This article was originally published on January 12, 2021 on Mad in the UK.
Readers of this site tend to know a great deal about the harm done by psychiatric diagnostic labels. As I have said elsewhere, psychiatric diagnosis is the first cause of everything bad that happens in the mental health system. After all, if they don’t diagnose you, they are not supposed to do anything to “treat” you, but once they give you any psychiatric label, they can do almost anything to you in the name of treatment, and since psychiatric diagnosis is totally unregulated, there is little or no recourse if you are harmed. Because I have written and spoken at length about these matters,1 I will not elaborate on them further here. Instead, I will address some other harmful words that are liberally used these days and that ought to cause us alarm.
The words on which I focus in this essay are “depression,” “anxiety,” “guilt,” “bullying,” and “microaggression.” It is alarming that even people who scrupulously avoid using psychiatric labels readily use the above, apparently without concern for the ways they (1) make it harder to identify what is really happening to someone who is suffering and (2) pathologize sufferers even though the terms do not come from the Diagnostic and Statistical Manual of Mental Disorders or the psychiatric portion of the International Classification of Diseases. Often, the sufferers themselves apply these words to themselves, perhaps unaware that this can cause them trouble and get in the way of their feeling better.
The words “depression,” “anxiety,” and “guilt” have in common that they are used to describe a person’s feelings, and it is hard to read an article or hear a media commentator talk about the pandemic without saying that the rates of these have dramatically increased (Caplan, 2020a). “Bullying” and “microaggression” are different, because they describe behavior by others that is harmful/abusive/traumatizing to the targets of that behavior.
“Depression,” “Anxiety,” and “Guilt”
I am an actor and director, and a few years ago, I was asked by the world’s best acting coach, the (now late) Eden Harman Bernardy, to speak to her students, who were increasingly being asked to audition to play characters who were described in psychiatric terms: “Chris is Bipolar” or “Marilyn is Borderline.” I explained that these categories are not scientifically derived, and that for a great many reasons, two people given the same psychiatric label usually differ from each other in a wide variety of ways, so it is not helpful to try to “play Bipolar” or “play Borderline.”
I also addressed with the students what are perhaps the three most commonly used, ordinary words for emotions: “depression,” “anxiety,” and “guilt.” Each is misleading in ways that make it hard to know what a person who ascribes it to themselves is really feeling.
David Cohen and David Jacobs in a classic article (2007) have shown that “depression” is essentially a wastebasket term, used so variously that if no attempt is made to understand more about what a “depressed” person is feeling, it makes hard for them and for the person who wants to help. People who say they are “depressed” may be feeling loneliness, sadness, grief, hopelessness, helplessness, despair, shame, nostalgia, meaninglessness, aimlessness, lack of physical energy, or brain fog. If the sufferer and the prospective helper leave it at “depression,” they will find it difficult to figure out what might be useful in alleviating the feeling. Furthermore, leaving it at “depression” is these days extremely likely to lead to the proposed “solution” being drugs marketed as “anti-depressants”; that is, if “depression” is assumed to be a clearcut, identifiable entity, then it can seem to make sense that an “anti-depressant” will fix “it.” Of course following the lead of Cohen and Jacobs, if “depression” itself is so vague, then if the people studied in research about treatments including psychiatric drugs are “depressed” people, the treatment is being tested on people whose suffering is troublingly heterogeneous. If a drug is given to people who have a certain bacterial infection, it makes sense that the drug is an antibiotic known to kill that bacterium. But giving an “antidepressant” drug to some people who are lonely, some people who have lost their religious faith and are struggling for that reason, some people who are bereaved, some people who are feeling ashamed, some who are being harassed at work but unable to leave their job because they support their children, etc., what do we think we have found when we look at the results of the drug? Indeed, how do we even begin to think about the results? If instead of calling their drugs “anti-depressants,” if drug company executives were required to be truthful, they would have to name them “drugs we’d like anyone not feeling happy and fulfilled to take, in the hope that they will be helped.”
So when someone says they are “depressed,” I ask them the following: “If you were not going to use that word to describe how you are feeling, what word or words would you use?” This helps that person and me to understand more about what is going on, and whether in a professional situation or speaking with a friend or family member or colleague, the road to feeling better will become clearer if the feeling or feelings are described as accurately as possible. It is unfortunate that people have been led to believe that reporting they are depressed is informative beyond conveying only “I don’t feel happy.”
When someone says they are “anxious,” I ask them the same question I ask someone who says they are “depressed.” The reason is that having identified oneself as feeling “anxiety,” one has little idea how to get to feeling better. In an acting class, a young woman performed a monologue, and afterward, Eden Harman Bernardy asked how she felt about how she had done. The woman replied, “I didn’t feel good about it. You see, I have been anxious all week about doing this monologue.” When I asked her what word she would use to describe how she had felt during the week if she were not going to use “anxious,” she immediately replied, “afraid.” She was afraid she would not do well, afraid of looking foolish, afraid it would prove she could not act. I find that nearly always when I ask a person to use a word other than “anxiety,” the word they use is “fear.” In contrast to the nebulous images “anxiety” evokes, “fear” points the way to reducing suffering: Fear is always of something. Once we consider what we fear, we can ask crucial questions such as, “If the thing I fear really happens, will that be a total disaster?” and “Are there steps I can take to reduce the chances that the thing I fear will happen?” and “How do I want to handle it if the thing I fear does in fact happen?” When we are already afraid, we paralyze ourselves emotionally if we also feel powerless, and the vagueness of “anxiety” increases not only the sense of powerlessness but our actual lack of power, because we don’t know how to think clearly about moving forward.
A parallel with the use of “depression” is that someone who reports to a professional that they feel “anxious” is very likely to light up the “anti-anxiety drug” spot in the professional’s brain, so that instead of guiding the person to identify the underlying fear and ways to minimize the feared consequences or plan to cope with them, both sufferer and therapist will match the vague “anxiety” with “anxiolytic drug.” Although for some people at least for awhile, drugs in that class may help suppress the physical effects of fear, they do not help the person understand the fear and learn to cope with it.
When Dr. Nikki Gerrard wrote a paper years ago as a graduate student and called it “‘Guilt’ Is a Terminal Word,” I was intrigued by the title. Her point was that to say, “I feel guilty” gives one nowhere to go to move beyond that feeling. Saying, “I feel guilty, because I rarely go visit my mother” does not change the situation. So in trying to help someone overcome what they are calling “guilt,” that word is terminal in that it stops the person in their tracks. “Guilt” sounds like something individual and intrapsychic, but when Gerrard talked with people about what they began by calling “guilt,” she found that the key factor was what she called a problem-in-relation, something about a difficulty in a connection that mattered to them, such as worry about loss of love. I thought that was a terrific insight, so I began asking people who said they felt “guilty” what word they would use to describe their feeling if they were not to use that word. Almost always, the response has been “shame.” Now, that is not a terminal word! “Shame” is the emotion we have when we feel we have been seen by someone — usually someone we care about — to fail to live up to a particular standard. Therefore, the routes to pursue are to ask “What is the standard you feel you are failing to meet?” “When you think about it, does that seem like a reasonable standard, one that you definitely want to meet?” “How did you come to accept that standard?” “Do you know who set the standard for you?” “In whose eyes do you feel you are failing to meet the standard?” “Do you agree that you are failing to meet it?” “How much do you care about that person believing you are failing to meet the standard?”
Another important aspect about the word “guilt” is that it is easier to pathologize (“This person is just inexplicably consumed with guilt”), because it seems less understandable than worry about losing a loved or admired one’s respect or care.
“Bullying” and “Microaggression”
These two words are causes for worry, because both of them minimize the damage done to the targets of such behavior, and that minimizing makes it easier to classify the target’s upset as overreaction.
I’ve never understood why the term “bullying” suddenly became popular, but each time I hear a description of behavior to which that term is applied, I am struck by the fact that the behavior is actually abuse. “Bullying” tends to evoke images of a young kid on a playground being mean to another child, and some schools have entire “anti-bullying” programs. But what possible useful distinction can be made between “bullying” and abuse? Aren’t cruelty and throwing one’s literal or figurative weight around in order to intimidate another person abusive? Surely nothing is to be gained by reducing such conduct to “bullying.” In fact, it is damaging that the perpetrator’s responsibility for causing harm is minimized.
The history of this term is important to understand. In 1970, when condemnation of overt race-based violence had increased in some quarters, leading some people to claim that racism was behind us, Dr. Chester Pierce (1970) coined the term “microaggression,” because he recognized the importance of drawing attention to less blatant manifestations of racism. The “micro” part of the term was intended to reflect the fact that bias and oppression can take forms other than physical attacks, name-calling, and explicit rejection or humiliation. “Microaggressions” are described as brief and/or subtle manifestations of prejudice and hatred that are “great in the power or magnitude of their consequences” (Caplan & Ford, 2014). I coordinated the Voices of Diversity Project (Caplan & Ford, 2014), in which we documented the factors on predominantly white university campuses in the United States that are manifestations of racism and sexism and that impede their targets’ attempts to acquire an education. Because some overt manifestations of racism and sexism (though not sex-based assault) had declined due to laws and regulations against hate speech and to civil rights laws, most of what we heard in our one-on-one interviews with students we called “microaggression.” In an irony that I did not recognize at the time we wrote the report of our research, we went to great lengths to report the students’ detailed, vivid, heartbreaking descriptions of the devastating effects those manifestations had on them. Only in 2020, when I read Ibram X. Kendi’s brilliant, important book, How To Be An Anti-racist (Kendi, 2019), where he criticizes the word “microaggression” as minimizing the effects that these “micro” events have did I realize how the term can make the targeted people feel that they are overreacting to “something so small.” As I recently wrote elsewhere (Caplan, 2020b), “I wish I had thought to point out in [the] article [reporting our findings] that the term ‘microaggression’ could mistakenly imply that the effects of such acts are minor. In fact, the very nature of these acts often makes it easier for the perpetrators to claim that their targets are overly sensitive or paranoid, which can cause huge torment.” I gave this example (one among a huge number) of a student’s description of something that happened to him:
An African American man said: “I have to stop and think sometimes, ‘Are they being racist? Or, is that just how they act? Or, are they just not being friendly because they’re having a bad day?’ So I try not to let it get into my head and make me angry and things like that. I just try to think it through, like maybe there are other reasons why they’re not friendly. So I try not to think about all the negative and try to think about the positive. I do speak and try to get them to speak, but if they don’t want to, I just try to go on with my day. It makes me feel like I am not wanted.” (Caplan, 2020b, p.5)
Imagine if that student had been told that what had happened to him was called “microaggression.” What he needed was someone to tell him that whoever told a racist “joke” or rolled their eyes when he spoke in class or turned away from him when the professor said to form work groups was being cruel and oppressive.
I hope that readers will consider how the five words noted here cause unnecessary human suffering and in various ways impede attempts to reduce suffering.
Caplan, P.J. (2020a). Is covid-19 making everybody crazy? https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/
Caplan, P.J. (2020b). Editorial/éditorial: “Microaggression” is not micro. APORIA: La revue en sciences infirmieres/The Nursing Journal 12(1), 4-5. https://uottawa.scholarsportal.info/ottawa/index.php/aporia/issue/view/524/309
Caplan, P.J., and Ford, J.C. (2014). The voices of diversity: What students of diverse races/ethnicities and both sexes tell us about their college experiences and their perceptions about their institutions’ progress toward diversity. APORIA: The Nursing Journal 6(3), 30-69.
Cohen, D., & Jacobs, D.H. (2007). Randomized controlled trials of antidepressants: Clinically and scientifically irrelevant. Debates in Neuroscience 1, 44–54.
Kendi, Ibram X. (2019). How to be an Anti-racist. New York: One World.
Pierce, C. (1970). Offensive mechanisms. In F. Barbour (Ed.), The Black Seventies. Boston: Porter Sargent, pp. 265-282.