Psychiatric Labels in Mental Health: Useful Guideposts or Cultural Constructs?
Psychiatric labels can clarify distress or add stigma. Explore their value, limits, and how future models may reshape mental health classification.
Psychiatric labels have long been central to mental healthcare, offering clinicians a shared language to describe patterns of distress and, for many individuals, providing a sense of clarity or validation. However, these same labels have also been critiqued for their potential to oversimplify, pathologise, or stigmatise the wide spectrum of human experience. As research and practice evolve, so does the conversation: Are these diagnostic systems scientifically grounded and culturally relevant, or are they frameworks in need of reconsideration?
Did Psychiatric Labels Emerge from Early DSM Editions Influenced by Eugenic Thinking?
Some scholars trace the conceptual roots of psychiatric diagnosis to early editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders), where categories were sometimes influenced by cultural and political contexts rather than biological validity.
Critics like Thomas Szasz 1961 questioned whether mental illness is a “myth” shaped more by social norms than medical facts. Others, including Horwitz & Wakefield (2007), highlighted concerns over “diagnostic inflation” — the broadening of categories that could pathologise ordinary sadness or anxiety.
While mainstream psychiatry has since shifted away from overtly eugenic frameworks, these critiques underscore a historical concern: that diagnosis can reflect institutional priorities or ideological biases, not just clinical observation.
Historical analyses show that the earliest forms of psychiatric classification in the United States — the foundations on which DSM-I was later built — were shaped by the values of the eugenics movement and early hereditarian theories of mental illness. Before the DSM existed, institutional manuals used between 1918 and 1942 organised patients into categories that reflected these beliefs. Terms such as “constitutional psychopathic state,” “moral imbecility,” and “mental deficiency” were rooted in assumptions that distress or cognitive difference signalled biological decline or inherited defect (Grob, 1994; Trent, 2017).
During this period, psychiatrists frequently served on state eugenics committees, where diagnostic labels were used to justify coercive practices, including involuntary sterilisation and long-term institutional care (Lombardo, 2008; Reilly, 1991). Influential thinkers like Kraepelin — whose theories strongly shaped early DSM descriptions of schizophrenia and personality disorders — also promoted ideas linking mental illness to hereditary degeneration (Shorter, 1997).
Because these ideas dominated psychiatric practice at the time, the first two editions of the DSM (1952, 1968) inherited many of the underlying assumptions that came from this earlier era, even though explicit references to eugenics gradually faded (Kutchins & Kirk, 1997; Mayes & Horwitz, 2005). While later DSM revisions moved away from these frameworks, historical evidence makes clear that the manual’s earliest structure and language were influenced by the eugenic and hereditarian systems from which it emerged.
Are Psychiatric Labels Equivalent to a Valid Clinical Diagnosis, or Do They Function More as Heuristic Categories with Limited Neuroscientific Basis?
Although psychiatric labels are thought to be essential for communication and care coordination, many researchers suggest they function more as heuristic tools (easy rules) than precise indicators of disease. The DSM categorises symptoms into named disorders, but these groupings often lack consistent neurobiological correlates.
Insel and Cuthbert (2015) proposed the RDoC (Research Domain Criteria) framework to shift focus from symptom clusters to measurable dimensions of brain and behaviour. Kendler (2023) has also cautioned against equating transient emotional states with clinical disorders, especially without considering context.
These insights suggest that while psychiatric labels are helpful for communication and insurance coding, their scientific basis may be more limited than commonly assumed.
Can a Psychiatric Label Be Both Helpful and Stigmatising—and What Does Neuroscience Tell Us About This Duality?
Many individuals find comfort in receiving a diagnosis. A name for their experience can offer access to treatment, eligibility for services, and a sense of narrative coherence. At the same time, labels may also carry stigma, reinforce stereotypes, or limit self-perception.
Research in affective neuroscience suggests that brain regions involved in emotion regulation, such as the amygdala and prefrontal cortex, interact in complex and individualised ways Etkin, Büchel, & Gross (2015). As Frances warned, overdiagnosis can lead to medicalisation of non-clinical states, especially when thresholds for disorder are loosely defined.
For example, someone experiencing short-term nervousness before giving a presentation might meet criteria for social anxiety disorder if thresholds are applied loosely. While the discomfort is real, it may not indicate a persistent clinical state of anxiety. Labelling such experiences as pathological could risk confusing temporary emotional variation with clinical states, especially in the absence of reliable biological markers.
In What Ways Do Psychiatric Labels Shift Across Cultures and Care Systems, and How Do These Shifts Reveal the DSM’s Cultural Insensitivity?
Another layer of complexity lies in the cultural variability of mental disorder expressions. Kleinman (1988) argued that Western diagnostic models may not adequately capture the lived experience of distress in non-Western settings. Labels derived from DSM categories may not resonate — or may be interpreted differently — in other care systems.
Lewis-Fernández & Aggarwal advocated for the inclusion of cultural formulation tools in psychiatric assessments to reduce misdiagnosis and improve care equity. These shifts suggest that psychiatry, while rooted in clinical practice, must also adapt to social and cultural realities.
How Does a Neurocognitive Model of Distress Differ from the DSM’s Symptom-Based Taxonomy?
The DSM primarily categorises mental disorders based on clusters of observable symptoms. In contrast, neurocognitive models aim to understand how individual variations in brain function such as attention, memory, or reward sensitivity shape behaviour.
Cuthbert & Insel (2015) outlined a dimensional approach that focuses on circuits and processes rather than syndromes. Casey et al. proposed viewing psychological distress through a developmental lens, acknowledging that risk and resilience are dynamic over time.
This approach may avoid some pitfalls of categorical diagnosis while offering a more personalised view of distress.
Can Individuals Map Their Own Neurocognitive Profiles Without Relying on a Clinician’s DSM-Based Diagnosis?
As access to neurocognitive tools grows, some researchers are exploring whether individuals can begin to map their own cognitive and emotional patterns outside formal diagnosis. Tools such as self-administered cognitive tests, journaling apps, or functional neuroimaging (when used ethically) are being studied for reliability and accessibility.
Poldrack et al. (2017) and Washburn et al. (2020) note that while these tools hold promise, caution is necessary to avoid overinterpretation or misuse. Nonetheless, they may empower individuals to better understand and communicate their mental patterns, potentially complementing traditional models.
What Might Replace DSM – Style Labels—and How Could These Models Better Respect Individual and Cultural Variation?
Emerging frameworks challenge the DSM’s categorical approach. Borsboom & Cramer (2013) proposed network models, which conceptualise symptoms as interacting rather than arising from a single underlying cause. This shifts focus from “what disorder is this?” to “how do these experiences relate to one another?”.
Drysdale et al.(2017) have also explored using brain connectivity data to identify depression subtypes, potentially improving treatment precision. These models aim to reduce stigma, enhance individualisation, and better reflect the brain’s complexity.
Labels as Tools, Not Truths
Psychiatric labels remain a core part of psychiatry and psychology, offering frameworks for understanding, treating, and navigating mental illness. However, their limitations (scientific, cultural, and ethical) are increasingly recognised. Whether through neurocognitive models, cultural frameworks, or symptom networks, the future of mental health/disorder classification may rest in approaches that are less prescriptive, more flexible, and better attuned to human diversity.
Used with care, labels can sometimes support a client’s needs. Used without reflection, they risk long term harm, because the underlying message can suggest a person is inferior to others. As understanding deepens, the challenge is to transcend the DSM and ICD labels, by understanding what diagnoses are trying to describe and translating that into more empowering language.
At NeuroCog® Clinic, we use a blend of proven therapeutic methods, guided by the NeuroCog® System, to meet your needs, as every person’s journey is unique. We combine neuroscience, psychology, and life context to support you in creating lasting personal change.
Additionally, Neury® helps more people understand their thinking patterns without reducing them to a single diagnosis, but rather by tracking patterns of emotions and thoughts to gain valuable insight and make lasting, positive change.
Learn more about how we work with neurocognitive profiles, not diagnostic labels, to support real-world needs and improve self-understanding.
References:
Borsboom, D., & Cramer, A. O. (2013). Network analysis: an integrative approach to the structure of psychopathology.
Drysdale, A. T., et al. (2017). Resting-state connectivity biomarkers define neurophysiological subtypes of depression.
Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation.
Frances, A. (2013). Saving Normal (on the pros and cons of diagnostic thresholds).
Horwitz, A. V., & Wakefield, J. C. (2007). The Loss of Sadness (esp. Ch. 2 on diagnostic inflation).
Insel, T. R., & Cuthbert, B. (2015). RDoC: Toward a new classification framework for research on mental disorders.
Kendler, K. S. (2012). Distinguishing depressive syndromes from normal sadness.
Kleinman, A. (1988). Rethinking Psychiatry.
Lewis-Fernández, R., & Aggarwal, N. K. (2009). Cultural formulation in the DSM-5.
Poldrack, R. A., et al. (2017). Scanning the horizon: towards transparent and reproducible neuroimaging research.
Szasz, T. S. (1961). The Myth of Mental Illness.
Washburn, D., et al. (2020). Validity and reliability of a self-administered neurocognitive test battery.
Grob, G. (1994). The Mad Among Us: A History of the Care of America’s Mentally Ill. Free Press.
Kutchins, H., & Kirk, S. A. (1997). Making Us Crazy: DSM—The Psychiatric Bible and the Creation of Mental Disorders. Free Press.
Lombardo, P. (2008). Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck v. Bell. Johns Hopkins University Press.
Mayes, R., & Horwitz, A. (2005). DSM-III and the revolution in the classification of mental illness. Journal of the History of the Behavioral Sciences, 41(3), 249–267.
Reilly, P. (1991). The Surgical Solution: A History of Involuntary Sterilization in the United States. Johns Hopkins University Press.
Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley.
Trent, J. W. (2017). Inventing the Feeble Mind: A History of Mental Retardation in the United States. Oxford University Press.
