The language of mental ill health is inescapable. Diagnostic terms, such as depression and post-traumatic stress disorder (PTSD), pervade popular culture and saturate the online world. They are the currency of countless news stories and awareness campaigns.
Author
Nick Haslam
Professor of Psychology, The University of Melbourne
The rise of diagnostic labels could be celebrated. It suggests the public's mental health literacy is increasing and the stigma attached to mental illness is in decline. As the shame associated with it diminishes, mental illness comes out of the shadows.
But the rise of diagnostic language may also have downsides. Some critics argue it reflects the medicalisation of distress and may contribute to over-medication. And just as naming conditions may reduce stigma, it could also increase it. Labels can be sticky, having lasting effects on how others judge people with mental illness, and how they see themselves.
In a new study, my colleagues and I examined how labelling a person's relatively mild or marginal mental health problems affects how others perceive them.
We found the presence of labels increases empathy and concern for those affected, but also pessimism about their capacity to recover. Essentially, diagnostic labels appear to be a mixed blessing when used at the less severe end of the distress spectrum.
Concept creep
When we talk about the rise of diagnostic labels, a particular concern is that concepts of mental illness have been expanding in recent years. They now encompass a wider range of experiences than they did previously. This so-called "concept creep" implies people may be using diagnostic terms to refer to phenomena that are relatively mild or marginal.
British psychologist Lucy Foulkes has argued people may be increasingly over-identifying mental illness. This means they are applying diagnostic labels to experiences that fall below the diagnostic threshold.
Recent studies (including those from my research group) support this possibility. This research has found people who hold expansive concepts of mental illness are more likely to diagnose themselves than those with narrower concepts.
The implications of applying diagnostic terms loosely are unclear. Using them to label relatively mild distress might have positive effects, such as encouraging people to take that suffering seriously and seek professional help.
But it might equally have negative effects, stigmatising the labelled person or leading them to be defined and constrained by their illness. It might even lead people to diagnose themselves inappropriately.
Our study
We wanted to understand the impact of these broadened concepts of mental illness by examining how diagnostic labelling influences the perception of people experiencing relatively mild problems.
Across two experiments, we presented almost 1,000 American adults with short descriptions of a hypothetical person experiencing a marginal, non-severe mental health problem. Each description was carefully tested to fall near the diagnostic threshold.
Participants were randomly assigned to read otherwise identical descriptions either with or without a diagnostic label (major depressive disorder, generalised anxiety disorder and bipolar disorder in experiment one, and PTSD, obsessive compulsive disorder and binge-eating disorder in experiment two).
After reading each description, we asked participants to report how much empathy they felt towards the person, how appropriate they were for professional treatment, and how much they should receive accommodations at school or work, such as extra time on assignments or special leave.
We also asked how likely they thought the person would be to recover fully (both experiments) and how much control they had over their problems (experiment two). We then compared these judgments between the label and no‑label conditions.
Labels had an impact
Participants who read descriptions preceded by a diagnostic label tended to report greater empathy toward the person and more support for efforts to accommodate their problems. They also saw the person as more appropriate for treatment than those who read the same descriptions unlabelled.
At the same time, the presence of labels led participants to see the person's problems as more lasting and their recovery as less under their control.
Many of these judgments varied between disorders. There was some evidence that labelling effects were strongest for less familiar disorders such as binge-eating and bipolar disorders.
Mixed blessings
When diagnostic labels are applied to marginal cases of mental illness, the implications seem to be mixed. On the one hand, labels legitimise help-seeking, promote flexible support and boost empathy. These positives contradict suggestions that labelling promotes stigma.
However, diagnostic labels also seem to encourage the view that mental health problems are persistent and that people have limited capacity to overcome them. In other words, diagnostic labels may lead people to see mental illness as an enduring identity rather than a transient state. These perceptions may erode expectations of recovery for people experiencing problems and undermine efforts to achieve it.
Even the apparent benefits of labelling could have a downside in the context of relatively mild distress. It might encourage unnecessary and ineffective treatment or entrench a "sick" role by offering special accommodations to people with marginal impairments.
Our findings shed light on the possible consequences of the ongoing expansion of diagnostic concepts. As these concepts spread to less severe forms of distress and impairment, and diagnostic labels are used more loosely, we must be alert to the probable costs as well as benefits.
Nick Haslam receives funding from the Australian Research Council.
