About Hope In Psychiatry – Not Labels And Limitations

April 24th, 2011

This article brings together information from psychology, solution-focussed therapy and linguistics to suggest hopeful ways of viewing people’s difficulties and intervening.

Table of Contents

  • Ralph & Sandy
  • Labelling can affect beliefs
  • Beliefs can affect outcomes
  • Mental Health Services
  • Beliefs versus Facts
  • Fostering Positive Expectations
  • Biological Explanatory Model
  • Linguistics – Language is powerful
  • Verb Tenses
  • Nominalisations
  • Lost Performative
  • Does being mindful of language make a difference
  • Summary & Conclusion

Ralph and Sandy were on the verge of separating again. They had been together a number of years but were having serious marital problems. They cared for each other but Sandy did not know if she wanted to remain in the marriage. She was depressed and crying frequently. Ralph was too bossy, and often angry, which he admitted. Not surprisingly there was not much sexual intimacy as they did not enjoy it. They came to see Steve de Shazer, a therapist and author on “Solution-focussed therapy.”

Prior to this therapy, Ralph had been in therapy for 14 years for his “voices” and had been diagnosed with paranoid schizophrenia for which he took medication. Sandy had been in therapy for 9 years for her “obsessive-compulsive illness.” Despite their therapy Ralph’s voices were frequent, and Sandy was unhappy, unemployed, and on the verge of separating.

They were used to therapy and talking about their ‘illnesses’ and so this could easily have become part of the conversation in therapy again. However, in “solution-focussed therapy” the focus is kept firmly on what is already working, or even partly working; exploration of problems is definitely avoided.

The therapist pays very close attention to the specific outcome the client desires; the therapist attends in great detail to all the client’s positive behaviours. This remains the focus of each therapy session. If the client mentions difficulties and failures the therapist steers the conversation back to any partial and momentary successes.

The rationale is that there are two possible pathways…a success pathway and a failure pathway (a helpful path and an unhelpful path.) The therapist wants the client to think, talk and behave according to their success pathway. The more people think those ideas, the less ‘air time’ they give their negative thoughts, and the less they entertain them and fulfil them. To have clients track their progress they are routinely asked to rate progress towards their goal on a simple scale of 1 – 10.

During five sessions spaced over eight weeks, Sandy and Ralph reported many changes. The frequency and enjoyment of sex increased; Ralph changed from being so bossy; Sandy was smiling more and feeling happier. She had described herself as “very depressed for the last 2 years,” but she reported moving up from 0 to 7 with 10 as the goal.

The frequency of Ralph’s voices had declined from the peak at 10, to 4, with 0 (the goal) standing for silence. He experienced anger less often. The therapist suggested an experiment of “pretending not to be angry” and Ralph found that effective “at least 95% of the time.” As a couple, they rated the week before the fifth session as between 6 and 7 (with 10 as the goal.) (Reference: Ch 12 Case Example Eight, “Putting Difference to Work,” by Steve DeShazer, Norton N.Y. 1991)

This therapy had not been completed prior to the publication of the book. Therefore it is not possible to know if the changes were permanent. However, the changes reported are the norm for this type of therapy.

It would be so customary in the present age for Sandy to be diagnosed and offered antidepressants or “mood-stabilizing” medication. And given the continuing frequency of Ralph’s voices (and “delusions of reference,” mentioned in the book) his medication might have been increased or altered. This would delay improvement while everyone waited to see the effect.

Instead the therapy generated improvement in their stated goals, including a reduction in the auditory hallucinations. How much better it is that medication was not the first intervention tried. Reading the book one sees that changes began from the first session; and they learned how to solve such problems. Even if medication had been used, and side-effects had not worsened their problems, would it have assisted them towards self-mastery? Would it have generated hope that they could learn to solve other difficult problems alone?

Labelling can affect beliefs

In 1968 a classic experiment in the field of education was published [ROSENTHAL R and JACOBSON L (1968) Pygmalion in the Classroom New York; Holt, Rinehart and Winston] showing that teachers’ expectations of students shaped the results of their students. The experimenters gave an intelligence test to all of the students at the beginning of the school year. They then randomly selected 20% of the students and reported to the teachers that these 20% were showing “unusual potential for intellectual growth” and could be expected to bloom in their academic performance by the end of the year. At the end of the year the students were re-tested and those labeled as “intelligent” had shown significant improvement over those who had not been singled out.

Subsequently many similar experiments have been conducted which reinforce and extend these findings. Put simply, beliefs make a difference. When teachers expect students to do well, they tend to do well; when teachers expect students to fail, they tend to fail.

Although there must be benefits to assessing people and placing them into groups (such as measuring effects of interventions between similar groups) no-one is likely to argue that labelling school children as “dummies” or “morons” would be a good idea. We know that we want children to have a good feeling about themselves and a positive self image. To get the most out of our children we would want them to think they have capabilities not limitations, and so most people know to praise successes and encourage small steps that might lead to success.

Beliefs can affect outcomes

In the sporting world there are countless stories of people excelling. It is accepted wisdom that psychology makes the difference between performing well and being a champion. Coaches and winners emphasize the end prize, knowing that visualising the result is an essential component to winning. Athletes mentally rehearse their skills; their focus is on what they do want, not imagining failure and mistakes.

Personal development books which write about people overcoming adversity don’t always show the person having the inner conviction that they can achieve their goal; but the people do persevere, and they do grow in conviction as they take risks and achieve successive steps. They always have failures, but they learn from them, and are prepared to fail again because their goal is important.

People, who succeed, have the right beliefs. Is there anyone at the top of anything, who believes that they cannot do what they are good at? No. Do they doubt themselves some of the time? Yes…but to get back to the top of their ability they (or those who support them) remind them of their successes, they recapture it and visualise it and get back into their pathway of success.

Mental Health Services

In mental health services, we want to build on peoples strengths and empower people towards makings changes. At the same time diagnosing illness is based on categorising people’s symptoms into illness labels. Let us look at whether this is supportive of the patient reaching their potential in recovery, or if it is limiting. Don’t diagnostic categories inherently attribute expectations to people’s future potential? And doesn’t this inadvertently coach people to limit them? Pessimism needlessly results, and is part of psychiatry’s historical legacy. Many clients surpass psychiatry’s predictions, temporarily or permanently, but the professional mindset persists. Labelling stops us from providing maximum help to troubled people.

Ralph and Sandy above are an example where it would be easy to be pessimistic about their prospects, but in four or five sessions so much had changed. Instead of hearing their detailed problems, everyone can quickly become impressed at their strengths and abilities. This can caution us that regardless of the labels people may change quickly, if we only have the tools that are suitable.

The “labelling experiment” told above was about ‘self-fulfilling prophecies.’ What people believe, often will become reality. It is important therefore to appreciate all the beliefs we offer to others and not mistake them as facts.

Beliefs versus Facts

Differentiating beliefs and facts is already a focus in psychiatry when dealing with individual clients. For example, efforts are made to determine if the person’s story is delusional or ‘real.’ The same distinction between fact and belief can usefully be applied to the practices of clinicians. Let us consider diagnostic categories. These are very much labels with inherent beliefs and limitations.

It is self-evident to some that such categories are only ‘constructs.’ In my opinion too few understand this and the implications. For example, ‘depression’ is a concept, but many people would argue strongly that it exists, that it is ‘real.’ It depends what people mean when they say ‘real.’ To speak precisely, people ‘feel depressed,’ or stated differently they ‘depress themselves’ by virtue of the way they think and act. Yet if one was to say that depression or schizophrenia or mental illness does not ‘exist’ one may well become embroiled in an argument; at least an explanation would be required.

If one forgets that the label is a concept, one might find it hard to reconcile the experience of clients who exceed the expectations that are connected with their diagnoses. For example, many people recover from their severe difficulties without medication. These exceptions may tell us something about people’s resilience and ability to recover.

However many professionals do not heed the significance of these exceptions, and important knowledge is lost. Instead, what would happen if these exceptions are captured by staff, and used to reappraise the pessimistic theories and expectations commonly attached to diagnostic categories? We might form the view that recovery from serious difficulties is achievable for everyone, if we just find the way to be helpful.

There are exceptional outcomes similar to Ralph and Sandy in the therapy literature. There are so many I should not refer to them as ‘exceptional.’ Individuals often surpass professional expectations. How can we foster that? What do they tell us?

FOSTERING POSITIVE EXPECTATIONS AND NOT NEGATIVE ONES.

Step back to facts versus beliefs. Professionals must be vigilant. When staff, clients and families are not mindful to differentiate between facts and beliefs, they risk taking as ‘truth,’ things that may only be beliefs, and limiting beliefs at that. For example, many people believe that schizophrenia exists, in contrast to it being a concept. Consequently many people have come to believe that they have a life-long ‘illness,’ and that they will need medication for the rest of their lives.

If a client takes this belief to be fact, it could well become a self-fulfilling prophecy. How difficult might it be for a person to really believe something different, if professionals are saying the opposite? And more difficult if the professionals have convinced the person’s family members and friends? Why not leave room for the possibility that people do exceed the expectations of the professionals? Why not leave room for the possibility that the professional opinion may change with more information coming available? This has happened before in mental health, many times.

The belief that schizophrenia exists and requires long-term medication conflicts with other experiences – for example, that some people get better despite ceasing medication against their doctor’s advice. Furthermore clinical trials show that many clients improve when they receive placebo medication. People are capable of much more than is commonly discussed in psychiatry. When one mistakes beliefs for facts people may be discouraged from trialling their own pathways and finding something better than what was offered them by the ‘experts.’

Biological Explanatory model.

Professionals often confuse beliefs and facts. Mainstream psychiatry is currently biologically driven, and the main explanatory model used is that of a biochemical imbalance in the person’s brain. This model dominates the treatment of clients in many settings, leading to the almost automatic prescribing of medications, and a lack of curiosity for alternatives. Yet the explanatory model is classically a belief, and is not universally accepted as proven.

If one was to ask the psychiatrist for the proof, they would not be able to tell you what your current ‘biochemical balance’ is, nor what the ideal should be. There is no such data. Yet because this belief about the causation of ‘mental illness’ is so widely held, few think to ask these questions.

The biological explanation shapes the treatment clients are likely to receive, and can blinker other possibilities. [Caution: These paragraphs should not be taken to mean that clients should cease or never begin medication; nor is this an endorsement of medication. This is an exploration of some of the factors influencing professionals trying to help clients who experience serious difficulties in their lives. The aim of this article is to widen perspectives and so offer more choice to professionals and clients.]

What happens to beliefs amongst mental health staff when some clients cease their medication, get better and stay better? Does that provoke us to question the dominant messages that are delivered to clients? Are we encouraged to explore the exceptions and ponder what it is that we don’t yet understand? Are alternative practitioners and methods (such as family therapy) which operate from different belief systems invited to share their perspectives in an ongoing manner?

How are we using our professional training to be curious and create more avenues to help clients? Will we stop labelling, and become careful about the beliefs we deliver to clients? When clients understand the limits to our professional knowledge they may feel empowered to share their ideas. If we listen to them, where might that lead us?

LINGUISTICS:- LANGUAGE IS POWERFUL IN INFLUENCING CLIENT OUTCOMES.

Despite working for 20 years in mental health services I have not heard discussion about the following knowledge. It is common sense and can transform the interaction between clients and professionals.

Just as labelling is potentially damaging to clients because of its capacity to create limitations in the thinking of staff, clients and families, there are other equally restricting ways that people use language, without being aware of the limiting effects. Becoming aware creates more possibilities.

Since this article is chiefly focussed on the power of beliefs, so too will this brief look at linguistics. I will cover “verb tenses,” “nominalisations,” and “lost performatives.”

VERB TENSES

Verb tenses and nominalisations can insidiously create the expectation that certain experiences will continue. This largely happens through presupposing certain things. For example a clinician may use the present tense and ask, “I understand you are feeling depressed; tell me about that.” Alternatively s/he may ask, “I understand you have been (or were) feeling depressed….” This leaves the present experience undefined by the clinician, and the client may be having a different experience at that moment which they may talk about. Does the clinician want the client to have the “depressed” experience more often? If so, then mentioning it and inviting the client to talk about it will most likely achieve that!

But from sports psychology, we know the more we focus on a particular behaviour and feeling, the more we are likely to create it. So the aim would be to invite the client to talk more about better experiences. And from the story of Ralph and Sandy we can see that positives can be amplified and snowball into more of what is desired. In contrast, talking of struggle, failure and difficulty can also snowball and become large in the client’s mind.

The clinician can use several forms of the past tense. They have different impacts, some moving the problem experience (of being depressed) further into the past than others. For example, “you have been feeling depressed; you were feeling depressed; you were depressed; you had been depressed.” By using the past tense the clinician invites the client to create a different experience (“What are you feeling now? Or, “What do you want to be doing/feeling instead?)

Changing verb tenses needs to be done skilfully and respectfully, rather than ignoring a client’s wish to talk about their recent or present experience. And changing a sentence is not a solution in itself. It is an ingredient in conversing therapeutically. It has power because it does not presuppose their experience at that moment is the same as the past, even the past of a minute ago! And as stated above, shifting their problem experience to the past opens up the present to be anything. The clinician then can assist the person to create their experience at that moment, and jointly anticipate what the future may be.

In contrast, if the clinician uses the present tense when talking about problems, it invites the client to focus on their problem as a current experience. By reminding or recapturing that experience they are giving it more ‘air time’ in their life. It may grow stronger as a result, or seem to be recurring or inevitable, rather than actually the result of what they do mentally/behaviourally and what others also do (for example, clinicians and family members asking about it.) Have you ever had the experience of wishing people would stop talking about something, of not wanting to be reminded of it further? Sometimes it is easier to move on into a better future if we are not pulled back.

NOMINALISATIONS

Nominalisations are nouns; not just any nouns. They come from “nominalising a verb,” which means turning a verb into a noun. For example, ‘deciding’ is turned into ‘decision;’ feeling hungry becomes ‘hunger;’ hallucinating becomes ‘hallucination.’ Nominalisations are not concrete things, such as those things we can carry or shift (eg chair or table.) Depression is another nominalisation, from the verb, ‘to feel depressed.’

We will never converse without using nominalisations, but being mindful that we are using them has some value. For example, some people talk of “my depression” – this implies that it exists and has continuity; it is like it is alive and is always part of their life. In contrast phrasing it as a verb, “I am feeling depressed,” does not imply a ‘condition’ and leaves open the possibility that I can change at any moment.

Does ‘depression’ exist? Interestingly there used to be a category of depression called “Agitated Depression,” where people were agitated, unsettled, unproductive and troubled (evidenced by not sleeping, or managing their daily responsibilities etc.) Strangely these people, by their own report sometimes did not report feeling depressed, yet they were labelled with “depression.” Diagnoses are categories which clinicians and scientists create and apply for specific purposes. People’s experiences are so varied but there cannot be infinite categories; so people are put into the one that fits the best. ‘Depression’ does not exist; it is a category.

Yet when one believes that ‘depression’ exists, they and the community generally come to think that it is something, rather than something you do. When you think carefully, a person feels depressed. It is a verb, which by definition is an action. ‘To feel depressed’ is something we do (ie we think.) We think about something in a certain way and we feel bad. But some people are not very good at recognising what they are thinking that leads to them feeling bad – they deny they are thinking anything in particular. So some people believe that there must be some other cause. This supports enquiries for some biological cause. But rarely does anything biological show. Sometimes people with low thyroid functioning can report feeling depressed. (However some with low thyroid function do not feel depressed.)

When we describe our experience (or that of others) with verbs (eg I am feeling depressed), we describe more precisely. When we move to using nominalisations (I’ve got depression) we are more removed from precisely what the person is experiencing (eg are they agitated, not sleeping, grumpy, unhappy, unmotivated etc?) Grouping clients into categories can serve some scientific and research purposes, but conversing in less precise ways is likely to move us away from the individual’s precise experience.

Grouping clients into categories can serve some scientific and research purposes, but conversing in less precise ways is likely to move us away from the individual’s precise experience.

This will often deprive us of options to tailor interventions to the needs of individuals. If we know they say ‘depressed’ and mean ‘unhappy’ we can explore what has been happening and what they can try differently. If they mean they ‘have been unmotivated,’ we can explore what they sometimes do feel motivated about, what already works for them, and how they may incorporate that more in their life.

Too often a uniform ‘fix,’ usually in the form of medication will be the dominant offering to people who are suffering. Medication usually entails the idea of having an ‘illness.’ This word is another nominalisation, from the verb, ‘to feel ill’ and has an inherent danger. Will the person feel empowered by this description? Will it encourage them to consider all the factors that are making them feel what they are feeling? Will they feel they have their own answers and search for ways to improve?

Along with “having an illness” the person will often be told s/he has a biochemical imbalance in the brain, causing the ‘illness.’ An ‘imbalance’ is another nominalisation, from the verb, ‘to balance.’ When developing concepts like these, we are not talking about facts, but ideas. Again, an inherent danger is that people may believe such ideas uncritically, limiting them as a result.

I am not saying we should never talk like this, but I do think there are better ways. With respect to brain biochemistry, there would be a range for each of the chemicals found in the brain, but that is different than to say there is a ‘normal’ quantity found at any location, and that professionals know what it should be. Some doctors have offered a different metaphor, of the brain being in a “bath-tub” awash with many chemicals, which will have different concentrations in different areas at any one time. That sounds very different than a ‘balance.’

If we believe there is a balance and an imbalance, that may shape us to think in a certain way. If we recognise that ‘balance’ is a nominalisation we can remind ourselves to be sceptical and open-minded, rather than accept limiting categories and belief systems.

LOST PERFORMATIVE

The ‘Lost Performative’ (or lost performer) refers to the fact that when we are asserting something, or repeating something, there is an ‘author’ of the assertion or fact, which is often left out. For example, “Mental illness is caused by a biochemical imbalance in the brain.” Who says so? The ‘authority’ or source behind this remark is not stated.

One has to be alert to realise this has been omitted. Once you are aware, you realise you do not need to believe it at face value; you can seek more information.

The lost performative is about identifying assumptions and increasing awareness of the distinction between facts and beliefs. I don’t think that people are going to start prefacing every statement with, “I believe….;” or say, “I read that Dr X has shown such and such and I believe that it is proven as fact.” But contrast that with statements in ward rounds, “Mr R has severe depression, and he needs an antidepressant.” The doctor is using a high level of abstraction (depression / mental illness) which is far removed from the client’s actual experience. We don’t know what information the speaker has collected and appraised. We don’t know what knowledge the speaker has about alternative approaches. We don’t know if the speaker has identified moments where the client is not depressed, or whether the speaker has seen these but disregarded them as not significant. We don’t know if the speaker is talking in a context of being new to the profession, in a ward round where the experienced doctors would expect and ‘approve’ of the standard descriptions and recommendations. We don’t know if the speaker has doubts about the scientific validity of the clinical trials that determined a particular drug to be effective.

Without explicitly acknowledging “Mr R has severe depression…” is an opinion, people can forget this and act as if it is the truth. Clients and families often have less capacity to critically listen and identify these linguistic traps, as they are in new territory and may defer to professional knowledge.

With respect to medication in psychiatry, drugs are approved for treatment after complex processes called clinical trials, which aim to show that the new drug makes a useful difference to a psychiatric ‘condition’ such as depression. Once a drug is in use, clients are likely to assume that it has been proven. Yet this is a complex matter; the scientific method never proves a theory, but at best shows that some hypothesis is likely or not. In complex experiments such as clinical trials many assumptions are made, which may be wrong and cast doubt about the conclusions reached. Some concerns that have been raised in relation to such trials are listed below.

– Was the clinical trial designed and conducted in an unbiased manner, by truly independent researchers?
– Since the drug would have been aimed at a particular condition, were the subjects truly similar so that the drug was tested for the intended condition?
– Were a number of clinical trials conducted for the drug? If so, did they all show the drug to be effective? Were all of the results made available to the public for review and critical appraisal, or only the favourable results?
– How much difference did the drugs make? Have the benefits been over-stated and the side-effects under-stated?

I do not wish to discuss such issues in this article. I only point them out to alert people to the possibilities of error. From the moment one begins to use a nominalisation such as ‘depression’ one opens the way to discussions and research on abstractions. When considering the conclusions of drug trials will one remember to regard them as tentative, given they are based on concepts which differ to the lived experience of people?

DOES IT MAKE A DIFFERENCE TO BE MINDFUL THAT PROFESSIONAL KNOWLEDGE IS OFTEN BASED ON NOMINANLISATIONS?

I recall a keynote speaker (psychiatrist) recounting the experience of the parents of a young man who had suicided. They had been told by a different psychiatrist that the young man’s condition of schizophrenia was genetic. The genetic explanation is a mixed blessing. It is presumably used to alleviate blame in the individual sufferer; “It is not your fault, it is something you inherited.” The sufferer may be freed from blame, but the parents may or may not be so freed. I disbelieve the genetic propositions. When I read the criticisms in the literature (Ch 1 Biological Psychiatry: Science or Pseudoscience? in “Pseudoscience in Biological Psychiatry: Blaming the Body” by Colin A. Ross & Alvin Pam – John Wiley & Sons, N.Y. 1995), I found the authors’ arguments compelling, and they did not even include the extra doubts that linguistic considerations would add.

Does it make a difference to remember that conclusions in psychiatry are premised on nominalisations such as depression / mental illness? If the person suicided because he felt despair, and he felt this from believing his problems were genetic, which he may have interpreted as “life-long,” that may have been damaging. Rather, if he understood that he had difficulties that needed solutions, and no-one had attached a label with “life-long” connotations, it may have made a difference.

To mentally note the ‘lost performative’ and think, “This psychiatrist believes that my problems are schizophrenia and are genetic,” may make a difference. But it is only likely to make a difference if the person is supported by others, who likewise have a linguistic awareness and can distinguish beliefs from facts. Otherwise the individual is likely to be out of step with staff and may be regarded as difficult or “lacking insight.”

From a simple and common example of ‘depression,’ we can recognise that it is easy to depart from the actual experience of the client and think in terms of abstractions (research, genetics, proof, illness.) These abstractions can invite one to view certain ideas as a fair representation of reality, especially if ‘everyone’ is thinking and talking the same. It is important to remain aware that the concepts shape us powerfully, just as a simple change of verb tense can have an impact.

It is important to remain aware that the concepts shape us powerfully, just as a simple change of verb tense can have an impact.

One last concept from the field of Linguistics, “E-Prime;” basically English written and expressed without the “to be” verb (is, am, are, was, were, be, being, been.) E-Prime teaches that when we use the “to be” verb it has the connotation of permanence, finality, completeness (eg he is weak, she is lazy.) However in the real world everything changes. We may describe people as constant, but everything changes moment by moment. If we fail to recognise this we will continue to assume our descriptions equate to reality. The more our thinking and describing differ from reality, the more error there will be in our conclusions and our actions. (Another example of this divergence from reality is nominalising verbs, discussed above.)

In sport they talk about “the one percenters,” referring to the small details that make the difference between good, and great. In “thinking,” there are also the one-percenters, and they too can make a difference in our lives.

As an example of E-Prime (from “Working with E-Prime,” by E. W. KELLOGG III AND D. DAVID BOURLAND, JR. (3) http://learn-gs.org/library/etc/47-4-kellogg-bourland.pdf), “If you saw a man, reeking of whiskey, stagger down the street and then collapse, you might think (in ordinary English) “He is drunk.” In E-Prime you would think instead “He acts drunk, or “He looks drunk. After all, you might have encountered an actor (practising the part of a drunken man), or a man who had spilled alcohol on himself undergoing a seizure of some kind, etc. Instead of simply walking by, you might look more carefully and send for an ambulance.”

In mental health, a client may get labelled as passive-aggressive. The implication of such labels is that the person is this way, not that s/he just acts that way on occasion. In most contexts of that person’s life s/he may act fine; but in the treatment context the person may act differently, perhaps influenced by the imbalance of power with professionals. To add this label to the client may then shape how people see that client, affecting the choices and experience received. All labels have consequences.

All labels have consequences.

E-Prime alerts us to the tendency to create a static view of people and situations. We are always in a process and as such situations should be viewed as changeable. Thus we are not in a “frozen universe” but one we constantly manufacture with our language.

SUMMARY

This article began with the story of Ralph & Sandy on the verge of separation; therapy led to many changes which may commonly have been tackled with medication. Then labelling was discussed and how it can lead to self-fulfilling beliefs. We would not use labels such as ‘moron’ or ‘dummy’ as we recognise it may harm or limit the person. Yet we apply labels to clients of mental health services, and this can be limiting in just the same way. There are choices. For example, Solution-focused therapy is intrinsically optimistic, driven by clients’ goals, and does not view people as limited. Psychiatric labels focus the client, their family and the staff on symptoms and problems. The focus we choose will shape processes and outcomes.

From sport and life generally we know people can triumph. Focussing on goals and progress is a key; so too is developing and holding the right beliefs.

Negative labelling’ shapes and reinforces beliefs about limitation instead. It creates pessimism about clients’ potential. The pessimism is further fostered by ideas about ‘biological illnesses.’ The study of linguistics reveals that such descriptions are not identical to reality. Nominalisations shift us away from accurately describing experience. Verb tenses impact us by shifting our attention, often without our awareness. The ‘verb to be’ also creates a static false view of situations and problems. Collectively these ‘errors’ result in the established ideas of mental illness, biochemical imbalances, medication being essential, and clients being disabled and limited, perhaps for life.

CONCLUSION

Remember a time when you saw a movie or heard a story of outstanding achievement; you felt inspired, you felt you could do more than you previously thought. We all shift our expectations according to our mood. Our beliefs alter. If we sustain our new beliefs we will attain more. To sustain new beliefs people generally need encouragement or mentoring. The mental health services could be instrumental in creating hope of change and growth at times of crisis.

Mental health services unintentionally give mixed messages. They encourage people to recover, but offer them pessimistic labels with inherent limitations. This does not make sense. Many professionals have been limited by their beliefs. Fortunately some clients surpass the diagnostic categories and professionals’ beliefs. We can learn from these examples. We can be curious about their achievements.

Current explanations of biochemical imbalances can be limiting. Therefore we need to review what we believe. We need to clearly distinguish between facts and beliefs. We need to be mindful of the language we use and how this inadvertently distorts our professional views. We need to examine the view of clients we formulate, and leave behind the pessimism engendered by the biological paradigm.

Psychological ideas and real life examples offer optimism; linguistic ideas offer the chance to be aware. Together they can be a catalyst to examine the past and create choices for the future. With our skills and our training we have more to offer than we have managed so far. Our clients need intelligent, reasoned thinking, not labels.

We must re-think. We must critically examine the illogical ideas and practices that have continued without thorough discussion. With awareness of the power of our words we can do better. By leaving behind beliefs about limitations, we can be hopeful. And when we bring hope to our meetings with clients, greater things can be achieved.

(The End)

Further reading regarding the effect of labeling in the classroom – http://fcis.oise.utoronto.ca/~daniel_sch/assignment1/1968rosenjacob.html


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