Interpretation is Everything: How Diagnoses Change Behavioral Meaning
In everyday life, we rely heavily on nonverbal communication to gather information. A person pacing could be interpreted as stressed or impatient, unless that person is known to have a mental illness. Then as Sedgwick argues, we have a propensity “…to attach complex social meanings to acts and behaviors that…would be interpreted in the light of quite different concepts” (1972, p.206). Put another way, the behavior may not change, but the interpretive frame, and the subsequent social consequences, will with diagnostic labels.
While there’s not a huge body of research on this topic, the claim is far from theoretical or anecdotal. Estroff et al. finds that people with severe mental illness can struggle to differentiate between their authentic personality and the stereotypes projected onto them by society (1991, p.361). One of the study’s participants is quoted as saying they constantly catch themselves “trying to prove that I’m normal or can handle things, but until the verdict’s in, I really don’t know” (Estroff et al., 1991, p.331). Expanding Sedgwick’s argument into this context, we see how stigmatization can cause those with mental illness(es) to base their sense of normalcy or stability on the way that other people interpret their behaviors.
Institutional Settings
Chew-Graham et al. finds that some medical students fear seeking help for their stress would deem them unfit as future medical professionals and change the way that future colleagues view their competence (2003, p.873). The students that didn’t seek help suffered from the same symptoms as their counterparts that did, but the risk of being associated with mental illness was enough to stop them from seeking any professional help (2003, p,878). Similarly, Mittal et al. finds that combat veterans suffering with PTSD hesitate “to seek treatment to avoid the ‘crazy’ label”. Their fear is that such a label will reframe their emotions, decisions, and behaviors in a negative way (2013, p.90).
Cultural Expectations
Cultural expectations not only amplify this problem but can also make it harder to address. Smart and Wegner find that women with eating disorders often try to mask behaviors rather than seek professional treatment for fear of being perceived as “less normal”. However, the masking only causes them further harm. They are more likely to suffer from intrusive thoughts about their eating disorder and more likely to perceive eating disorder characteristics in other people (i.e., project their experience) (1999, p.481). Similarly, Ellis et al. highlight the pressures that African American men feel to appear impermeable to stress. They describe how participants commonly turn to behaviors such as increased (or decreased) exercise and increased (or decreased) eating when stressed in lieu of talking to their partner or a professional (2015, p.110). These examples show how behaviors being associated with certain diagnoses robs people of the benefit of contextual interpretation; what otherwise might be seen as change in exercise simply due to a stretch of bad sleep becomes a change in exercise due to mental instability.
Violence
Diagnostic stigma can also influence the way harmful or violent behavior is interpreted. For example, the primary claim of Ordinary Men is that the violent actions of Reserve Police Battalion 101 can be explained by a desire to conform to social pressures (Browning, 1992). Yet when Ed (a man with mental illness interviewed by Estroff et al.) was triggered and subsequently attacked furniture in his parent’s home, they had him involuntarily committed to a hospital (Estroff et al., 1991, p.335). This contrast calls attention to the ways that diagnostic labels create a willingness to view “acting out” as something that needs to be punished rather than something that needs to be further understood.
Ultimately, shifting away from patterns of stigmatizing behavioral interpretation requires increased public education and a foundational change in how people think about the behavior of fellow humans (Byrne, 2000, p.67; Thoits, 2011, p.15). Rather than simply accepting the fact that we judge the actions of others, we have to challenge ourselves to ask questions such as “what assumptions am I making about this person because of the behavior I see?”. In the case of those we know with mental illness, we must ask ourselves “do I unknowingly view this person’ behavior through the lens of my own stigmatized understanding of their illness?”. Only then can we start to strip diagnostic labels of their power over behavior.
References:
Browning, C. R., & Mazal Holocaust Collection. (1992). Ordinary men : Reserve Police Battalion 101 and the final solution in Poland (1st ed.). HarperCollins.
Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment : The Royal College of Psychiatrists’ Journal of Continuing Professional Development, 6(1), 65–72. https://doi.org/10.1192/apt.6.1.65
Chew-Graham, C. A., Rogers, A., & Yassin, N. (2003). “I wouldn’t want it on my CV or their records”: medical students’ experiences of help-seeking for mental health problems. Medical Education, 37(10), 873–880. https://doi.org/10.1046/j.1365-2923.2003.01627.x
Ellis, K. R., Griffith, D. M., Allen, J. O., Thorpe, R. J., & Bruce, M. A. (2015). “If you do nothing about stress, the next thing you know, you’re shattered”: Perspectives on African American men’s stress, coping and health from African American men and key women in their lives. Social Science & Medicine (1982), 139, 107–114. https://doi.org/10.1016/j.socscimed.2015.06.036
Estroff, S. E., Lachicotte, W. S., Illingworth, L. C., & Johnston, A. (1991). Everybody’s Got a Little Mental Illness: Accounts of Illness and Self among People with Severe, Persistent Mental Illnesses. Medical Anthropology Quarterly, 5(4), 331–369. https://doi.org/10.1525/maq.1991.5.4.02a00030
Mittal, D., Drummond, K. L., Blevins, D., Curran, G., Corrigan, P., & Sullivan, G. (2013). Stigma Associated With PTSD: Perceptions of Treatment Seeking Combat Veterans. Psychiatric Rehabilitation Journal, 36(2), 86–92. https://doi.org/10.1037/h0094976
Sedgwick, P. (1972). Mental Illness Is Illness. Salmagundi (Saratoga Springs), 20, 196–224.
Smart, L., & Wegner, D. M. (1999). Covering Up What Can’t Be Seen: Concealable Stigma and Mental Control. Journal of Personality and Social Psychology, 77(3), 474–486. https://doi.org/10.1037/0022-3514.77.3.474
Thoits, P. A. (2011). Resisting the Stigma of Mental Illness. Social Psychology Quarterly, 74(1), 6–28. https://doi.org/10.1177/0190272511398019