Shrink Rap: Diagnosing Diagnoses–The Label Game

We go through life with labels that describe who we are. This is a fact of the psychotherapeutic world, as it is in the rest of life. We even label ourselves–shorthand for explaining who we are to others and to ourselves.

Imagine for a moment that each label is a Post-it, with attitude. From our earliest days, people slap so many labels on us so that we begin to resemble chickens covered in ruffles of paper instead of feathers.

Consider the first label the world slaps on us. Announcements of  “It’s a girl!” or “It’s a boy!” are often reinforced by pink or blue blankets and/or knitted caps–to spare people guessing what kind of plumbing our diapers hide and to help them mold our culturally determined, sex-informed behavior. Other labels quickly follow: daughter/son, sister/brother, granddaughter/grandson, Anglo/Hispanic/Black/Asian/Native/Mutt, nephew/niece, cousin.

As someone’s personality is revealed, other labels join the first ones. Is the kid a “Buddha baby” or “fussy”? Is the kid “quick” or “slow” Is the kid “adventurous” or “cautious”? Does this little person take after Grampa, Grandma or Uncle Willie?

As a child grows into toddlerhood, formally or informally, we continue slapping labels on him or her. Gale might be at the 80th percentile in intelligence, with social skills somewhere in the middle. Betsy may be off the charts in coordination, with verbal skills toward the low end of the continuum. Farley may be gifted musically, but lacking in confidence. We might label Harriet as beautiful and George as homely. We might label John as charismatic and Laura as prickly.

As a child grows into adolescence, we add sexual labels: heterosexual, gay, lesbian, bisexual, questioning, asexual, metrosexual, hypersexual, sexually adventurous, sexually inhibited. Often, those who sexually label others intend to label themselves. “She’s hot!” coming from a man can be a way of advertising his hyper-heterosexuality. “He’s a slut!” can be a declaration of sexual conservatism.

Because labels are so prevalent in life, it is easy to see why those of us in the psychological professions often label the people we work with. This past week, I have read or heard people in the news being labeled post-traumatic stress disordered, autistic, attention deficit disordered, hyperactive, borderline personality disordered, obsessive compulsive, addicted, antisocial, narcissistic, bipolar, schizophrenic, delusional, among many other things. You can probably put famous or infamous faces to many of the labels I have just named.

In fact, for insurance purposes, health-care professionals must find labels in what some consider the bible of psychology, The Diagnostic and Statistical Manual of Mental Disorders. Developed to make the diagnosis and treatment of mental disorders more scientific, it requires certain criteria to be met for each of the labels all of us encounter in the news.

Useful as these labels can be, they come with some very real dangers. To attach psychological labels to someone is to describe him or her with a very broad brush. For example, I would label myself a man because, anatomically, that is what I am. But what is more important and more difficult to describe are the unique ways in which I express and embody my manhood. There are many ways in which I do not fit the broad-brush, cultural definitions of being a man. I do not like football. I love working with children and spent several years being a househusband. My wife earns more money than I do. I often cry during movies. I write children’s books. I don’t know the first thing about fixing a car (racking up hundreds of dollars in repair bills when I tried to tune my first car, a VW Fastback).

Further, when a person is labeled, that person and the people around him or her begin to look for attributes that justify that label, whether they exist or not. Instead of seeing a shy, intelligent, developmentally appropriate rebellious young boy of ten, we focus on Asperger’s symptoms–whether they are there or not. Instead of seeing a young woman aspiring to come into her own, we see oppositional defiant disorder. There may be some truth to these diagnoses, but a diagnosis can take over, robbing its object of any nuance or individuality.

The other danger of such labels is that they tend to include negative judgments. What are the benefits of being attention deficit disordered (and there are many)? What gifts are part of living with Asperger’s? What healing window into the past is offered by realizing one is narcissistic or borderline personality disordered?

It is often easier to write such people off than to deal with the complicated, unique reality of such disorders, and the opportunities they offer. I want my brain surgeon to have obsessive-compulsive tendencies. I want my lawyer to be narcissistic on my behalf.

People are not canned goods. But I like to approach my clients with the wonder and sense of mystery I used to approach unlabeled cans in the bargain bin of the grocery store. I was a beginning elementary school teacher. My salary was tiny. Scraping by, unlabeled cans became my poor-man’s lottery. I paid heavily discounted prices for the chance of a wonderful surprise.

What I have discovered in my practice as a shrink is that my clients offer me work that is emotionally exciting–most especially because they don’t have labels. When I expect peaches, opening a can of baked beans is disappointing. Without expectations, the surprise of beans is wonderful.

And so are the people I work with.

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