Self-labelling with psychiatric terminology can be harmful to young people

A new study published in Journal of Health and Social Behavioraddresses the long debate on the consequences of self-labeling the process of adopting psychiatric language as mental illness to describe one’s discomfort.

There has been much debate among the public, researchers, and mental health professionals about whether adopting a mental illness label is empowering and helpful to mental health recovery or actually detrimental to psychological well-being.

Sociologists Lexi Harari, Sharon S. Oselin and Bruce G. Link draw on several sociological theories to study the impact of self-labeling on young people with mental health problems. Drawing on longitudinal data involving middle school students in Texas, their study suggests that identification with a mental illness label is detrimental to young people’s self-esteem.

While a medicalized insight perspective emphasizes the importance of self-labeling for psychological well-being and recovery, a sociologically informed insight perspective draws on modified theories of labeling, self-labeling, and stigma resistance to suggest that self-labeling can generate negative consequences for self-esteem, write the authors.

young woman and her reflection in the mirrorAccording to the medical model, understanding oneself in psychiatric terms is essential because it provides insight into one’s illness or allows one to make sense of one’s anguish by accepting a diagnosis of mental illness. This acceptance is thought to promote help-seeking and contribute to successful treatment outcomes. Based on the insight perspective, self-labeling with a mental illness should improve self-esteem.

However, this perspective is criticized because when someone chooses to refuse a self-label, they are often seen as not fully understanding their disease or accused of refusing treatment. Sometimes, refusal to self-label is even considered a symptom of mental illness requiring further medical attention.

In contrast, the sociological perspective perspective critically considers the negative social consequences associated with self-labeling. For example, this perspective uses modified labeling theory consider the judgment and negative treatment people often experience after being labeled as having a mental illness in a clinical setting.

It also draws self-labeling theory to examine the negative consequences that labels have on psychological well-being.

Finally, apply Stigma resistance theory to suggest that people often choose to reject self-labels to avoid negative stereotypes commonly associated with mental illness. According to this perspective, labeling oneself with a mental health diagnosis is expected to damage self-esteem.

Drawing on these conflicting perspectives, the researchers created a test to investigate whether self-labeling leads to better or worse self-esteem for 11- to 14-year-olds. To do so, a school-based intervention was done in Texas to educate students about mental health and reduce negative beliefs about people suffering from mental illness.

During this period, data was collected to see if the young person self-labelled or agreed with the statement: I have a mental illness. Over the course of two years, the researchers followed students about their personal experiences with self-labeling to test whether young people (1) adopted self-labeling, (2) consistently maintained self-labeling, (3) have abandoned a self-label, or (4) never self-labeled. Using this information, they tested whether having a self-label improved or damaged self-esteem over time.

The results support the sociological perspective because self-labeling has been shown to be detrimental to young people’s self-esteem. In particular, the authors point out the following:

It is the adoption of a self-label that is especially detrimental to self-esteem in both the short and long term.

Their findings reveal that young people who stopped self-labeling had improvements in their self-esteem, which shows further support for the external perspective, signaling that self-labels are generally detrimental to young people’s self-esteem and, for extension, losing them can produce positive effects. . The researchers found no differences in self-esteem outcomes based on the participants’ race, ethnicity, or socioeconomic status.

Because this study took place in a Texas school district and explicitly focused on a middle school age group (ages 11-14), these findings do not represent youth experiences nationwide.

Despite the limitations of this study, these findings are of utmost importance due to the exponential increase in mental health screening and the overdiagnosis of mental health conditions in children and young people. Awareness of the harms of self-labeling is also critical because practitioners in treatment settings often assume that self-labeling facilitates the mental health treatment process and improves psychological well-being.

However, psychiatric survivors who have personally navigated the mental health care system share that mental illness labels have led to feelings of hopelessness and trapped them in a system that overmedicated their suffering.

Professionals and the mental health system need to consider the complex ways in which the recognition, adoption and acceptance of mental illness diagnoses can harm psychological well-being and self-esteem, especially for young people at a critical stage of development of identity.

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Harari, L., Oselin, SS and Link, BG (2023). The power of self-labels: examining the consequences on self-esteem for young people with mental health problems. Journal of Health and Social Behavior002214652311759. https://doi.org/10.1177/00221465231175936 (Link)

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