changes, as it does for most people, is how they respond to me and my symptoms. As such, while I’d like to say I could give two farts and a whistle for how people label me, the reality is that I know I have to be very careful with what labels I accept or don’t accept; which is why I can understand and agree with protesting when people lob certain labels around.

    I had a doctor once tell me that the glasses he saw the world through were rose-colored, the glasses I saw the world through were dark grey, and my problem was that I really needed to change my glasses. What I did instead was change doctors. I also came up with a label for my old doctor: quack. It doesn’t change his skill or ability, it doesn’t change him as a person; but it will certainly guide my responses to him the next time I see him.

  22. crab as a euphamism for cancer could lead to some embarrassing misunderstandings.

    i am the worst commenter ever.

  23. Be nice to Ted everyone

  24. I have often thought it odd that of all the branches of medicine psychiatry is the only one where we have to go out and occasionally “catch” our customers and then force treatment on them. It has also struck me as decidedly odd that whole diagnostic categories or labels jf you prefer such as homosexuality and moral imbecility have been ditched in the past, which can only make one wonder about the validity of other diagnostic categories still in use today.

  25. “For those people, I can use other words, like “fuck” and “off”.”

    Brilliant. You just made my shitty day a bit more bearable.

  26. it absolutely aggravates the HELL out of me whenever i hear anyone mention mental illness or anything involving it especially if they call it a label from doctors because that hits so closely to home. My illness is my life it influences almost everything i do and for people to tell me that?, How dare they, they don’t understand how hard it is just to accept the fact you have a mental illness, let alone how hard life becomes than normal lives. I wish thy could get a taste of how it is then they’d shut there mouths. It’s not fair to call ny mental state a label, it’s a true condition that the person suffers from, people are just so fucking disrespectful, they don’t give a shit about the feelings of others.

  27. […] I know mental illness is culturally and personally complicated. A faction, a rather large vocal fa in hot water with the National Audubon SocietyA grant Toyota Motors made to the National […]

  28. Ah yes, the blue pill panacea..No thinks…Yoga? Cant seem to figure out how to do that without knocking over the ashtray…But thanks for telling the truth!

  29. I’ll admit I didn’t read the whole post… but I can see why some people think that EVERY SINGLE WORD is a label. Existence, as far as humans go, is pretty much a linguistic phenomena.

    Words are how we label reality, period. No word exists. There is no inherent meaning. Nothing is REAL.

    It’s all made up mentally interesting one.

    It’s… all… made… up.

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