The language of mental illness is inescapable. Diagnostic terms like depression and post-traumatic stress disorder (PTSD) permeate popular culture and flood the online world, providing the voice for countless news stories and awareness campaigns.
The rise of diagnostic labels is a welcome development. It suggests that public health literacy is increasing and the stigma of mental illness is decreasing. As the shame associated with it diminishes, mental illness is emerging from the shadows.
But the proliferation of diagnoses has its downsides. Some critics argue that it reflects the medicalization of suffering and may contribute to overmedication. And just as naming illnesses can reduce stigma, it may also increase it. Labels can stick around and have lasting effects on how others judge people with mental illness and how they view themselves.
In a new study, my colleagues and I examined how labeling a person’s relatively mild or marginal mental health problems affects how others perceive that person.
We have found that the existence of labels increases compassion and concern for those affected, but also pessimism about their ability to recover. In essence, diagnostic labels seem to be a double-edged sword when used at the less severe end of the suffering spectrum.
Concept Creep
When we talk about the proliferation of diagnostic labels, what is particularly worrying is that concepts of mental illness have expanded in recent years, covering a wider range of experiences than they once did. This so-called “concept creep” means that people use diagnostic terms to refer to phenomena that are relatively mild or marginal.
British psychologist Lucy Foulkes argues that people are increasingly over-diagnosing mental illness, meaning they assign 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 that people with broad beliefs about mental illness are more likely to self-diagnose than those with narrower beliefs.
The consequences of loose application of diagnostic terms are unclear. Their use to describe relatively mild conditions may have positive effects, such as encouraging sufferers to take their suffering seriously and seek professional help.
But it can also have negative effects, causing the affected person to be stigmatized or feel defined and limited by their illness. It can even lead to those affected misdiagnosing themselves.
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Our study
We wanted to understand the impact of these expanded concepts of mental illness by examining how diagnostic labeling affects the perceptions of people with relatively mild problems.
In two experiments, we presented nearly 1,000 American adults with brief descriptions of a hypothetical person suffering from a minor, non-severe mental health problem. Each description was carefully reviewed to ensure that it was close to the diagnostic threshold.
Participants were randomly assigned to read otherwise identical descriptions either with or without diagnostic labels (major depressive disorder, generalized anxiety disorder, and bipolar disorder in the first experiment and PTSD, obsessive-compulsive disorder, and binge eating disorder in the second experiment).
After reading each description, we asked participants to indicate how much empathy they felt for the person, the extent to which professional treatment would be appropriate, and the extent to which they should receive relief at school or work, such as extra time on assignments or special leave.
We also asked how likely they thought the person was to make a full recovery (both experiments) and how much control they had over their problems (experiment two). We then compared these ratings between the labeled and unlabeled conditions.
Labels had influence
Participants who read descriptions with a diagnostic label tended to report more empathy toward the person and more supportive of efforts to manage their problems. They also viewed the person as more suitable for treatment than those who read the same descriptions without a label.
At the same time, the existence of labels led participants to view the person’s problems as more permanent and their recovery as less under their control.
Many of these judgments varied across disorders. There was some evidence that labeling effects were strongest for lesser-known disorders such as binge eating and bipolar disorder.
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Mixed feelings
The effects of applying diagnoses to marginal cases of mental illness appear to be mixed. On the one hand, they legitimize help-seeking, encourage flexible support, and increase empathy. These positive aspects contradict the assumption that labeling promotes stigmatization.
However, diagnoses also seem to promote the view that mental health problems are permanent and that people’s ability to overcome them is limited. In other words, diagnoses may lead people to view mental illness as a permanent identity rather than a temporary condition. These perceptions may diminish sufferers’ expectations of recovery and undermine efforts to achieve it.
Even the obvious benefits of labelling can have disadvantages when the burden is relatively mild. It could encourage unnecessary and ineffective treatments or reinforce the role of the ‘sick’ by offering special accommodations to people with minor impairments.
Our findings shed light on the potential consequences of the ongoing expansion of diagnostic concepts. As these concepts are extended to include less severe forms of suffering and impairment and diagnostic labels are used more loosely, we need to be aware of the likely costs and benefits.
