“Fat . . . Borderline . . . Retard . . . .”
It is always shocking to me how easy it is for medical and mental health professionals to reduce their clients to less-than-desirable and less-than-accurate one dimensional labels behind closed doors.
I’ve heard excuses that range from 
minimizing (“oh-he-knows-I-don’t-mean-it”) to intellectualizing (“it’s just a short-hand way to refer efficiently to a particular group of symptoms).
Whatever the reason . . . ignorance, mean-spiritedness, or just plain old laziness . . . if you’ve been tempted to mock a client or speak derisively about a client behind closed doors, you might want to check out Tara Parker-Pope’s post on professionals mocking their clients.
It’s one of those things that wasn’t discussed in my ethics classes but probably should have been.
After all, if we are reducing our clients and all of their complexities to a simple one-word label, it’s likely we don’t have our client’s best interest at heart.
And how can anyone honestly present that it wouldn’t affect the treatment of their client? If I have labelled her “the anorexic woman”, or him “my BPD guy”, it will influence my choices, both long-term and immediate. It’s reductive and insulting.
David! I’m so glad to have your voice here! Thank you for taking time to join this conversation. I have been in the field for 30 years and was just telling someone else that back then it was common to refer to clients by their symptoms or diagnoses. I’m embarrassed to say that I learned from the beginning to refer to my clients as “my alcoholic” or “the cutter” or “the borderline.” And, of course, you are right! It’s insulting. It’s embarrassing. And, it’s unethical in my opinion to even think of my clients in those terms. Yet, for more than half of my time in the field of mental health it is what I did.
Only about 10 years ago did I start to hear colleagues – mostly younger and newer colleagues – talk about how disrespectful and hurtful it was to refer to clients in this manner. It was hard . . . really hard to change that habit but it’s so important to do so. It’s the right thing to do and I’m grateful to the wisdom that comes from those with fresher eyes who are willing to call out the wrongs they see perpetuated generation after generation . . . . I know that this world and I am better for it.
David . . . I just noticed that you don’t have a little picture of you next to your comments. You’re missing an opportunity to help people remember who you are. If you want to have a little picture of you show up in your comments, you can find out how right here. It’s really simple – I promise!
Thank Tamara for your honesty and changing for the best!
Diagnosis were never meant to label people but to provide a standard set of symptoms to better understand someone’s illness, selection of treatment …. and of course for insurance purposes. It is hopeful to know that those who oppose to refer to their clients as someone with a “label ” instead of someone whom they care about are speaking up.
Nice refreshing discussion.
Hi, Marlinda! Thanks for joining the conversation here!
But I do have to say that my understanding is that diagnoses were developed simply to provide a common language among professionals and, later on between professionals and insurance companies. I don’t believe that diagnoses further the understanding of an individual’s health or illness. More often than not those diagnoses are not scientifically based. Nor do they provide guidance to best practices or treatment. As harsh as this sounds, before you decide that I don’t know what I’m talking about, check out some of Paula J. Caplan and Lisa Cosgrove’s writings beginning with their short (and stunning) little book Bias in Psychiatric Diagnosis. It is a fascinating, practice-altering, and easy read that I think should be required reading in all graduate programs.
Marlinda . . . I just noticed that you don’t have a little picture of you next to your comments. You’re missing an opportunity to help people remember who you are. If you want to have a little picture of you show up in your comments, you can find out how right here. It’s really simple – I promise!
Tamara,
Thank you so much for hosting this conversation. It troubles me when I hear colleagues refer — often disparagingly — to clients in this manner. It is both judgmental and harmful. My graduate school supervisor reminded me, “Labels are for jars, not for people.”
Thank you for compassion.
Warmly,
Lisa
Hey, Lisa! It’s great to have your voice here! Welcome, welcome!
I’m so glad to hear both you and your supervisor in graduate school emphasizing this.
It cannot be said often enough.
Whether it is an intentional slight or a thoughtless habit, to refer to individuals as their diagnosis or in more disparaging terms is unprofessional and hurtful.
I’m always amazed at colleague who manage to justify this behavior as “venting” as if that makes it any less damaging – to their own reputations and to those individuals that they are referencing.