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Saturday 28 January 2012




The Medical Model of Mental Health and Psychiatric Labeling

Labeling and Drugging - An Inadequate Foundation for Mental Health Treatment

Also, Mental Health Disorders, Labeling and Stigma

Labeling, based on the medical model of psychiatry, is a method and a theory, although widespread and the standard approach in psychiatry, is not universally accepted in all professional communities.

John R. McHugh, M.D. is (2003)professor of psychiatry at John Hopkins University of Medicine and chief psychiatrist at John Hopkins hospital in Baltimore.

Espanaol - 19 prominent psychiatrists, psychologists and mental health professionals - (not an exhaustive list) - who disagree with the current medical model of mental health - Blog in Spnaish

The medical model is convenient, it gives therapist a clear-cut approach to handling individual situations, but most of all, it has been used by the psychiatric world in a way that leads to labeling and subsequent prescribing of psychiatric drugs. The typical procedure for the medical model of mental health involves, identifying symptoms, assigning an appropriate label, and administering what is deemed appropriate drugs.

Labeling and drugging is a convenient way of treating mental health disorders,
and is profitable for insurance and pharmaceutical companies.

This practice, along with the stigmatization of individuals who have mental health disorders, or who exhibit symptoms of such disorders, has come under the most scrutiny and criticism as lacking sound basis in professional circles in the field of mental health.

Pharmaceuticals are vigorously marketed to physicians, many times, with incentives.

Dr. Paul McHugh who chairs (2003), the department of psychiatry and behavioral sciences at Johs Hopkins University School of Medicine feels that the DSM label of Borderline Personality Disorder, has lost its usefulness. He is quoted in Time Magazine as stating that the DSM ("bible" of psychiatry labeling), has "permitted groups of 'experts' with a bias to propose the existence of conditions without anything more than a definition and a checklist of symptoms. This is just how witches used to be identified," cites multiple-personality disorder as an example of an "imagined diagnosis"; while much of the evidence supporting its existence has been debunked, multiple-personality disorder is still listed in the DSM, though today it's called "dissociative identity disorder." Diagnostics: How We Get Labeled, John Cloud. (Jan. 20, 2003). Time Magazine.

There are other mental health theories which provide a more practical, reasonable and accurate consideration of mental health issues such as the bioecological model of mental health, and positive psychology from Penn State University.

How Labeling and Stigma in Psychiatric Practice are Related

In a study by the American Sociological Association, of the theory of labeling in mental illness, the conclusion was reached that, "consistently support the prediction that the likelihood of social rejection increases after others gain knowledge of an individuals status as a mental patient."'

"When mental [health disorders] are used as labels, these labels hurt". SAMHSA

SAMHSA's, the US Government mental health association, gives this guideline, Before You Label People, Look At Their Contents. SAMHSA states, "When mental illnesses are used as labels - schizophrenic, manic, or hyperactive - these labels hurt."

The Brigadier General of the United States, and Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury,
Loree Sutton, stated concerning many forms of mental illness, "Stigma is a toxic, deadly hazard, which must be eliminated," in a public service announcement.                                                                                           

"Psychiatric labels lead to stigma - Stigma leads to discrimination."Loree Sutton, Brigadier General of the United States

"Labels lead to stigma -- a word that means branding and shame. And stigma leads to discrimination. Everyone knows why it is wrong to discriminate against people because of their race, religion, culture, or appearance. They are less aware of how people with mental illnesses are discriminated against. Although such discrimination may not always be obvious, it exists-and it hurts."

Another thought to consider with persons who have or who have had mental illness is that labels stick. Even after a person may have recovered from bouts with serious mental illness, the label may have a long-lasting impact on other's perception of him or her.

"My son is bipolar."
Labels can be damaging and hurt the one being labeled,
affecting their view of themselves.

If a person recovers from cancer, do we refer to him or her as "being cancer," or he or her "is cancer". No, because we know that cancer is something that we can recover from and be cancer-free. With mental illness, labels are made, "he is OCD," "she is bipolar," as if to say, the word "bipolar" sums up one's whole existence, we don't need to take that person's actions good or bad too seriously, because it all comes down to the fact that he or she "is" this or that label.

In a study published in the American Journal of Psychiatry concerning the subject of stigma, the studies author Bernice A. Pescosolido notes that despite greater insights into mental health disorders in recent decades, one of the reasons for stigma surrounding mental illness lingers is that people tend to look at mental illness as something that never goes away. "When you attach a feeling of permanence to this, then it justifies, in some ways, a person's sense of 'otherness' or 'less-then-humanness'". Hitler took that idea of labeling and stigmatizing to the extreme, as we know, exterminating those with mental illness, but also labeling those who did not fit into his idealized schema as "untermenschen," meaning "sub-human" or "under-man".

That same type of stigmatizing can occur when considering those with mental health disorders as well. It should be noted that there are medical doctors who, before becoming doctors, started medical school after receiving a diagnosis of bipolar disorder. There are lawyers and collge professors with schizophrenia, who are active, productive members of the respective groups, no less than any other professional.

Full Recovery from Mental Illness is Possible

An Internet search on the key words, self help, provides numerous references for depression self help and ADHD self help, but comparatively few for bipolar disorder self help. Why? Because many who are labeled bipolar disorder are often taught to resign themselves to the label with a lifetime of taking psychiatric drugs in view. It is often thought of as an incurable disorder which must be managed with medication. Many who are labeled bipolar, then, may not take practical measures to help themselves. The label, in this case, can be a hindrance for many to take steps to help themselves.

Symptoms associated with bipolar disorder can be brought into remission
and full recovery is possible.

If you have the gout, as an example, you will no doubt be encouraged to change your diet. If you have diabetes, a diet free of excess sugar can be of much benefit. If you are diagnosed with bipolar disorder, then by all means, take positive self help steps to overcome the disorder.
Labeling can have profound effects on the level of will with which you exert yourself to try to ovecome mental health disorders. If you believe you can overcome a disorder, you are more likely to work very hard to do so. If you feel that the mountain cannot be climbed, then for sure, you will never try to climb it.

One encouraging account in relation to autism can be of help to persons with mental illness. In one well-known example of a boy, "Evan" who had suffered with autism, his mother utilized a tremendous amount of resources and therapy for her son's help, she didn't give up. Within a few years, the boy no longer qualified for the label, "autistic," he had sufficiently recovered from his symptoms.

Psychiatric Labels - Child From Dr. Scott Shannon, child psychiatrist.

The same has happened with many who have been labeled with ADHD, bipolar and other serious disorders. So, don't let yourself be put down by the label. Try to help yourself and fight your way out of the cocoon. If you do, you will gain a victory over stigma, and come out of it a more compassionate and understanding person, better able to take on the next set of challenges life presents.

Words of Stigma Can Be Poison

The stigma of mental illness is real, painful, and damaging to the lives of people with mental illness. Stigma prevents them from getting the treatment and support they need to lead healthy, normal lives. Many people don't want to be... labeled as "mentally ill" or "crazy."

Stigma keeps people from getting good jobs and advancing in the workplace. Some employers are reluctant to hire people who have mental illness. Thanks to the Americans with Disabilities Act (ADA), such discrimination is illegal. But it still happens!

Stigma leads to fear, mistrust, and violence. Even though the vast majority of people who have mental illness are no more violent than anyone else, the average television viewer sees three people with mental illness each week-and most of them are portrayed as violent. Even children's movies and cartoons can present a stereotypical version of mental illness, coloring children's view from an early age against those with mental health disorders. (Lawson, A., Calgary University). Such inaccurate portrayals lead people to fear those who have mental illnesses.

Stigma results in prejudice and discrimination. Many individuals try to prevent people who have mental illness from living in their neighborhoods.

Mayo Clinic similarly states,
"Stigma is a very real problem for people who have a mental [health disorer]. Based on stereotypes, stigma is a negative judgment based on a personal trait - in this case, having a mental health condition. It was once a common perception that having a mental illness was due to some kind of personal weakness. We still have a long way to go to overcome the many misconceptions, fears and biases people have about mental health, and the stigma these attitudes create.

Psychiatric stigma can be subtle, Mayo Clinic

Stigma may be obvious and direct, such someone making a negative remark about your mental health condition or your treatment. Or it can be subtle, such a someone assuming you could be violent or dangerous because you have a mental health condition. These and other forms of stigma can lead to feelings of anger, frustration, shame and low self-esteem - as well as discrimination at work, school and in other areas of your life. For someone with a mental illness, the consequences of stigma can be devastating."

Controversy and Resolution in Labeling Theory

Labeling theory was first applied to the term "mentally ill" in 1966 when Thomas Scheff, Professor, Emeritus, Dept of Sociology, University of California, Santa Barbara, and former Chair of the section on the Sociology of Emotions, American Sociological Association, and President of the Pacific Sociological Association, published the book, Being Mentally Ill. Scheff challenged common perceptions of mental illness by claiming that mental illness is manifested solely as a result of societal influence. See George Albee, Ph.D. webpage.

He argued that society views certain actions as deviant and, in order to come to terms with and understand these actions, often places the label of mental illness on those who exhibit them. Certain expectations are then placed on these individuals and, over time, they unconsciously change their behavior to fulfill them.

The term "mentally ill" is considered by some to be a part of labeling,
Thomas Scheff, PhD.

Criteria for different mental illnesses are not consistently filled by those who are diagnosed with them because all of these people suffer from the same disorder, they are simply fulfilled because the "mentally ill" believe they are supposed to act a certain way so, over time, come to do so.

Scheff's theory had many critics, most notably Walter Gove. Gove consistently argued an almost opposite theory; he believed that society has no influence at all on "mental illness". Instead, any societal perceptions of the "mentally ill" come about as a direct result of these people's behaviors. In Gove's view, the mentally ill behave unnaturally a lot of the time because of their disorders, so we treat them differently.

Most sociologists' views of labeling and mental illness have fallen somewhere between those of Gove and Scheff.

On the other hand, it is almost impossible to deny, given both common sense and research findings, that society's negative perceptions of "crazy" people has had some effect on their perception of those with mental health disorders. Disney movies are one commonly known example, of labeling person's as "crazy," and "lunatic," many of their most popular movies have scenes of "crazy" people or humanized animals running amuck.

Words Can Heal - Ending Stigma and Mental Health Disorders

Here are six steps you can follow to help end the stigma which surrounds mental health disorders

1. Learn more. Many organizations sponsor nationwide programs about mental health and mental illness. Several are listed at the end of this article.

2. Insist on accountable media. Sometimes the media portray people who have mental illnesses inaccurately, and this makes stereotypes harder to change.

3. Obey the laws in the Americans with Disabilities Act (ADA). The ADA prohibits discrimination against people with disabilities in all areas of public life, including housing, employment, and public transportation. Mental illnesses are considered a disability covered under the ADA.

4. Recognize and appreciate the contributions to society made by people who have mental illnesses. (See Elyn Saks, schizophrenia, on this site). People who have mental illnesses are major contributors to American life-from the arts to the sciences, from medicine to entertainment to professional sports.

5. Treat people with the dignity and respect we all deserve. People who have mental illnesses may include your friends, your neighbors, and your family.

6. Think about the person - the contents behind the label.
Avoid labeling people by their diagnosis. Instead of saying, "She's a schizophrenic," say, "She has a mental illness." Actually, never use the term "mentally ill."

Programs to End Psychiatric Stigma

Many National and State groups have begun projects and campaigns to reverse stigma. These groups offer a range of programs and materials, from speakers bureaus to training programs for mental health professionals. To get involved, call.
To learn more about mental health, call SAMHSA's National Mental Health Information Center at 800-789-CMHS (2647).

SAMHSA's National Mental Health Information Center
P.O. Box 42557
Washington, DC 20015
800-789-CMHS (2647)

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