The discussion around mental ill health is unavoidable. Terms like depression and post-traumatic stress disorder (PTSD) are deeply embedded in popular culture and widely present online. They form the basis for numerous news articles and awareness campaigns. The increasing prevalence of diagnostic labels might be seen as a positive development, indicating that public understanding of mental health is improving and that the stigma associated with mental illness is decreasing. As this stigma fades, mental illness becomes more openly discussed. However, there are potential disadvantages to the growing use of diagnostic language. Some critics suggest it may signify the medicalisation of distress and contribute to over-medication. While naming conditions might reduce stigma, it could paradoxically also increase it.
Labels can be difficult to shake off, potentially influencing how others judge people with mental illness and how these individuals view themselves. In our recent study, my colleagues and I investigated the impact of labeling a person’s mild or borderline mental health issues on how others perceive them. We discovered that while labels increase empathy and concern, they also foster pessimism about the individual’s ability to recover. Essentially, diagnostic labels can be a double-edged sword when applied to less severe forms of distress. A particular worry about the rise in diagnostic labels is the tendency for concepts of mental illness to have broadened in recent years, now covering a wider array of experiences than before. This so-called “concept creep” suggests that people might use diagnostic terms for experiences that are quite mild or marginal.
British psychologist Lucy Foulkes argues that people might increasingly over-identify with mental illness, applying diagnostic labels to feelings that don’t meet the diagnostic criteria. Recent studies, including those by my research team, support this notion. They found that individuals who have a broad understanding of mental illness are more inclined to self-diagnose than those with a narrower view. The effects of loosely using diagnostic terms are unclear. Applying them to mild distress might have positive outcomes like making people take their suffering seriously and seek professional help. But it might also have negative consequences, such as stigmatizing the person labeled or making them feel confined by their illness. It could even lead to inappropriate self-diagnosis. We aimed to understand the effects of these broader concepts of mental illness by examining how diagnostic labeling affects perceptions of people with mild issues.
In two experiments, we presented descriptions of someone experiencing a minor, non-severe mental health problem to nearly 1,000 American adults. Each description was crafted to be near the diagnostic threshold. Participants were randomly divided to read versions of these descriptions with or without a diagnostic label (major depressive disorder, generalised anxiety disorder, and bipolar disorder in the first experiment, and PTSD, obsessive-compulsive disorder, and binge-eating disorder in the second). After reading, participants reported their level of empathy toward the person, their views on the person’s need for professional treatment, and whether accommodations at school or work were appropriate, such as more time for assignments or special leave. We also asked about the likelihood of full recovery (both experiments) and the perceived control the individual had over their problems (second experiment). We compared these responses between the label and no-label groups. Participants exposed to a diagnostic label expressed more empathy and support for accommodating the person’s issues, perceiving them as more fitting for treatment than those who read unlabeled descriptions.
However, the presence of labels also led participants to view the individual’s issues as more enduring and their recovery as less within their control. These judgments differed depending on the disorder. Some evidence indicated that the effects of labeling were stronger for less familiar disorders, like binge-eating and bipolar disorders. When diagnostic labels are applied to borderline mental illness cases, their impact seems to be mixed. Labels can validate the need for help, promote flexible support, and enhance empathy, countering the belief that labeling leads to stigma. Yet, diagnostic labels also appear to encourage perceptions that mental health issues are long-lasting and that individuals have limited potential to overcome them.
In other words, labels might lead people to see mental illness as a permanent identity instead of a temporary condition. These views could lower expectations of recovery for those experiencing problems and hinder recovery efforts. Even the apparent advantages of labeling could have drawbacks in the context of mild distress, such as fostering unnecessary and ineffective treatment or reinforcing a dependent or “sick” role by providing special accommodations to those with minor impairments.