How we view people with medical labels?
A few weeks ago we conducted an online study on this question (the link to the survey was the “Click to participate” on the right side of the screen), and I wanted to thank the participants and tell you a bit about what we found.
In this study all the participants viewed a potentially funny video involving an individual who would seem to have “issues.” (http://www.youtube.com/watch?v=-Sd-j0rKeKw) The video clip showed a college student getting upset in an arguably overdramatic fashion after she got in trouble for inadvertently setting off her sorority house’s fire alarm by using the house’s fire extinguisher just for fun. Her friend apparently found it amusing enough to post it on youtube, and the clip has received millions of views since then.
The study had three groups: The first one was not given any additional information regarding the person. A second group was told that this person had suffered from stress since childhood. The third group were told that the person student in the clip had suffered from OCD since childhood.
What we found was that participants who were told that the girl had suffered from OCD since childhood found the clip less funny, laughed out loud from it less, and were less likely to recommend it to others than other participants. They also felt worse for the student and thought she deserved a smaller fine for inadvertently setting off the sorority house’s fire alarm than if they were either told beforehand that the student had suffered from stress since childhood (or received no justification at all). Participants who were told she had OCD also thought she seemed more likeable, intelligent, and creative. But they also thought that she seemed like a bigger loner and more antisocial.
What I think this means (and we need more research on this) is that giving individuals a disorder-label causes others viewing them to place the blame on the disorder and not on the person. Think for example about a parent who is told that their kid has ADHD – would this parent blame themselves less than if they were told that their kid is an active difficult kid? I think the answer is yes, and maybe this is one of the reasons that we as a society seem to be obsessed with diagnostic labels (other reasons include incentives for psychologists, medical companies etc).
By the way, did I tell you that I have a Restless Hand Syndrome”?
Irrationally yours
Dan
The Upside of Irrationality, explores some positive and some negative ways that irrationality plays out in our lives.
Nowadays even drunkenness is considered a disease. We should find some medical label for people who can’t help but cheat on their partners, who steal or believe in woo-woo.
In the extreme we are all the product of our genes and our environment. We are therefore not to blame for anything.
To me, the key about such diagnosis (whether of an impairment, or a social difficulty) is not that it excuses the bearer of blame for his behaviour, but that the knowledge allows for solutions to be found. If someone is badly behaved due to stress in their life, knowing this, some counselling could be arranged to help her in the future. This is more beneficial for her, and for society if her behaviour improves.
Well I think studying the effect of treatment and labeling of mental illnesses would be interesting and beneficial, since we seem to have a lot of people thinking it is not a “real” illness and attributing them to personal flaws….
It so just happens that the most effective way to keep alcoholics sober is to recognise it is an mental illness.
I am quite interested in how patients with mental illness’ quality of life either worsens or gets better in different situations by saying we have a mental illness.
Somethings are clear, like getting proper treatment would make us feel better. However, do we limit ourselves in certain ways because of the illness labels, which may have a bigger impact than how other people may try to limit our possibilities because of the illness label?
I believe that is a natural human reaction to feel sympathy for what someone has to deal with, and we tend to quickly forgive their bad behavior as a result. For example, parents who too quickly label their child as ADD, and then use it to explain every abnormal action, when most of that is probably just normal childhood behavior. I think there is also a risk that those labeled with a problem take advantage of that situation, knowing they are more likely to get away with it. Does the child labeled with a learning disability not try as hard because of the label? Do they give less of an effort? What if they weren’t aware of it? I think labels affect both the perception by others as well as the perception of themselves.
David Rosenhan studied this phenomenon in his brilliant “On being sane in insane places” (Science, New Series, Vol. 179, No. 4070 [Jan. 19, 1973], pp. 250-258). Normal healthy people were sent to mental institutions complaining about hearing voices.
All but one were diagnosed as schizophrenic. Even worse, most of their behavior during their staying in the facilities were considered to be typical, considering their alleged conditions. Many of their most mundane actions were forced to fit into a psychiatric profile – even when they were not.
Some argue that in medicine false positives (Type 2 error) are safer than false negatives (Type 1 error). Nevertheless, in psychiatry once you got a label it’s har to get rid of it – whereas in other areas, as oncology, a false positive is a reason to celebrate.
Best regards, Rodolfo.
Isn’t this part of a broader phenomenon of ‘labeling’? Presumably in life in general it makes sense to seek to rapidly categorise as a means to inform choices. We cannot extensively research every thing or person we come across, so we use practical shorthand, and labels are an attractive means for doing so. So when offered a choice between a BMW or a Skoda, I’d pick the BMW on the basis of its label (including perhaps the price label), since the alternative would be to exhaustively research and compare the two cars. This might seem very sensible, until, having chosen the BMW and driven it away, I discover the brakes don’t work.
As with all rules of thumb there are two main problems. First, there are exceptions to rules, so we consistently err when applying the rule in situations where it does not hold. Second, human beings find having to reassess and admit the possibility of error in prior decisions painful. Put the two together and you have a tendency for over-reliance and uncritical use of labels, and the potential for strong confirmation bias.
That would seem to explain the results of the experiment a bit more than our preferring to place the blame for things on conditions, or at least to offer a more generalised explanation, wouldn’t it?
I agree with Dan. All of these labels are just a cop-out.
There are different, and proliferating, “frames” for making sense of experience and, apparently our brain’s priority, others.
A medical frame, especially regarding personal behavior, is historically almost a brand new frame. Globally it is likely used by low single digits % of folks. Magical/supernatural explanations and frames are overwhelmingly dominant and growing.
One advantage of an evidenced-based, scientific frame, and this domain has been growing throughout history, is that it depersonalizes the “problems” and actually engages some parts of our brains while disengaging others. Defensive, fear-response, emotional, etc appear to drop in activity while more problem-solving areas increase. Is that “better?” Depends.
For most, the “problem” that needs to be “solved” is acute emotional discomfort — right now! Depersonalized frames aren’t very good as other more pop frames in solving that “problem,”e.g., criminal/legal, moralistic/”bad actor”, “choice.”
They always “win.”
Hey Dan,
I picked up your book on Vancouver Island last week at a coffee shop. Great job. I’m something of an EW fan (generally it doesn’t it)and love this kind of analysis. It’s good to know there are people like me out there.
Thats you.
Hope you are doing well and looking forward to another book.
Best to you…
Mark
I didn’t know where to comment on an error in Predictably Irrational so am posting it here. P 280 states that Bear Stearns was sold for $2 per share. JPMorgan was told to pay $2 per share but would up paying a whopping $10 per share or the employees threatened to screw it up.
Why don’t you make a video of a pseudo-scientist getting berated for wasting taxpayers’ money, and then ask if people are less sympathetic upon finding out that said pseudo-scientist comes from a well-to-do family? You’d pretty much cover the entire Ivy League with that one.
I’m wondering if there may be a differential based on how “medicalized” the label is. Stress vs PTSD for example. I’d venture to guess if the disability was something that had a element of self-control (substance abuse, for example)there would be less sympathy. One might also suspect that the age of the viewer would have some effect — teens would find this funny regardless of labels.
Just to be clear, drunkenness is not considered a disease. Alcoholism is considered an addiction, which can be treated like other mental health disorders, and is considered by mental health professionals as a disease.
I agree with Dan S that medicalization of any behavior is a way of labeling. Proponents of this argue that it reduces the stigma associated with it. Depersonalizes it, as Elmer says.
I disagree a bit, however, with Dan S.’s argument that labeling allows people to place blame on conditions. That may be the case with medicalization. However, not all labels remove blame from the individuals. Labeling indicates the group people belong to and can result in uncritical acceptance of their immorality (or blameworthiness) or virtue on the basis of the label. We call it bigotry when it involves behavior or attitudes that are rooted in labeling on the basis of identity group (race, ethnicity, gender, sexuality, class, etc).
Plenty of studies show that simply using particular labels that identify group membership results in applying or removing blame. Criminal justice studies show that once a “defendant” in a hypothetical scenario has been identified as black, even if the research subject has not actually seen the defendant, the likelihood of being “convicted” increases. The role of labeling as part of the shorthand that applies virtue or vice to individuals has also been shown when studying access to credit, the rigor with which job applications are reviewed, and even with prescribing pain medication.
Our brains, and likely all animal nervous systems, crave shortcuts or saving brain effort – especially those we label as conscious/language. Political consultants, always practical, are some of the best at understanding how our brains are “cognitive misers.”
Focusing on the “symptoms” of a mental state or behaviors, saves a lot of brain processing. Of course, it is often a highly inaccurate way to track and process the experience and problem-solve.
But,
- Our brains hate problems — too much work
- Tracking empirical reality is obviously not a key adaptive skill since supernatural beliefs predominate.
However, tracking (always imperfectly, of course) empirical reality is a very specialize skill typically for experts and very useful in the hospital and airplanes, etc.
Increasingly, tracking the empirical realities of brain impairments is also becoming a more expert, evidence-based and urgent matter as the social “costs” of brain impairments are experienced more acutely and we now have new tools for understanding.
Hmm.. reality shows. Probably anything personal would skew the view for most people, different from the cold state. (Everybody thinks they’re stressed.)
Imho, as a study about assumptions based on emotion and narrative, this was a success.
Speaking in terms of my own reactions to formal diagnosis of “label” (for myself and family), the label often has the effect of letting us move past blame and get on with finding solutions to the situation as it exists.
I think that the post is rather ignorant asany parent with kids who has nurological disrders can atest. Actually these days ADHD has pretty much clinical meaning. Dr. Daniel Amen tracked it down using SPEC imagaing techniques. what he found is that the prefrontal cortex shuts down when ADD persion is trying to perform tasks or certain complexity. This portion of the brain controls executive function and this disfunction causes ADD/autistic people to not being able to concentrate, social and other wierd behaviors.
I believe Bernie has a point – lack of personal control over a disorder should be differentiated from lack of personal responsibility.
As for the “medicalization” theory of social medicine it is considered to be one that can neither be proven nor disproven and as advances in medicine are made many “medicalization” theories are proven false.
Just because diseases were attributed to the Gods and miasmas, and in some cases the education of women, for millenia doesn’t mean those theories were right.
Bottom line: If you misbehave – regardless of the reason – take personal responsibility and apologized and make amends.
“Think for example about a parent who is told that their kid has ADHD – would this parent blame themselves less than if they were told that their kid is an active difficult kid?”
Speaking as one of those parents, that comment is a joke. I resisted sticking a label on my child for many years, so it wouldn’t follow her around. Finally “the system” required it, and I gave up worrying about it.
“Blame” comes into the picture in a lot of ways, but not in the high handed way you throw it out there. More like blame as in did I miss something in pregnancy or childbirth? Was I a good enough parent when she was young and the family was under some stress? Blame as in how do you know how much to hold a child responsible for something when her abilities and maturity are so uneven? Blame as in I’m so exhausted but I still need to muster up some more patience for the child ripping her homework into pieces in utter frustration. And blame as in not blaming those who don’t know what these kids endure, how they struggle to fit in, and how poorly understood they are, especially in school. Most of the world sees the difficulties and never gets a look at the resilience that enables these kids to slog off to school each day with their head up.
Keep working ,great job!
Many people tend to think just because an individual has a medical label, that their incapable of controlling their own actions. In my opinion I believe society is going too far with the medical labeling. It’s like no one can take the blame for their own actions anymore. I don’t understand why people are always looking for someone or something else to take the blame for them. For example, why should a person who decides to spend their money on a bottle of alcohol instead of paying their rent have the due date extended because they have a “disease?” I just don’t understand it. Everyone should learn how to look past a person medical label especially if they brought it upon themselves, and take a long hard look at the actual person standing in front of them. That will be the only time any real judgments or assumptions can be made about a person.
I completely agree with Kiki on society’s personal look on medical labels. Alot of times when people are labeled into a certain category or group whether they know it or not their actions sometimes may speak upon it, though that label may not be what defines them as a person. For example if you were raised being taught that you were so much less than everyone else because of your families financial situation than one day you stumble upon money and you begin to buy the finer things in life your whole attitude an vibe changes because your now categorized in the group of people with money so everything changes. Honestly now-a-days people use labels to cover up anything just to simply get away with whatever possible but its society’s fault because medical labels have become so important now-a-days, you can’t just be sick anymore you have to have a specific illness or virus simply to seperate one group from another becasue we love to compare.
Social-cultural/personalized/moralizing framing of medical conditions is far more common in history and even now that medical models.
By definition, illnesses and impairments of the brain create non-homeostatic behavior since the function of the brain organ is to produce behavior.
The function of the heart is to produce carido-vascular “behavior.”
The medical facts are clear and getting clearer on brain disorders. Brain impairments are no more “moral” than heart disease.
Is someone immoral when they have heart disease and “choose” to have shortness of breath and impaired blood-flow?
Of course, effectively no one believes or accepts the medical model — for any body state. Supernatural and moral belief systems dominate. Understandable.
I agree with Kiki. It does seem like no one can take control of their one actions. With all the labeling that goes on its difficult to actually take blame for whatever has happened. I also believe that instead of blaming someone with a medical label people do try and find solutions to the actions which is good too. It puts people to work and maybe try and find a cure, solution or reasonable answer to the actions. I still think that everyone should be blamed or punished equally whether they have a medical label or not because if not how are they learning to not do that wrong again?
Let’s remember that while we can discuss the pros/cons, right/wrong of accepting labels, the empirical evidence for the medical conditions in brain disorders and impairments are accelerating and some of the best evidence-based medical knowledge available.
Most will deny the medical model but the evidence is some of the best in all sciences.
That the medical evidence calls into question most criminal/socio-cultural/legal belief systems about these conditions and the people suffering from them again, seems just normal hyper-focusing on symptoms and moralizing. Not trivial, but little evidence to support.
Since the begining of society there has always been right and wrong. Some people with certain medical conditions can’t control themselves because they see the things that are right and wrong in a scewed perspective, and others who are sick can, but because of their surroundings and how people treat them, they refuse to. There’s obviously many different types of medical conditions and each one has to be delt with in its own way. It’s just easier to blame an illness than the actual person or blame others who might have raised or influenced them. I think if people put more thought into how to deal with people who have the dendancy to act out because of there condition (even if their drunk) life would go along smoother without things such as mental hospitals and depersonalizing drugs. I wouldn’t say I’d actually judge the person’s illness rather than the actual person, but caution it and feel the need, to not blame, but guide. You can’t really blame any illness or the person, but you can always guide them along.