Mental health labels may be doing more harm than good – here's why

‘Fine,” used to be the stock response to: “How are you?” Uttered automatically, without qualification. Ask the question today and you might get a slightly less equivocal answer. We are a nation living on our nerves. Increasingly so. More than half of us are said to suffer the “Sunday Scaries” – anxiety ahead of the working week.

Between 1993 to 2014 the number of people with common mental-health problems went up by 20 per cent according to the charity Mind. In any given week in England, eight in 100 people will be diagnosed with anxiety, or depression, or both.

Destigmatising mental health has been welcomed by medical professionals and charities. But there is an emerging fear that we are also over-pathologising emotional health.

At her clinic, therapist Jodie Cariss has noticed that more and more people suffering anxiety are desperate for a formal diagnosis of some kind. “They’re looking for something to hang on to,” says Cariss, the founder of Self Space. “I think the conversation about mental health is both important and useful, but teetering on being a bit dangerous as well.”

ADHD, OCD, trauma: chances are these were terms that you never used 10 years ago, but today are used liberally for everyday experiences. We refer casually to life events as “traumatic” or “triggering”.

The adoption of mental health language by the general populace without any clinical knowledge has implications for those with serious mental health problems.

Louis Weinstock, a psychotherapist, recalls how a teenage girl with acute mental health problems, which included self-harm and suicidal thoughts, confided in him that she had started to question whether her suffering was real or not. She had seen so many of her friends posting about their “anxiety” and “depression” that “she felt like she wasn’t ill enough to justify her experience,” says Weinstock, author of How the World is Making Our Children Mad and What to Do About It.

The pandemic undoubtedly caused a surge in anxiety problems among young people. But Weinstock worries that, for some, the idea of having a mental health issue has become an identity, and one that they are rewarded for having.

Improper understanding

On TikTok, the social media app that is wildly popular with a mostly younger audience, a growing number of social media stars have styled themselves as “mental health influencers”. Many of them are young women or teenagers who post videos of themselves experiencing symptoms such as Tourette’s tics or rapid switches from one personality to another due, they claim, to borderline personality disorder. Without possessing any medical credentials, they post videos that purport to help viewers “self-diagnose” their own mental conditions.

Weinstock believes that these phenomena are the inevitable result of letting psychiatric terms loose in society without proper understanding of what they mean. Social media is particularly ripe for spreading misinformation, particularly as those who post are rewarded with likes for content. “We know that certain types of content are going to get pushed,” he says. “You don’t hear any positive stories about mental health problems. You just hear anxiety, depression and self-harm flashing into the nervous system.”

The consequences of a disproportionate focus on the negative sides of mental health was tragically shown in the case of Molly Russell. In September, an inquest found that unsafe online content contributed “in a more than minimal way” to the death of the 14-year-old schoolgirl who took her own life in 2017. Out of the 16,300 posts that Russell saved, shared or liked on Instagram in the six months before her death, 2,100 were related to depression, self-harm or suicide.

According to Weinstock, the problem with constantly scanning ourselves for signs that we might be unwell is that it can lead to a state of “hypervigilance”.

“If you are looking for signs that you might be depressed or anxious, then you can almost guarantee you will find evidence that you are,” he says.

Tendency to pathologise

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) adds new terms with each edition. No sooner are they added than there are countless sufferers who fit the criteria. The manual, which started out as a pamphlet in 1952, is now a thick tome. Conditions added in March this year included unspecified mood disorder, non-suicidal self-harm and new symptoms for prolonged grief disorder.

“People typically think these terms are very scientific and something to do with the brain,” Weinstock observes. “But if you look at the history behind how these terms originated, it’s essentially a group of men who vote them in.”

This tendency to pathologise our behaviours, says Cariss, emanates from our “desire to make something feel concrete in a world that feels really uncertain. People are looking for an anchor when they are feeling all at sea.”

But she worries that the act of labelling ourselves as broken or ill can prevent us from digging a bit deeper into what the causes might be. “There’s a desperate need for quick fixes, rushing to an answer that feels like it might take the load or the pressure off.”

She would rather that people focus on how to change how they’re feeling than labelling that feeling.

And ways to change the way you feel can be quite simple: move your body, drink more water. Or have that difficult conversation that you may have been avoiding.

Taking responsibility for why you might be feeling the way you feel is something Cariss talks about in her book How to Grow Through What You Go Through.

“How can you take accountability for the way that you feel? You need to roll up your sleeves and do the hard work,” she says. “Instead of just thinking, ‘I’m anxious’, ask yourself, ‘Am I anxious because I’m not feeling happy in the way that I’m living, for instance, or because I’m over-using booze?’”

The term “Sunday Scaries” was recently prominent in the news, referring to the more than two-thirds of Britons who report work stresses, lack of sleep and looming to-do lists as the primary causes of anxiety before the start of the working week.

The worst affected were young adults, with 74 per cent of those aged 18-24 experiencing what psychologists call “heightened anticipatory anxiety” as the weekend ends.

Serving a purpose

For Cariss, those Sunday-night worries are a classic warning that you need to attend to the reasons in your life why you might feel that way. “It doesn’t mean handing in your notice or anything too dramatic, but rather tuning into how you’re feeling. Have you partied all weekend and now the week ahead feels as if it might be exhausting?”

In cases like this, rather than being a problem to be fixed, anxiety can actually serve a purpose. In her book, Future Tense, clinical psychologist Dr Tracy Dennis-Tiwary argues that anxiety is actually a positive thing. “It’s information about the future. It evolved to help us navigate uncertainty and keep us focused and working hard to make our future the best it can possibly be.”

That message rarely makes its way to us because an entire economy has sprung up to aid us with our mental health: from self-help books and holistic remedies to pharmaceuticals and cutting-edge talk therapy. “And yet we remain a profoundly anxious society,” Dennis-Tiwary points out. “We need to learn to be anxious in the right way,” she suggests. “It’s a skill to build, much like fitness and muscles.”

While Dennis-Tiwary doesn’t want to downplay the experiences of people with serious anxiety disorders, the vast majority of us who feel anxious are simply experiencing what it is to be alive.

The Pandora’s box of mental health has been opened. It now sits, quite rightly, alongside physical health as an important consideration for our wellbeing. However, the hope of therapists such as Cariss, Weinstock and Dennis-Tiwary is that, in time, more of us will learn to use more nuance in the language that we employ in this context.

“Right now we have this language of trauma and vulnerability to talk about everything we’re struggling with. But not all pain is trauma,” says Dennis-Tiwary. “Until we accept that the messy work of being human is to experience emotions, we’re not going to get that nuance.”