I am dissatisfied with much of mainstream vocabulary and ideas around matters of emotional distress and extreme states.  I operate from the position that common approaches toward something many are calling “mental illness” are in a pre-scientific phase and have a long way to go.

Today’s labels (like bipolar, schizophrenia, and even depression) make a lot of assumptions that are unsupported by science (the chemical imbalance theory, for example).  They also don’t account for what can be a steep power differential between the labeler (a professional with privilege) and the labeled (a person in a marginalized emotional state).  Psychiatric labels describe behaviors as seen from the outside but say nothing about why such states come about or how we might make meaning of them.

When I was first told I had ingested an “antipsychotic” drug, the power differential between me and the prescriber was greater than any I had ever experienced.  I had been locked up.  I had been humiliated.  I was wearing the same hospital gown for three days, I had been hidden from society against my will and I was highly sedated, disoriented and disheveled.  The person who coercively prescribed this drug was seated across the table in ironed slacks, a dress shirt and a silk tie.  He had nice combed hair and keys that opened all the doors.  It was obvious who had the power.

“So, how are those antipsychotics working for ya?”

It took me about a quarter-second to realize, wait – I think this well dressed man just called me psychotic!  Two nights earlier when I took the pills, the attending nurse simply called them mood stabilizers which felt far less insulting.

But psychotic?  He thinks I’m psychotic?  If he didn’t, why would he have given me an anti-psychotic drug?  That accusation was like a dagger in my chest.  At the time, that word – psychotic – evoked memories of horror movies.

In my own experience, receiving the label of bipolar (not to mention the phrase antipsychotic) was not helpful, although many who receive this label find it can have value – at least at first. 

A psychiatric label may help you organize patterns in your life (like ups and downs or audible voices), but it really says nothing about who you are, where you are going or why these patterns have surfaced.  A psychiatric label is only a name for a collection of frowned-upon behaviors that someone with power over you has connected.  At best, a label can only describe patterns during a particular slice of your life experience, but cannot describe your whole life.  Yet labels are taken way too seriously!  They are interpreted by prescribers and the public alike as permanent conditions, as diseases.

A psychiatric label is only a name for a collection of frowned-upon behaviors that someone with power over you has connected.

For me, the label of bipolar hemmed me into a box and dictated my vision of what was no longer possible in my life.  It led me to hand over a great deal of my personal power to medical professionals, and had a huge impact on how others viewed me as both my self image and physical appearance shifted.  After about a year and a half, and with the help of many people (like Will Hall and Laura Delano), I chose to leave the identity of bipolar behind.  I chose to withdraw from psychiatric drugs (yes, it’s possible and extremely rewarding!).  As I distanced myself from the little bottles with my name on them, my identity began to heal.  Even during the throes of psychiatric drug withdrawal, something inside me was empowered by the bag of pills under my sink I had not taken.  That bag was like a victory bag.

As far as labels are concerned, today I prefer the label of John Herold, thank you very much!

I sometimes imagine I’m a time traveler from the far distant future visiting an ancient society called the 21st century.  I assume, with the benefit of time and progress, they will have very different vocabulary and radically evolved conceptualizations of these ideas, just as we have very different ideas about human behavior today than people did, say, a few hundred years ago.

Therefore, in homage to our future selves, and in anticipation of stronger and more accurate language  in the future, there are certain phrases I tend not to use:

The big gun
Mental illness
Mental wellness
All diagnostic labels
Schizophrenia, Bipolar, ADHD, Depression, Borderline, OCD, etc.
Vague and Judgmental Adjectives
Inaccurate Nouns
and even Recovery

I don’t actively stop others from using these words, but I’m careful with my language.  I do a lot of rephrasing.  You might find my habit a little contagious.  I have been told by a peer support specialist (now a dear friend) that after hearing me speak she stopped using diagnostic language at work.  That’s the most beautiful thing I could ever imagine hearing.

I don’t use mainstream diagnostic vocabulary because I don’t believe in the framework behind the labels.  I’ve experienced first-hand that the label of mental illness can be psychologically damaging.  I believe such labels can lead to deeper and deeper oppression, leading us to relinquish personal agency and power to a science that is merged with marketing and as a result, doesn’t really have its act together.

In Processwork we don’t often use diagnostic psychiatric vocabulary.  Instead we use phrases like “altered and extreme states of consciousness.” 

Lately though I’ve been realizing that maybe those aren’t optimum terms either, because like diagnostic labels, they don’t take into account the power dynamics between those experiencing such states and those using labels to describe them.  I think much of what gets called mental illness has more to do with the steep power differential between identified “patients” and identified “normal people.”  This friction shows up inside ourselves (when we doubt our own sanity), with each other, with broader society and especially in relation to mental health professionals.

So let’s bring forward some new vocabulary.

Instead of using mental illness, consider these ideas:

Privileged states of consciousness

Privileged states refer to experiences the mainstream calls “normal.”  But it gets complicated.  The mainstream accepts certain extreme states as okay and not mentally ill.  For example, consider mania at winning the lottery, mourning a death, laughter at jokes, elation at love, anxiety over uncertainty, or even hearing voices during prayer or meditation.

One of my favorite examples of a privileged extreme state is Beatlemania.  (warning: video contains footage of big emotions)

Ask yourself, how are these people not mentally ill?

Privileged states benefit from adjectives that are descriptive but not pathologizing (looking at it like a disease).  Consider names like sadness, happiness, nervousness, anger, contentment, unity, love, fear, elation, and anticipation.   In the mainstream there is general fear around states that fall outside its perception of normal.  From the privileged position, people who experience such states are “not well” and “should seek the treatment they need,” take their medication, etc.

Marginalized states of consciousness

This term refers to experiences the mainstream pathologizes as abnormal, often identifying them as mentally ill.  These are experiences the mainstream power holders tend to disavow within themselves and others.  Generally not liked, these states threaten life as normal.  The more these states are marginalized within ourselves (using common phrases like “I’m not weird,” “I’m not crazy,” “I’m in full control”), the more squarely these states (and labels, and drugs) fall on a select few.

These would be our identified “mentally ill.”

The marginalization continues as these people are given labels implying they are ill, forced to surrender their personal power, take psychiatric drugs, and live with fewer opportunities to achieve their dreams.  Those who experience these states are further marginalized as the mainstream questions their hold on reality by assuming that once they’ve entered such a state, they are there for life.  Many of us who have experienced this kind of oppression swallow it, bringing it inside ourselves – at which point we keep ourselves in a state of powerlessness by buying into the notion that we’re sick.


  • Heather Hunter

    This article can change how we speak about ourselves and others. As usual you hit the nail on the head my friend.

  • Delores Jankovich

    This is an excellent article and I find every word in it filled with truth. I am a survivor, mother of someone who experiences extreme states and former mental health therapist. I strongly feel that language is so important and that we must eradicate labels and the use of toxic psychotropic drugs. Your article is very articulate and well thought through, clearly delineating the way people are perceived, leading to further oppression of the vulnerable and to further disempowering. Thank you! Yours is a voice that must be heard.

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