One of the most frequent issues I come across in discussions on mental health, psychiatry or psychology is the issue of labels. From references to patients who can become clients or service users, through labels of mental illnesses, to the latest calls to change the names psychotropic medication. I tend to react with scepticism to such calls, more often than not with negative reactions to my scepticism. And here I would like to account more fully, why I tend to reject the calls to change labels.
Labels are no doubt important and there is a library of research particularly in persuasion and propaganda studies. But labels are explored further afield. From Bourdieu who writes about label-generating official taxonomies and titles (like ‘professor’) which bestow power and glory upon their holder, through the use of clinical labels such as ‘schizophrenic‘ which are often used to insult, to many reports of words such as ‘flood’ or ‘swarm’ in reference to immigrants. Such labels may have significant consequences for the ways of speaking (and perhaps thinking) about the objects they construct.
Having said this, I still think the problem of labels in mental healthcare is, I think, overrated, mostly because it is seen in abstraction from the rest of the language system. I would like to give you two examples. The first is about the irrelevance of label change, the other shows that the change is never neutral. Always what really matters, is the consideration of the entirety of ‘speaking’ practices about an issue, or as linguists would say: discourse.
And so, let me first consider labels used in diagnostic criteria (which I discussed in Men’s Discourses of Depression). Let’s have a look at the ICD criteria for the depressive episode. Here are some of the labels they use: depressed mood, loss of pleasure, fatigability, loss of confidence, thoughts of death, and indecisiveness.
Granted, I am not a clinician, yet these labels are vague, complex, dilemmatic, extended in time processes as losing one’s confidence or thinking about killing oneself are rendered by simple (not to say simplistic) labels which can very easily be read into.
The very core of depression ‘depressed mood’ offers hardly any insight into what exactly it might be, and when I asked psychiatrists when depression starts, they could not answer the question. So, shall we change the labels then? I would imagine, it would be possible to find words which could replace those above. And yet, I think it’s immaterial.
Why? Well, because it’s not the labels which are a problem. The problem is that the criteria are put as nouns, and so they are rendered as things. People don’t think, don’t feel, don’t decide – rather, they have things. Subjective experiences are changed into objective objects which are to be found, identified and dealt with by clinicians. Not only are they more objective and universal because of this, but also, it seems, they don’t belong to anyone. Where am I? I could ask! Such arguments could easily be extended onto labels such as ‘schizophrenia’.
And so, we can change the labels all we want, but unless we change the entirety of speaking of mental illness (the discourse), the change of labels is hardly the point. Indeed, I made similar points with reference to definitions of delusions, where the point is not labels, but the way delusions are described (linguists would say – constructed discursively).
The second example I would like to use might be somewhat controversial, still, I think it’s important to tackle it. I want to deal with the issue of labels referring to suicide. It’s commonly accepted that the expression ‘commit suicide’ should be avoided. The reason is that ‘commit’ is suggestive of something illegal. In other words, we commit a crime. As suicide is not one; ‘commit’ should be avoided. Commonly, the preferred word (yes, a label) is ‘die’, in other words, instead of saying ‘He committed suicide’ we should say ‘He died by suicide’.
The problem is that the change is not ‘innocent’, it has consequences. By using ‘die’ we remove the person’s agency in taking their own life. ‘Die by suicide’ suggests that the death happened, and yet, it doesn’t. The person actually does something in order to ‘die by suicide’. The label changes the way we are encouraged to see suicide. It no longer is an action of a person who takes their life, but an event that happens to him or her. Removing the stigmatising connotations of crime, we also remove the intentional aspect of suicide.
So perhaps we should use another label which is proposed, admittedly, less frequently. We could say ‘He completed suicide’. The word ‘complete’ takes care of the problem of agency – it does suggest an action a person takes, it acknowledges the act of ‘taking’ life. The problem with it is that ‘complete’ has clear positive undertones. To complete something is largely something socially approved, such as exams, repairs, studying, and the like. And we could continue substituting label for a label, and we would probably find that each and every one carries with it assumptions which construct suicide in a particular way.
Now, it’s not my position to say which label should or should not be used. I only want to point out that there are no neutral labels, each carries a different worldview and it is not the suicide labels which should be discussed, but the worldviews they carry. Because this is, really, what we are deciding – not a label, but a world view, ideology, if you wish.
And that’s the linguist’s take on labels in mental health. Here’s the bottom line. Labels matter, of course, they do, but they must not be seen in abstraction from the discursive context of which they are part. In other words, labels are never ‘only labels’, they are part of the entire way of speaking, which to use a much-quoted phrase by Foucault, ‘informs the objects of which it speaks’. It might also be a good idea to consult a linguist.
But I would like to finish with one last point. Some time ago I took part in a discussion on the live donation of kidneys. What was disturbing about this discussion were the labels used to refer to kidneys and retrieving them from live people. My point was that no matter what we call it, a kidney remains a kidney.
Dariusz Galasiński is Professor of Discourse and Cultural Studies at the University of Wolverhampton.