On the Concept of “Mental Illness,” the Harms of Psychiatric Labeling, and the Most Unrecognized, Oppressed Minority Group in America

When Western researchers started positing this theory, thanks to new technology allowing them to map brain functioning and DNA, they thought it would help decrease stigma toward the mentally ill, by removing the sufferer from blame. If “mental illness” is due to some inherent physiological abnormality, then society can’t blame a person’s behavior or inability to achieve full recovery on things like character weakness or life choices, so the thinking went.

Unfortunately, the opposite occurred. Research conducted throughout the globe has shown that over the past four decades, in regions where the biomedical model has gained ascendance, negative attitudes toward the mentally ill have actually significantly increased, including heightened public fear of the mentally ill and greater social ostracism. Why? Because the implication underlying the biomedical model is that of a person whose brain is so permanently broken and abnormal he or she is always unstable, unpredictable, unhealthy, and dangerous, Watters explained.

In other words, the biomedical model doesn’t allow for the more accepting view Kimwana’s family had: of a daughter who fluctuated in and out of periods of health (normalcy) and suffering. Wrote professor Sheila Mehta of Auburn University, who has conducted studies and experiments on how the biomedical view influences Westerners’ perception of mental illness: “We may actually treat people more harshly when their problem is described in disease terms… We say we are being kind but our actions suggest otherwise… Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as… almost a different species.”

Watters may not have realized his observation about how central a role culture’s naming and defining of an illness plays in individuals’ prognosis was touching on a field of recent research known as “labeling theory.” It grew out of postmodern and feminist lines of social psychological research that started being explored in the 20th century, pioneered by such academics as Erving Goffman, Charles Horton Cooley, Carol Gilligan, Herbert Blumer and Thomas Szasz. These researchers developed theories like symbolic interactionism and social constructionism that proposed new ideas about how people develop a sense of self, and where “mental health” falls into that. Szasz, the famous father of anti-psychiatry, denounced the labeling of mental disorders, calling it a political act by those in power: An attempt to exert social control over people who threatened them by branding nonconformists with a “spoiled identity.” One well-known example of this is how early women suffragists were accused of suffering from “nervesickness” and other mental ailments in the 19th century by men who opposed their fight for civil rights. Szasz suggested describing people with “mental disorders” as struggling with “problems in living” instead.

In the past decade, new research in labeling theory has revealed troubling evidence that the way we name and define mental disorders in Western psychology can cause even more harm than the illness itself. The aforementioned Patrick Corrigan and Petra Kleinman, for example, have demonstrated the stigma the mentally ill experience from psychiatric labeling is often internalized, causing low self-esteem, self-prejudice and feelings of worthlessness. Anthony Taylor and Palmer Reg Orovwuje’s studies have found the rejection and humiliation the psychiatrically impaired experience is so strong it amounts to a “second illness.” A landmark study by Jo Phelan, Bruce Link and colleagues, in the 1980’s, showed that simply being labeled as chronically “mentally ill” had twice as large an impact on an individual’s income and employment than the actual symptoms themselves. 

Labeling theorists say what happens is, the term “mentally ill” becomes in effect a person’s “master status,” leading to a self-fulfilling prophecy in which the person buys into the label and starts to limit him or herself by socially isolating, ceasing to apply for jobs, and conforming to additional expectations associated with their label. A viscous cycle ensues that ironically only ends up fueling psychiatric practitioners’ belief they correctly nailed the person’s alleged “mental illness” in the first place. The label and its stigma, therefore – not the alleged disorder – is what ends up sustaining the illness, according to these researchers.

After reading stuff like this, I start to wonder, am I inherently wired to hate myself, to constantly interpret my life in comparison to others’ negatively, as those close to me say – or is it actually the other way around. Is it perhaps Western psychology’s form of diagnosis and labeling – and the entrenched, societal stigma it’s left in the American mindset in its wake – actually, that has taught me to hate myself as much as I do?

That biological reductionism counterintuitively exacerbates stereotypes about the mentally ill – even by practitioners themselves – has certainly proven true for me. The countless treatment providers who’ve tried to “fix” me over the past decade have, for the most part, blindly embraced the gene/brain abnormality theory. And while I have no doubt they mean well, and they try to make clients like me feel better by saying things like “it’s not our fault” – the way they’ve treated me in practice has done nothing but exacerbate my “internalized stigma.” Always, when I’ve struggled at a certain point while in a treatment center, or months after discharge relapsed yet again, practitioners have never stopped to consider whether the problem perhaps has more to do with them, not me. Whether their failure to see me as a culturally-embedded person – rather than an illness – and reconsider their treatment approach as a result, might be a problem. On the contrary, they continued to prescribe me the same regimented, authoritarian, debasing and outmoded form of treatment they’ve been prescribing – in their cookie cutter approach – to eating disorder patients, no matter what their age or background, for years.

Despite having attended several residential and day treatment programs over the past decade, and doing every fu—ing thing – no matter how humiliating or traumatizing it’s been – these programs have asked of me, it’s never worked. And invariably the

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4 comments

  1. Diane R. Anderson says:

    Good morning Jeanene,
    I am eager to read your entire article and I copied it into Words so I can have it with me at all times even when there is no internet access for me here.
    I did read the first page quickly and the last paragraph… My heart felt and my eyes are crying for the pain that you are going through. You are a wonderful writer and you have a lot to offer that the world sees and recognizes it or not. It takes more courage to fight and that is what you are doing right now. You have started a fight for you and to help others by making this disease more visible. Scientists can go to the moon but can’t figure out the intricacy of the human brain to cure mental illness. I can’t wait to dig further with you in understanding the dimension, the fears and the nutritional effects that could make a small difference.
    Always listening,
    Love,
    Diane

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  3. Jeanene, Just because we choose not to call it “mental illness” doesn’t mean we don’t believe the suffering exists. Your friend was using faulty logic. You did not state, “People aren’t really suffering.” What you did state, and I do too, is that we choose not to call this “illness.” We don’t deny the existence of suffering. As I said in my blog post, calling it “illness” actually diminishes our recognition of suffering, boxing us into categories and pre-determined “treatment.”

    As for the discrimination against ED, I see that everywhere. It even exists in the Movement. How many times have I heard, “My bipolar was real. Your eating disorder was a choice.” So a manic person doesn’t “choose” to waste thousands of dollars on a plane ticket to Hollywood, thinking he/she is having a love affair with a movie star due to either “I can’t help it it’s my illness” or “It’s not an illness but I was really suffering.” Either way, calling it “illness” or not, ED gets left between the cracks.

    Yes, ED impacts us physically and is often caused by something amiss in the body. How often have I heard, “After 20 years, I found out the cause was a food allergy.”? Or, “My kid wouldn’t eat, but we found out he had dental problems that made it impossible to chew.” The treatment centers don’t even address these things. They don’t care what the cause is, they only force-feed and monitor every function of the human body as if we are caged animals.

    I suffered from both anorexia and binge eating. The binge eating went ignored in the treatment center and the focus was on forcing food, or even fake food, into me. They assumed the binge eating came from hunger. If only they’d listen to patients and realize that it doesn’t. In fact, I’ve had uneducated doctors and well-meaning friends state that it’s good to binge because it puts weight on a person.

    Say, what? Is no one speaking out on this? I think there are more deaths from binge eating (stomach rupture, car accidents, suicide) than anyone wants to admit. I know that in 1986 and 2012, when I really did want to do myself in, it was because no one presented to me any reasonable solution to binge eating. I was either turned down, blamed repeatedly, or given pat answers by “staff” who really didn’t know what I and other men and women experience who do large-quantity binges.

    Even outpatient treatment is slavery. People with bipolar or OCD might see a therapist once a week, maybe twice, and the psychiatrist once a month, but with ED, you have to see not only a therapist who runs your life, but also a nutritionist, often weekly, and a PCP for the forced weigh-in, plus the psychiatrist. Some must endure the forced weigh-in twice weekly. For many, this means at least three appointments per week, and if you don’t show up for one, you risk sectioning, that plus living with constant threats, “If you don’t gain 1/2 pound by Friday, you’re sectioned!” That’s not a life. It’s hell. It’s treating an adult like kindergarten, basing “care” on distrust and suspicion. I’ve been told, “All ED’s lie.” That, too, isn’t true. We don’t lie any more than anyone else. When i see it in a young ED, it’s usually the result of repeated scaletime bullying.

    • Jeanene Harlick says:

      Julie, I can’t respond in full right now – but I am very much in agreement with so many of your points! I am not sure how people can be so clueless… Like I said on your blog – Western society is pathologizing what are natural human emotions and behaviors which stand outside what they deem “normal” – because they’re uncomfortable with people who choose to live authentic lives; who feel intensely; who are in touch with the true nature of world, being human, the faulty parameters of “success,” etc. I.E. people who are akin more to artists and seers, and choose not to take the easy route by trying to squeeze ourselves into the cookie-cutter living and emotional range that is considered “acceptable” today …. That’s one reason why it’s very informative to look back at the history of “mental illness” – by reading people like Foucault, Goffman, R.D. Laing, etc., and understand how much a construct mental illness labels are… And how society exacerbates what is actually normal human suffering – suffering which could be manageable if it weren’t stigmatized because we express it in unconventional ways…. That’s not to downplay that there is also a lot of struggle arising from past trauma, too, and that that is deserving of help and working-through — but not the stigma, labels, and prejudice which sometimes come with that…

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