Dear Therapist:

Can you please share your thoughts on the phenomenon that I am noticing (not common baruch Hashem, but it happens) where people disparage others by "diagnosing" them with a mental illness. Thus, people who are rigid are called "OCD," those who are a bit different are "apspergy" and those who are jumpier are "ADD." More disturbing to me is that I have noticed the word "narcissist" being thrown around quiet casually. Unfortunately, people will always make fun of others but when you give it a real diagnosable name there seems to be a real danger of it sticking and causing damage to a person's reputation. I would appreciate you sharing your thoughts on this for the column. Thank you. 

Response:

You phrase your question in terms of how labelling can affect people’s reputations. Although this may be a concern, I believe that the larger concern is the way in which people can themselves internalize certain labels. There is a reciprocal relationship between how we view ourselves and how others view us. So, our reputations can be affected by our feelings toward ourselves (and vice-versa).

As with many things in life, mental health-related labelling can be something of a double-edged sword. Your concerns are certainly valid. When people are labelled, it can become easier of them to view their feelings, thoughts, and actions as based on these labels. This often becomes self-perpetuating and can become a self-fulfilling prophecy.

For instance, if I believe that I have OCD, I am more likely to notice any obsessive thoughts while deemphasizing the majority of my thoughts that are not obsessive. Since I am so concerned about having OCD, I can become “obsessed” with the idea of having this disorder, causing me to hyperfocus all the more on obsessive tendencies. This continually reinforces my belief that I have OCD. What I don’t recognize is that we all have obsessive tendencies. Since I’m so focused on “my OCD,” I don’t stop to ask myself whether my “obsessions” are within the norm.

We all exist on multiple spectrums. We are all on the depression spectrum, the anxiety spectrum, the obsession spectrum, the attention spectrum, and many others. This simply means that we are all human; we all think and feel. Some of us feel or think certain things more strongly than others. At a certain point, mental health professionals might “diagnose” based on various factors, like number of symptoms, severity, and effect on the person’s life.

To some extent, diagnoses are arbitrary. Although they technically should be universally understood in the same way, diagnosing can become somewhat subjective. Naturally, an experienced and competent practitioner will have a clear sense as to what should be diagnosed and what should not.

In this sense, it is important that people recognize that diagnosing should be left to the professionals. As mentioned, amateur diagnosing can be harmful. Actually, professional diagnosing can be harmful as well. I have seen clients who had been through the mental health system and were very well-versed in their diagnoses and symptomatology. Often, before directly working on any problems, they need to be “deprogrammed.” Letting go of the sense that they are “different” and that there is something wrong with them (i.e., that they can’t help themselves), not only can be immensely freeing; it can make the difference between successful and unsuccessful treatment.

For many reasons, using mental health terms in a pejorative way can be emotionally hurtful as well as actively harmful. However, I take some solace in the existence of the yin-yang concept that allows for a certain homeostasis in many areas of life. In this instance, the other side of the double-edged sword relates to the very fact that mental health terminology has become a part of the common vernacular. The more widespread these terms become, the less impact they will typically have. If OCD is reserved only for those who have significant issues in their daily lives, the term is likely to be viewed in a negative fashion. If, however, OCD becomes associated with normal, albeit perhaps a bit quirky, actions, its power becomes diluted.

However, every person reacts differently to similar situations and triggers. While some may be undaunted by references to their OCD, ADHD, narcissistic, or bipolar tendencies, others can be deeply hurt. What it comes down to is open-mindedness, compassion and empathy. If we recognize that our words can hurt others despite having little impact on us, we would be more careful about our choices of words.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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