The “Mental Illness” in All of Us, Part 1: Disorders and Labels

What exactly is mental illness, anyway?

I’ve always been fascinated with the concept of how we define mental illness. If we are looking for the textbook definition then it would be “…medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” –

I prefer to use the more common definition of a “disorder:” a negative feature that impedes daily functioning. Think of someone who is afraid of spiders (arachnophobia) Being afraid of spiders does not necessarily qualify as a disorder until it affects daily functioning. Avoiding places that may contain spiders on a daily basis earns a label in our mental health system.

Diagnoses are merely labels that better enable professionals in the mental health field to treat individuals by providing a set criterion in the DSM. This works very well in the medical setting where expedited treatment is necessary, but in my opinion, it does not work as well in the residential and long-term treatment settings. There it is more important for the professionals themselves to conduct their own assessments of the individuals they are working with. Of course, it is necessary for them to receive any records of prior treatment, but those records should only serve as reference points, not as permanent and unwavering labels.

Labels such as “ADHD, Oppositional Defiant Disorder, and Intermittent Explosive Disorder” unfortunately tend to be attached to someone’s medical record and remain there. The good side of labels is that they enable professionals to be more efficacious in their treatment when working with people with documented history. The bad side of labels is the part that we rarely discuss in the real world. When we give someone the label of a disorder it does not only stay on a piece of paper or on a medical records computer; worse, it is internalized by the individual. Once someone is told by a professional they “have” something, they carry that label with them the rest of their lives. We hear all the time “I used to have clinical depression” and “I have ADHD so I have a hard time studying” as well as “I was told once that I may have Aspergers, I think that’s why I don’t socialize with others very well.” So you see, these diagnostic labels are often carried with young people the rest of their lives. The stigma (both internal and external) that goes along with those diagnoses cannot be underestimated. In fact, sometimes it leads to a negative feedback cycle of seeing symptoms where they do not exist, then blaming the label. After all, its much easier to say “The reason I treat my parents, teachers, and probation officer with disrespect is because I have a disorder” than it is to think or say things like “I make bad decisions”, “I have poor coping skills”, or “I was angry that day and I didn’t control it very well.” Think of your thought process if you were in this situation. Most of us would be very likely to blame our actions on a disorder that we were labeled with, thereby passing all responsibility away from ourselves.

Although someone with this disorder would be more predisposed to lashing out or acting irrationally when faced with confrontation with a person of authority, not every bad action he or she makes is a result of his or her disorder. By blaming the disorder for his or her actions the individual sometimes does not take the steps necessary to prevent them in the future. These steps might include work in therapy, thinking about their actions and their consequences, learning positive coping skills, and cultivating positive communication skills, all to lessen the likelihood of repeating their actions in the future.