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Abu Dhabi, UAETuesday 21 August 2018

What happens when amateurs misuse mental health terms?

The misappropriation of mental health terminology has muddied the waters for those suffering serious conditions, writes Justin Thomas

When basketball player LeBron James, left, moved from Cleveland to Miami in 2010, Cavaliers owner Dan Gilbert called him 'narcissistic'
When basketball player LeBron James, left, moved from Cleveland to Miami in 2010, Cavaliers owner Dan Gilbert called him 'narcissistic'

Disclosing a mental health issue does not carry the same stigma it once did, thankfully. In fact, some of the terminology surrounding mental health has even passed into common parlance; some people might joke about being “OCD” when it comes to cleanliness or when describing a compulsive shopping habit.

Even when our mental health issues are genuinely distressing, we are now more open to discussing our experiences.

An issue of Harper’s Bazaar magazine earlier this year published an article listing 39 celebrities who have opened up about their mental health with the headline “proof that anxiety and depression can affect anyone”.

But what about when the mental health issue is more severe or enduring than mild depression and anxiety? What if the mental health problem is labelled, for example, paranoid schizophrenia or narcissistic personality disorder? In such cases, stigma and silence generally still prevail.

Furthermore, beyond depression and anxiety, we still use the labels of some mental health conditions perjoratively. We regularly use psychiatric diagnoses, especially the so-called “personality disorders”, to disrespect one another.

There are thousands of armchair psychologists – and some professional ones – out there who have remotely diagnosed Donald Trump as a narcissist – that is, a person experiencing narcissistic personality disorder (NPD).

That might be their opinion but when such speculative diagnoses are bandied about, they tend to be vocalised with mockery and disdain. The popularity of psychology books such as Jon Ronson’s The Psychopath Test has also inadvertently contributed to many of us misdiagnosing (or diss-diagnosing – using psychiatric diagnoses as terms of disrespect) our bosses, husbands, wives and colleagues as “psychopaths” – that is, people experiencing anti-social personality disorder (ASD).

Again, when we suggest that our boss might be a raving narcissist or a manipulative Machiavellian psychopath, we rarely make such statements with the sentiment of compassion, concern or pity.

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A big part of this problem is our mental healthcare system’s outdated reliance on specific and frequently obsolete diagnostic labels.

Furthermore, the actual names we have dreamt up for some psychological disorders make matters even worse.

For example, consider the controversial diagnosis of borderline personality disorder (BPD). What is the borderline, who decides where the border is and can a personality even be considered disorderly? BPD is a particularly badly named malady and its suggested alternative name, emotionally unstable personality disorder (EUPD), is not much better either.

There are, of course, some occasions when people are comforted by having a diagnostic label, however poorly worded. Having an official diagnosis might help us feel understood or give us a sense of clarity about our situation. It might also help us make sense of past chaos and reassure us that we are not alone in experiencing what we experience.

However, we can still derive the positive effects of diagnostic labels without recourse to Greek mythology (such as Narcissus) or vague and inaccurate concepts, such as borderline. Using broader descriptive categories – for example, mood problems, anxiety or interpersonal problems – we can achieve the same goal of providing some clarity about the nature of the issue.

Beyond such broad descriptive categories, healthcare professionals can also provide detailed written lists of the specific symptoms experienced by the individual patient. This approach has been called symptom-centric and problem-descriptive. It makes a lot of sense clinically and to reduce stigma.

In a 2011 statement to the American Psychiatric Association, the British Psychological Society expressed concern about the continuous medicalisation of natural and healthy responses to distressing experiences – in other words, giving psychiatric diagnostic labels to normal human states and traits.

The BPS also suggested that classifying mental health issues as illnesses missed the social context and, often, the causes. One viable alternative is to switch to the descriptive symptom-focused approach.

This newer way of seeing and describing psychological complaints or mental health conditions has already received support at the highest levels of the psychiatric world.

For example, in the US, the National Institute for Mental Health, one of the world’s largest funders of mental health research, recently announced that it would no longer be funding psychiatric research that utilised former illness categories such as schizophrenia, borderline personality disorder or major depressive disorder.

NIMH now prefers to support clinical research where patients are grouped by symptoms – enduring low mood, widespread interpersonal hostility, persistent worry – rather than the old broken labels.

While it won’t end stigma, rethinking how we conceptualise and name mental health issues will go some way to further reducing the negative feelings and behaviour displayed towards people experiencing them. It might extend the current stigma amnesty beyond depression and anxiety and it might also stop us misdiagnosing one another.

Dr Justin Thomas is professor of psychology at Zayed University

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