What's In a Label?

An editorial article published today in the Boston Globe decries the deteriorating state of clinical psychological and psychiatric diagnosis in this country. The gist of the article, written by a clinical psychologist, is that the current rush to “label “behaviors is gaining such momentum that the labels have begun to lose their reliability and usefulness.

Unfortunately, the article has great merit. The writer posits examples of a 2 year old diagnosed with “bipolar” disorder, and a violent stabbing suspect diagnosed with Asperger’s Syndrome. As he aptly points out, the chaotic array of stimuli experienced by a 2 year old in the normal course of child development would make accurate diagnosis of bipolar disorder highly unreliable, if not impossible in a child that young. Moreover, the purpose of such diagnosis would be highly suspect as well. The reference to Asperger’s Syndrome in the case of the student stabbing incident is also of doubtful relevance, as the condition has nothing to do with violent behavior.

In an era of “sound bites” and quick fixes we are all too quick to slap a label on behavior. The pressure is to brand some behavior as pathological in an attempt to find a quick “answer” to the present apparent problem. Typically that “fix” involves medicating the person to near comatose status in order to neutralize the perceived pathology. Obsessed with TV programs like CSI, ER, House and others of that ilk, we try to establish some easy or quick diagnosis and solution within the allotted time, between commercials, of an hour long Program. Real life does not fit within the confines of network programming, and real life problems are infinitely more complex.

Meaningful and effective solutions require that the root of the problems be examined and understood to some degree. A school child acts out and is promptly labeled ADD or hyperactive. Medication is the typical response to calm or quiet the child. Too often, the acting out behavior is simply a symptom of a deeper and more complex problem that medication will only mask and prevent from being discovered and understood. For example, the parents of an unruly child being subjected to abuse at home may be more than willing to agree to medication. Denial of the abusive circumstances or underlying problems prompting the acting out behavior deflects attention from the parenting role. The child winds up further damaged by the quick fix approach. And there are countless other examples. Yet the health care industry bureaucracy typically demands a swift labeling and short term response. It is more concerned with "illness" than it is with "wellness."

Until we collectively take more time to carefully examine and understand the many upsets, variations and eruptions in the Human Condition, we will find ourselves more densely populated but drifting farther and farther from Humanity. Diagnosis that is unreliable will often lead to non-treatment or mistreatment. Without careful and appropriate diagnosis and treatment, we cannot hope to solve or cure real problems. Ironically, our impatience and unwillingness to take more time in individual cases may well cause the clock of our existence as a humane and civilized society to run down more quickly. Once we each have our own pathology label, what then?