In A Name: the Pitfalls of Labels

The word “name” was once synonymous with reputation. Naming things features prominently in many world religions and the process of naming a thing has been infused with ritual, magic, power and danger.

Within languages we find we face gaps in translation where one culture deems the naming of something relevant yet another has no name for it. Here are just a few wonderful examples:

Wintercearig: Old English for winter-sorrow, a feeling of sadness equal to that of the cold of winter. Yaourter: French, literally “to yogurt” or attempting to speak or sing in a foreign language that you do not know well; often involving nonsense sounds to fill in the blanks. And of course, Schadenfreude: German for happiness or cheer over someone else’s misfortune. 1

On the one hand I am drawn to adopt all these wonderful words that frame an entire string of feelings, thoughts or behaviors into a single name, but thar be monsters in those waters perhaps lying under all that smooth appeal.

To quote psychoanalyst and psychiatrist Jacque Lacan [1901-1981]: “The word kills the thing.”

By this he [Lacan] meant that an abstract kind denoted by the signifier can never capture the singularity of a thing.” 2

A category therefore erases individual details and discrepancies through applying group characteristics that are common to all. There is expediency in categorization and naming, but not necessarily accuracy.

Is A Label Good or Bad?

The most common argument for labeling mental conditions and containing their symptoms and expressions within arbitrary categories, is that it’s a far better option than the historical habit of applying one dismissive, stigmatizing and disastrous category: insanity (with all it’s even more unpleasant synonyms).

But should we really congratulate ourselves on being so much more progressive than our grandparents merely because we have numerous labels now and they didn’t?

In 2012 it was made public that actress Catherine Zeta-Jones lives with Bipolar I. Recently Zeta-Jones had the following to say on Good Morning America:

“You know what? I’m sick of talking about it because I never wanted to be the poster child for this. I never wanted this to come out publicly. It came out,” she said, “I dealt with it the best way I could. It was just saying, hey, I’m Bipolar. Everyone has things going on and we deal with them the best we can.” 3

Similarly, actress Kate Beckinsdale “regrets being candid about her teenage eating disorder troubles because now she’s always asked about anorexia in interviews. The actress admits she hasn’t even told her own daughter about her teenage troubles and feels “violated” every time her past health problems come up in interviews.” 4

Now of course these are famous women in the public spotlight and we often actively lobby for them to become spokespeople and “poster-children” to further numerous causes, and we most certainly expect for them to represent their own conditions accurately and responsibly that others might be inspired to seek help and relief. It does not surprise me that they might feel pigeonholed, used and misunderstood in that process from time to time.

However, famous or not, labels are a problem.

Predicaments Are Not Problems

On the radio the other day they were playing that ancient Bob Geldof Christmas song Do They Know It’s Christmas?—Band Aid. The performance was stuffed full of singing celebrities to raise money for the famine in Ethiopia at the time. Have you ever noticed how sanctimonious and embarrassingly condescending the lyrics actually are?

Given that Ethiopia is one of the countries in Africa where the majority of its population practices the Christian faith, then they do not need to be asked whether they are aware of Christmas— and yes, Bob and Co., Africa is an entire continent with 48 independent states on the mainland and 6 additional island states. 5

There are so many cringe-worthy lines in the song it’s hard to choose the best one, but I think I’ll go with “there won’t be snow in Africa this Christmas.” Well yes of course there’s no snow with the exception of the entire Simien mountain range in Ethiopia (capped with snow year round). You can take a look at “snow in Africa” on Ethiopia’s Ras Dashen here, where there are fairly violent snowstorms every night in fact.

We, in our developed, or Western, or Global North nations regularly appear to confuse bringing attention to a predicament with generating solutions for a problem.

A predicament is a situation, especially an unpleasant, troublesome, or trying one, from which extrication is difficult. 6 A problem is a situation or question to be considered, solved or answered. 7

Famine in Ethiopia was, and is, a predicament. Here is a list of the famines Ethiopia has experienced thus far: 9th Century, 12th Century, between 1540 and 1750 there were 11 major famines in the region, 1888-1892, 1913, 1957, 1960, 1965, 1973-1975 and 1982-1985 (Do They Know It’s Christmas?). 8 More recent famines include 2002-2004, 9 2009 10 and the current impacts of the 2011 drought across the Horn of Africa. 11

Of course you must first identify a problem in order to solve it and that, presumably, is what labeling mental disorders and conditions is about: identification of the problem. Ironically, the actual problem may be that these conditions are not problems.

Equivalently, sending aid to Ethiopia in the 1980s occurred because the starvation of hundreds of thousands of people was a problem to be solved by airlifting food to them.

But when you misidentify a predicament as a problem, you get very unexpected complications as you apply what you think is the solution:

According to one Ethiopia expert, Alex de Waal, the relief effort [during the 1982-1985 famine] may have cut the death toll by between a quarter and a half. The problem is that it may have contributed to as many deaths.” 12

If you would like to understand how it is possible that Band Aid/Live Aid may have contributed to deaths even as their money flowed to non-governmental organizations in Ethiopia, I highly recommend you read David Rieff’s entire article in the Guardian as per reference of the above quote (see below).

There is a huge difference between a predicament and a problem. Having an eating disorder is fundamentally a predicament. Remission is the period during which the symptoms of a disease or condition abate or subside—that, by definition, cannot be considered a solution. It’s respite from the predicament of the active state of the disorder.

Identifying and determining the ways in which it might be possible to realize some kind of respite or remission from a predicament is a completely different cognitive effort than identifying a problem and then developing and implementing a suitable solution to that problem.

Does talking about the scope of a predicament help develop options for extrication, respite or remission? Well perhaps only if you begin the process by confirming it is indeed a predicament and not a problem.

And just because something is a predicament, and not a problem, does not mean that we should simply throw our hands up in the air and say: “If it has no solution, then it does not bear thinking about!”

Predicaments are much tougher than problems to navigate and they require more patience, consideration and testing of theories as well. There is not just no easy solution to cyclical famine in Ethiopia, there is likely no solution at all. However, there are likely numerous options available to aggressively intervene such that a faster respite or remission is realized nonetheless. And that could save lives.

Exploitainment and Redemption

You are likely all aware of the reality shows that have sprouted up everywhere to bring attention to various mental disorders and those who live with them. I have actually lost count on the number of shows focused on hoarding (there are several in my country). There is one for OCD (Obsessed); the contrived (and dangerous) fat and thin one in the UK that involves those with eating disorders; the ever-popular and equally dangerous Biggest Loser (where the presence of fat is wrongly identified as illness and moral failing); Intervention for ogling addicts; and My Strange Addiction, a grab bag of those struggling with various compulsions.

It is well named to categorize all of these shows as exploitainment.

The only variation we have added to the original 19th century format of circus sideshow oddities and “freaks,” is that in the new reality show format we have included a form of unethical psychological experimentation (banned within the halls of academia, but fully covered off in the contracts of reality show participation). Additionally, a few sessions with a caring professional (let’s not forget the added drama of some arbitrary deadline) and the “freak” is redeemed. Hugs all around.

Given that the quoted sustained remission rates from these TV shows are never independently corroborated; the number of participants who die as a result of relapse or taking their own lives is not insignificant; and the infamy associated with being a participant is lasting*, it is difficult to understand why people continue to submit to such denigration and experimentation.

* “Some of the people starring in episodes [of Intervention] since then have even become familiar characters (as it were) in the pop culture landscape. Season two’s Cristy—a meth addict who liked stickers on her face but did not like wearing clothes – was one of the show’s first subjects to become an object of internet infamy. And chances are good you’ve seen Allison from season five, or at least the YouTube mash-up video where she described her passion for huffing up to a dozen computer duster cans a day.  (“It’s like I’m walking on sunshine” she replied when an A&E interviewer delicately asked her to explain her strange habit.) The next day, her appearance was immediately posted on YouTube, where her computer sniffing was accompanied by the soundtrack of the Katrina and the Waves’ tune of the same name.

But the most famous Intervention subject is probably Rocky, a professional boxer from season eight whose 38-second “Best Cry Ever” YouTube video has received an astounding 16 million views. If that’s not enough, a hip-hop remix of the song has a separate view count of one million, and it was even lampooned on Saturday Night Live in a sketch with Mad Men’s Jon Hamm.

Although many of the people commenting on the “Walking on Sunshine Intervention Style” video describe themselves as Allison’s “fans” and “supporters,” there’s clearly more at play here than well-wishes and sympathy—flabbergasted fixation and detached mockery also have a lot to do with the public’s fixation on Intervention.” 13

“Detached mockery”what an accurate description.

It’s likely these participants enter the process because the story of redemption and being made whole again is universally appealing to us all. The desperation that may accompany how the condition reduces their quality of life, renders them confused about what they are signing away in their drive to reach out to what may feel like a last chance for redemption and healing. Several profess to want their participation in these shows to be an embodied message of “save yourself before it is too late” to others who may not be “as far gone” and for whom there is still hope for redemption.

Neither respite nor remission is redemption. A reprieve is not redemptive, it’s most certainly a relief but it’s not a solution. It can even be transformative in many ways, but that process isn’t linear, it’s cyclical. And, most importantly, redemption is the act of being saved from evil or sin, and chronic neurobiological conditions are fundamentally not evil or sinful.

Exploiterature and Memoirs

I have now read dozens of memoirs from those who have realized a remission from eating disorders, few actually detail the experience of recovery.

The drama is in the active state of the condition and not in the tough slog and subtle shifts that are the essence of a recovery effort.

And so, dutifully responding to a reader’s need for the equivalent voyeurism that TV viewers depend upon in the reality format, memoirs relay in painful detail the excruciating demands these conditions exact on the mind and body every single minute of the day and night. Just to warn you, the following excerpts are all likely triggering.

“…eats six ounces of yogurt, panics about losing control and fitting into her Ally McBeal wardrobe and begins doing lunges while sobbing – “sobbing and lunging – it's got to be at least 30 calories.”” Portia de Rossi 14

 “As the year went on, I began to fill a bowl with a ridiculous amount of mustard, eat mustard straight, using a carrot stick more as a spoon than as an edible.” Marya Hornbacher 15

 “Then I put seven peas and eight carrot squares on my plate, but I didn't like the number eight because it sounds like "ate," so I took one off. I didn't go near those fried potatoes, obviously.” Lori Gottlieb 16

 “Woohoo! The Plan is working! I have finally reached the goal and passed with flying colors. And they say you gain weight over the holidays. Ha! It's strange though, I'm not quite satisfied yet...” Morgan Menzie 17

 “In my 400-calorie-a-day-week I have plenty of low-calorie bread.  Sometimes the supermarket runs out, and I wonder if all the other anorexics have got there before me.” Grace Bowman 18

 “If my stomach contracts, or I wake up feeling nauseated, or I’m light headed, or I have a hunger headache, or better yet, all of the above, it means I’m getting thinner. So it feels good. I feel strong, on top of myself. In control. Thanks to the dictator.” Deborah Hautzig 19

 “I am the space between my thighs, daylight shining through.” Laurie Halse 20

You get the idea. There is no dearth of detail and data in the over 100 memoirs of those who have lived with active eating disorders that ensure we all understand the scope of its active presence in the lives of so many.

And now all the dirty secrets of eating disorders are available for the world to see on TV and read in hundreds of bestseller books, so what?

Maybe it’s time we stop congratulating ourselves so much for labels, awareness-raising efforts and celebrity sing-alongs all misidentifying predicaments as problems that can be solved.

Labels Have Become A Problem

Let’s even say, for argument’s sake, that these conditions are not predicaments, but indeed problems to be solved. Even then, within a solution to a problem often lies the seed that sprouts the next problem.

The ballet Swan Lake was first performed in 1875 and little is known of the details of its original incarnation besides the fact that it was not considered successful. It was only when choreographer Lev Ivanov and composer Ricardo Drigo revived and reworked the ballet some twenty years later that it gained its popularity. They reworked the original ballet to have the parts of both Odette and Odile (white and black swan) performed by a single prima ballerina, Pierina Legnani. Legnani was a phenomenal athlete and technician and Ivanov redesigned what is now known as the Black Swan Pas de Deux to include 32 fouettés. Those 32 fouettés were a huge success.

Today, however, many prima ballerinas loathe the 32 fouettés. And it’s not because they are incapable of performing the technically demanding turns, but rather they resent the fact that the turns are, in essence, for effect and lack any meaning within the context of the arc of the storyline of the ballet itself.

In other words, the solution to the problem of Swan Lake’s unpopularity in its original incarnation is now a very modern problem within the increased complexity and honesty of storytelling through dance today.

A solution has a shelf life. Labeling neurobiological conditions when there was simply “insanity” before that, was an attempt to solve the problem of such a de-humanizing and one-size-fits-all dismissal of those living with mental conditions of one kind or another.

Just like Band Aid’s efforts in the 1980s, I can more than understand that doing something seemed preferable to accepting the status quo.

While we cannot accept the status quo, we have to stop making things inadvertently worse because we fail to identify that these are predicaments we must face and not problems we must solve.

Guide Me Along the Path

It’s easy to misinterpret my observations as casting a pall of cynicism and cruel apathy on all of these genuine efforts to help others. However my point could not be further from that depressing and jaundiced view.

The producers of all those reality shows are not monsters. There is not a single eating disorder memoir author who sets out to sensationalize her own pain. These are all genuine attempts at framing what everyone has come to understand as “a problem” and that to raise awareness of the problem can only, inevitably, result in solutions becoming more readily and easily available to all.

Face to Face With The Predicament

After the secrets are all revealed; the patient faces her neurobiological predicament; and all the hugs and temporary relief of the label are a distant memory, then he or she arrives at base camp ready to embark on her journey towards remission— the actual easing of the predicament.

I stand at the base camp of recovery. It’s a pretty chaotic place actually.

It’s loud and confusing and there are thousands all crowded around the START. Everyone is looking for the Ultimate Guide and no one wants to get it wrong.

I am not a guide. Those would be the health care practitioners out there.

I hand out leaflets. I yell out a brief orientation and explanation. I cover off a few possible dangers that may be encountered. I offer fallback positions in the event of extreme events. I also explain that those at the start are not climbing a mountain but rather they are entering a maze.

They may sometimes surprisingly find themselves popping out right back at base camp. The maze changes shape and it’s sometimes menacing and frightening but occasionally peaceful and restful. Some tucked away points are beautiful, others horrifying. The maze is unique for each person. I reinforce that there is no right or wrong. Or at least I try to, over the din and confusion.

Some show up to base camp having arrived here countless times before; others are overwhelmed first-timers. The veterans have made numerous attempts and fired countless shifty and unskilled guides. Some have hired untested guides, others have experienced guides from other journeys in unrelated mazes.

Only a few are lucky enough to have actually happened upon guides who can really flow with the changing maze as each trekker files into it.

What is the destination? There is no destination. When will you arrive? There is no finish line.
How can you succeed? It is not measured in those terms.

How very frustrating.

How very freeing.

There is a reason Harriet Brown’s memoir, as a mother of a child with anorexia, is listed in the Recovery Experiences in the reading section of this site: it’s because she speaks of the maze of recovery and little of the trip up to base camp. Getting to base camp is no small feat of course, but there are hundreds of memoirs to review if you want a lens on that journey.

No other experience will reflect your experience. Their maze is not your maze.

Tools for Recovery are available in the youreatopia.com Shop

1. http://betterthanenglish.com/

2. https://larvalsubjects.wordpress.com/2013/02/06/the-power-of-naming/

3. http://hollywoodlife.com/2012/12/07/catherine-zeta-jones-bipolar-disorder-good-morning-america-gma-interview-december-2012/

4. http://www.contactmusic.com/kate-beckinsale/news/beckinsale-regrets-anorexia-confession_1027409

5. http://www.nationsonline.org/oneworld/africa_map.htm

6. http://www.thefreedictionary.com/predicament

7. ibid.

8. Endale, Derseh. The Ethiopian Famines, Entitlements and Governance. World Institute for Development Economics Research of the United Nations University, 1993.

9. Lautze, Sue, Yacob Aklilu, Angela Raven-Roberts, Helen Young, Girma Kebede, and Jennifer Leaning. "Risk and vulnerability in Ethiopia: Learning from the past, responding to the present, preparing for the future." Boston: Feinstein International Famine Center, Tufts University and Inter-University Initiative on Humanitarian Studies and Field Practice (2003).

10. http://news.bbc.co.uk/2/hi/africa/8319166.stm

11. http://www.cbc.ca/news/world/analysis-drought-in-the-horn-of-africa-does-the-world-still-care-1.1022146

12. http://www.guardian.co.uk/world/2005/jun/24/g8.debtrelief

13. https://www.thefix.com/content/affliction-network?page=all

14. De Rossi, Portia. Unbearable lightness: A story of loss and gain. New York, NY:Simon and Schuster, 2010.

15. Hornbacher, Marya. Wasted: a memoir of anorexia and bulimia. New York, NY:Harper Collins Publishers, 1998.

16. Gottlieb, Lori. Stick Figure: A Diary of My Former Self. New York, NY:Simon & Shuster, 2000.

17. Menzie, Morgan. Diary of an Anorexic Girl. Nashville, TN: Thomas Nelson, 2003.

18.Bowman, Grace. Thin. London, UK:Penguin Global, 2008.

19. Hautzig, Deborah. Second Star to the Right. London, UK: Puffin Books, 1999.

20. Halse, Laurie. Wintergirls. New York, NY:Speak, 2010.