Dynamic nominalism: Label With Care
There is an interesting article in the May 13, 2024, issue of The New Yorker entitled “Read The Label: How Psychiatric Diagnoses Create Identities” by Manvir Singh in which Singh describes how psychiatric diagnoses influence the development of the phenomena they name.
Singh writes “As the philosopher Ian Hacking observed, labelling people is very different from labelling quarks or microbes. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how ‘individuals experience themselves - and may even lead people to evolve their feelings and behavior in part because they are so classified.’”
Singh writes further, “Hacking referred to this process, in which naming creates the thing named - and in which the meaning of names can be affected, in turn, by the name bearers - as ‘dynamic nominalism.’”
A client asked me last week, “My husband said that his therapist told him he was borderline. What does that mean?”
What does the name a client is labeled mean for them and for their relationships? A new identity for the individual and the people they are in relationship with is being constructed. Is this labeling helpful or harmful or both?
Three new books—Paige Layle’s “But Everyone Feels This Way: How an Autism Diagnosis Saved My Life,” Patric Gagne’s “Sociopath: A Memoir,” and Alexander Kriss’s “Borderline: The Biography of a Personality Disorder”—illustrate how psychiatric classification shapes the people it describes. It models social identities. It offers scripts for how to behave and explanations for one’s interior life. By promising to tell people who they really are, diagnosis produces personal stakes in the diagnostic system, fortifying it against upheaval.
From “Why We’re Turning Psychiatric Labels Into Identities” by Manvir Singh in The New Yorker, May 13, 2024
The concept of dynamic nominalism means that people tend to turn their labels of identity into a lived experience. One of the tools that fuels the development of dynamic nominalism is the depiction of psychiatric labels in artistic works such as novels, films, song lyrics, memoirs, autobiographies, etc.
Sometimes the depictions of psychiatric labels are helpful to people and other times they may be harmful. The depiction itself is neither good or bad but rather how the consumer of the depiction uses the depiction.
Do you ever talk about depictions of psychiatric labels with friends, family, or professionals, and if so, what has been your experience doing this?
Just as personality tests (see, I’m an introvert!), astrological signs (I’m a Libra!), and generational monikers (I’m Gen Z!) are used to aid self-understanding, so are psychiatric diagnoses. When Paige Layle was fifteen, a psychiatrist told her that she had autism spectrum disorder. She describes the rush of clarity she experienced when hearing the DSM-5 criteria: “I’m not crazy. I’m not making it up. I’m not manipulative or trying to fake anything. . . . There’s a reason why I’m the way that I am.”
From “Why We’re Turning Psychiatric Labels Into Identities” by Manvir Singh in The New Yorker, May 13, 2024
The key words “dynamic nominalism” indicate how a person tends to create the characteristics that the label assigned to them describes which then contributes to the person’s self understanding and their identity. The assignment of the label is an act of power on the part of the expert who is performing the assignment function. This power is given to licensed mental health professionals who have the social sanction to diagnose. With this power we create schizophrenics, depressives, borderlines, autistics, psychopaths, and any number of other identities. To what extent is assigning a psychiatric diagnosis like an astrologer assigning a person to an astrological sign, or the person who administers some sort of psychological screen or test and assigns a personality type to the person such as introvert or extrovert?
Mental health professionals may be reluctant to assign a psychiatric label to a patient being aware of the iatrogenic consequences of such an act, and yet in order to get paid for the service they are providing, they must assign a diagnosis required by the insurance company for payment. This label then becomes a permanent part of the person’s medical record which will influence the perception of the person by other people with access to that person’s medical record for the rest of their life.
I am an introvert and a Capricorn. I also am a dysthymic. I also laugh, guffaw actually, because in my heart of hearts I know that I am none of these things. They are just labels and the meanings they may carry for a perceiver have consequences only in certain contexts and are temporary.
What psychotherapy is about is the ability of people to explore and disclose what they really think, how they really feel, and what they really want without the fear of being assigned a label that will limit their ability to be understood and appreciated at a deep and cosmic level by another human being who will stand in solidarity with them.
So, labeling people is a powerful act with wide and long ranging consequences and should be done with a degree of caution, trepidation, and self awareness. It is not simply a bureaucratic act done for money without a price to be paid by the person so labeled.
Perhaps the motto for mental health professionals should be, “Label with care.”