Wednesday 29 January 2020

A Landscape of Labels: Mapping Illness and Wellness

Imagine looking down on your country or continent from a plane. You are aware of the general terrain: mountains, lowlands, lakes and rivers. Perhaps you recognise some locations – places you have visited or heard about – but there are no lines or labels down there on the ground to distinguish this country or state from the next.

Now take out a map of the same area. The map is not the landscape, it is a model of the landscape, and it is full of labels. This area has a line drawn around it. The area inside is labelled so. If it is a political map, the line might define a country; this line a different country, this line a county, state or principality.

Select a different map of the same region. Maybe this one displays regions in terms of economic affluence, manufacturing output, average rainfall, or languages spoken. The area that was labelled “England” will now carry other labels. The labels applied depend on their definitions, and which maps we choose.

Maps and labels are incredibly useful. Without them we would, literally, not know where we are, individually or in relation to one another. Travel would be a challenge, travel planning even more so. On the political map I live in an area labelled “Newcastle upon Tyne” within the area labelled “England.” Fran lives in an area labelled “Portland” within a rather large area labelled “United States of America.” The map of languages will tell us that our nations each have English as their first language. We learn some interesting and useful things, but the labels do not tell the whole story. They are not who we are.

I find it helpful to think of health and wellness in a similar way. There is an area of the broad landscape of emotional, physical, and mental experience which on the diagnostic map is labelled “bipolar II disorder.” Parts of this area fall within a larger region labelled “depression.” If I choose a different map, some of the labels may be different. The “depression” region is larger, maybe. There is a region labelled “manic depression” which more or less corresponds to “bipolar disorder” but doesn’t match exactly. Another map has only two regions: “health” and “illness.” You get the idea.

Wherever we are on the ground the labels applied to us depend on who is looking at us and which maps they are referring to.

The labels of illness are useful where they help to define where we are on the landscape of wellness, and which treatments and approaches may benefit us. We can think of treatment as helping and encouraging us to move from our “regions of illness” and journey towards regions labelled healthy on the map. Fran might move in and out of areas labelled “mania” or “depression,” for example. If it is not possible to make these journeys for some reason, treatments can help us live more comfortably wherever we find ourselves.

Knowing that Fran is American (was raised and lives within the geographic area labeled “America”) helps me draw useful inferences about her cultural identity, and likely points of similarity and difference between us. Similarly, knowing Fran lives in a region of the wellness landscape labelled “bipolar” helps me to approach her with a degree of understanding and empathy. In both cases of course, it is possible to draw false conclusions, or apply the labels without reconciling them with who she actually is.

It is my responsibility to remember that she is not “an American woman with bipolar,” but an individual with her own unique, personal experiences and story. The same applies to how we think and behave towards ourselves. We can use the labels for what they tell us but take care not to over-identify with them.

Fran, you were saying last night that one of the most important things with us is that I don’t see you as “an ill person.” That I see the person, the whole person that you are. You mentioned that the labels (I think you meant labels like bipolar, cfs, fibro) are useful because they help you focus on why you have certain issues, and also because they qualify you for benefits. But you said it is possible to become too attached to them?

Yes Marty.. The labels help me care for myself.. They help me to understand why I do what I do sometimes.. The problem is if I make that my identity.. the way engineering was an identity for me before I got sick..

Misinterpreting the labels of mental illness is at the root of stigma and prejudice. We don’t have the time or the energy to get to know everyone we meet. Labels act as a shortcut. I suggest it is not possible to completely avoid this kind of thinking; we appear programmed to label the world around us and it is likely we could not function as social beings if we did not. The important thing is to recognise that the labels we apply say as much about us and the maps we are using as they do about the people we are labelling.


1 comment:

  1. This was an interesting read, thank you for sharing it! I agree that MH labels shoud be approached with caution. Whether we're self-labelling or labelling someone else, we need to remember that labels only tell part of a person's story. We're much more than a simple label, or even a collection of overlapping ones!