What's In a Name

I work in the mental health and substance abuse/addiction field. Over the last several years, there has developed a new awareness of labels. Instead of "schizophrenic," we're supposed to say "a person with schizophrenia." Instead of "addict," we're supposed to say "a person with addiction," or "a person with substance abuse/dependence." Instead of calling a person a "borderline," we're supposed to say, "a person with borderline personality disorder."

You get the idea.

The purpose for this is to avoid a label which identifies a person as one thing, and one thing only. To call a person with schizophrenia a "schizophrenic" suggests, according to the argument, that the person is defined by his or her schizophrenia, and that is the sum total of what they are. Of course a person with schizophrenia is multifaceted. Many work, have families, enjoy hobbies, and are active in their churches and communities. The proponents of the label awareness group state that because that is not all a person is, we should not define them by that. They should be thought of as a person with an illness, rather than the illness itself. Another reason is that so many of these mental health and substance use illnesses have stigma attached, it's a way of combating the stigma.

I'm not much for political correctness anyway, but this is another example of the perceptions of some dictating the reality for all.

Let me reframe this: I can say pretty confidently that I am a husband. Does that suggest in any way that this is the sum total of my identity? I am a father. Is that all I am? I don't have to say that I am a person who is married or a person with children, to understand that while these are essential features of what make me who I am, they are not the sum total of my identity. I am Catholic. That's not all I am. That religious label leaves out the idea that I am male, that I am married, that I have children, that I'm a counselor, and that I ride a motorcycle. I don't have a problem saying I'm Catholic, though. It's part of me.

Nathaniel is a hemophiliac. It doesn't matter whether I call him "a hemophiliac" or "a person with hemophilia." What I call him has no power over who he is or over his conditon. Do I want Nathaniel to be defined solely by his illness? Of course not. But calling him a hemophiliac no more defines him than calling him a Catholic. They are both important pieces of his identity, but neither name him as the sum total of who he is.

Some would say that the stigma about being married, having children, being a male or being Catholic is not like the stigma attached to mental health diagnoses. I would argue that anybody that thinks there's not a stigma attached to being Catholic is kidding himself. And if you think I'm not stigmatized when I tell people that I'm a biker in a motorcycle club, well...you are more open minded than most.

Seriously, the real issue is not what we call people. The idea that a name gives to a thing its essential quality is called nominalism. This is a strain of philosophy that states (simplistically put) that we assign a thing its essence by naming it. We all know that what I call a thing has nothing to do with the thing's essence. It's just a word that identifies it. "What's in a name?" quipped Shakespeare's Juliet, "That which we call a rose by any other name would smell as sweet." What we call something has no power either to define or to change a thing's essence. If we perceive schizophrenia or addiction or hemophilia or down's syndrome or Catholic or Baptist or Republican or Democrat as negative, calling it something else is not going to change what we perceive to be the negative qualities of that condition.

The real problem is the attitudes of some towards those with mental health diagnoses, or physical disability, or mental handicap, or differing religious or political views. I do not believe we can change a person's mind by changing the language that we use to talk about it. I've seen it too often: the look that glazes over some people's faces when I talk about addicts. It doesn't matter to these people whether I say "addict" or "a person with addiction." No matter what I call it, the negative response is the same. Whether I say "addict" or "a person with addiction", they hear someone with weak will power who should just be able to quit. It even exists within circles of the same group. For example, I work specifically in methadone assisted treatment with opioid addicts. As soon as I say that, other addicts get a look on their faces like I'm a drug pusher helping an opioid addict stay addicted, just switching the heroin for methadone. Stigma exist. Changing our language is not going to help confront the stigma.

What does help confront and resolve the stigma is honest conversation. We do not have to work at word games. When I experience stigma against my opioid addicts because they are receiving methadone assisted treatment, I meet it squarely. I open up the conversation and give accurate information. So often the reason for stigma against something is because those with stigma are uninformed. Accurate information does more to dissipate stigma than any word games we can play.

How do I keep Nathaniel's hemophilia from being the sole factor of his identity? I put it in perspective. I do not deny that he has hemophilia, and I'm willing to talk to anyone about it who doesn't understand it (giving information about it). I also will not allow him to define himself by it. As he grows, Lesley and I will give him information about it. I like Dirty Harry's idea, "A man's gotta know his limitations." As Nathaniel grows, I will encourage him to define his own boundaries, his own identity. He will, slowly and in age appropriate ways, decide what his hemophilia means to him, and how it will affect his behaviors. My job will be to give him age appropriate information about what hemophilia is and what consequences his behaviors may produce. He will be free age-appropriately to choose what to do and what no to do, and he will be responsible for the consequences.

I'm already fighting the fight against stigma with some family members about hypothetical situations in his life. On what playground equipment should he be allowed to play? Should he be allowed to ride a bicycle? In what sports activities should he participate? They all want to define these according to his hemophilia. I prefer that he should define these according to him.

In the end, we cannot be defined by one thing, no matter how essential that thing is to us. I would not be who I am if I were not Lesley's husband or Jacob, Caitlin and Nathaniel's father. These are essential to my identity. They are interrelated. I would not be Jacob, Caitlin or Nathaniel's father if it weren't for me first being Lesley's husband. Neither of these labels, however, define me exclusively. If anything were to happen, God forbid, to Lesley, I would still be my children's father. The same is true of being Lesley's husbad if we had no children. One label is not the sum total of who I am. Nathaniel's label of hemophilia is not the sum total of who he is. A person's addiction, mental health impairment, handicap, religious or political affiliation is not the sole criteria of the person's being. So suggesting that using  label to describe a person necessarily excludes all other possiblities of the person's identity is inauthentic.

In the end, if I don't like a label, maybe what I should be changing is my own attitude toward those with that label. It's a lot easier to change myself than it is to change an entire language. And maybe by changing myself, I might be able to help others change, too.