Labels – the good, the bad, and the ugly

Yesterday, I wrote a rebuttal to Dr Caroline Leaf’s social media post, that “Psychiatric labels lock people into mental ill-health.” In my rebuttal, I suggested that psychiatric labels don’t lock anyone into mental ill-health any more than a medical diagnosis locks people into physical ill-health.

In the feedback I received, one intelligent young lady commented that, “I understand your point completely, but I took her words differently. I have often seen people who use their diagnosis as an excuse. For example, a kid gets diagnosed with Autism or ADHD, and suddenly the parents are using that as an excuse for their bad behaviour instead of teaching and helping them to deal with it. Another example, an adult is diagnosed with something mild, but uses it as an excuse to no longer care about trying to get a job or trying to get treatment and make an effort to get better”.

I certainly understand where she’s coming from. I’ve seen it too. A diagnosis is used as an excuse for someone’s avoidance, or a tool to milk every drop of sympathy from another. Giving someone a label seems to hinder some people more than help them.

Thankfully, there’s more than one side to the label story. I wanted to use today’s post to discuss the good, the bad, and the ugly side of diagnostic labels.

First, lets look at the ugly side of a diagnostic label. There will always be emotional and social connotations to every diagnosis that a person receives. Sometimes that’s sympathy, and sometimes that’s stigma. If a young woman told her friends that she had breast cancer, I’m sure that news would be met with an outpouring of care and support. If the same young woman told the same friends that she had chlamydia or genital herpes, I’d bet that most of the responses would be blaming or shaming, which is one reason why no one tells other people they’ve got chlamydia or herpes.

The same goes for mental health. The media often portrays people with mental illness as either homicidal or weak [1]. So the general response to mental health diagnoses is either fear or contempt. Even those who are neutral towards mental health often don’t understand it, so it’s difficult for those with mental health issues to receive true empathy for their plight.

Then, there is the bad side of a label. Labels can be misused, intentionally or unintentionally, for all sorts of reasons. They can also be wrongly applied. It might be that someone uses their diagnosis to draw sympathy from people, or money, or help when they don’t really need it. They might use their label as an excuse to avoid certain things they don’t like. There are innumerable ways that people can milk secondary gain from their problems.

However, appropriate diagnosis can bring many benefits. For example, correct labelling brings with it understanding and empowerment.

A diagnosis can help us understand more about ourselves, or the person with the diagnosis. That child with ADHD isn’t just being naughty, but has difficulty regulating their behaviour. That person with Asperger’s isn’t being intentionally rude, but has trouble with social cues, understanding body language, and communicating in an empathic way. A correct diagnosis also helps us understand our own strengths and weaknesses. They help us recognise what it is about ourselves that we can’t change, what we can change, and what we need to change.

Once you understand what it is you can change and what you can’t change, it empowers you to change what you can for the better, and accept and adapt to what you can’t change. You stop wasting precious strength and time fighting what you can’t change. Instead, all of the effort that would have been needlessly spent on the unchangeable can be effectively spent on improving what needs to be, and can be, changed.

In fairness, I should point out that a diagnosis isn’t always needed to make positive change. Acceptance and Commitment Therapy is a form of psychological therapy that encourages flexibility to accept those parts of our lives that are uncomfortable, whether they have a label or not, and allow our values to shape our life direction. Sometimes we can spend so much energy looking for a diagnosis that we stagnate, forgoing the forward momentum of what we value to focus on having a label for the symptoms.

But where a diagnosis can be made without undue effort, it can provide clarity to what often seems to be a jumbled mess of dysfunctional traits.

So, sure, sometimes labels can be used for the wrong things. That doesn’t mean they’re not useful or we should stop using them. There may be a stigma to a diagnosis of herpes or depression, but there are also good treatments available. The diagnosis may provide a way of changing a life of ongoing suffering to a life fulfilled.

More often than not, a good diagnosis helps bring clarity to a situation, enabling understanding, acceptance and empowerment. Rather than locking people in, a correct label usually unlocks a person’s potential to grow despite the problems they face.


  1. Corrigan, P.W. and Watson, A.C., Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002. 1(1): 16-20

‘Vagina’, and other ‘offensive’ medical terms

Back in my university days, I emceed a 21st birthday party for a friend of mine. One of the games I got everyone to play was the peg game.

The premise is simple enough. Everyone gets a clothes peg at the beginning of the party, and whoever had the most pegs at the end of the party was declared the winner. In order to get other people’s pegs, you had to catch them saying certain words that I arbitrarily chose to be forbidden. The words I banned just happened to be “Happy”, “Birthday” and “Craig”, the name of the party boy. It made singing “Happy Birthday” at the end of the night more challenging, but everyone still had a great time.

The peg game on a cultural scale is the modern scourge of political correctness. Terms like ‘manhole’ are replaced by ‘personal access units’ to avoid upsetting women, while ‘baba black sheep’ has been changed to ‘baba rainbow sheep’ in some schools, in case the nursery rhythm could be deemed racist. Meanwhile, ‘brainstorming’ is unacceptable because it may offend epileptics.

Proving that the centuries-old terminology of medicine is not immune from the PC plague, the Journal of Sexual Medicine has published an article in which the authors declare that the term ‘vulvovaginal atrophy’ should no longer be used because the word ‘vagina’ is not publicly acceptable [1].

Perhaps I’m just old and inflexible now, but to me this smacks of puerility and paternalism (sorry … authoritarianism, just in case I offended fathers). Lets face it, lots of medical terms have stigma attached to them, or are in some way publicly unacceptable. Lets rename herpes for a start … how about ‘Blistering of the Reproductive Parts’ or BoRP for short, unless someone is offended by the term ‘reproductive’. Maybe, ‘Blistering of ones bits’ … damn it, that’s shortened to BooB, which is an offensive reference to mammary glands. ‘Blistering of bits’ … but then that’s shortened to BoB which is offensive to people named Robert. I guess we’re stuck with ‘herpes’ then. In the end, it doesn’t matter what term you use, because the connotation or stigma is in the meaning of the word, not the word itself.

And how childish is it to be offended by the word ‘vagina’ in the first place. Half the planet has one for goodness sake. Refer to it by any other word, and no one cares. Va-jay-jay, flower, pussy, muffin, her ‘Downton Abbey’ … there are too many euphemisms to list. To me, they all sound like they belong in either the playground of a kindergarten, or a high school boys locker room (depending on the term, of course). And yet somehow the neutral, anatomical term is apparently less acceptable.

What really worries me is the example this sets for our children. I went to great pains to teach my children the anatomically correct words for their body parts from an early age, and answer their questions about their ‘private parts’ openly without embarrassment. Why? Not just because I’m a doctor, but because they’ll grow up to view their bodies as normal and natural, not shameful or taboo. This is beneficial for their health and for protection from child-sex predators. From The Atlantic magazine, “Teaching children anatomically correct terms, age-appropriately, says Laura Palumbo, a prevention specialist with the National Sexual Violence Resource Center (NSVRC), promotes positive body image, self confidence, and parent-child communication; discourages perpetrators; and, in the event of abuse, helps children and adults navigate the disclosure and forensic interview process.” [2]

What sort of example does it set when, as has happened in the US, a biology teacher was suspended because he said ‘vagina’ in class, or a Michigan State politician was removed from their parliament because she said ‘vagina’ on the floor of the chamber? What sort of example does it set when major medical journals are advocating that neutral, anatomical words are considered offensive? A poor one, I’d wager. All it achieves is to further stigmatise our bodies while impeding good communication, “reinforcing the culture of secrets and silence perpetrators rely on for cover.”

Rather than stop using the word, we just need to get over it. I’m not suggesting that we go around yelling ‘vagina’ at the top of our lungs, or gratuitously slip it into conversation at every opportunity. Lets be mature adults instead. Lets talk about any parts of our body in an appropriate context, without shame or condemnation. That’s how we protect our most vulnerable, and live in a truly progressive society.


  1. Portman, D.J., et al., Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. J Sex Med, 2014 doi: 10.1111/jsm.12686
  2. Buni, C., The Case for Teaching Kids ‘Vagina,’ ‘Penis,’ and ‘Vulva’. The Atlantic, 2013, Atlantic Monthly Group, Washington USA