by Rebbetzin Chana Hughes
Chana Hughes works as a systemic and family therapist for the NHS as well as privately. She helps adults and young people with depression, anxiety and mental health related issues as well as with couple and relationship difficulties. She is the Rebbetzin of Radlett United Synagogue.
Several years ago, we had guests over for Yom Tov. After a luscious meal of steak and roasties I brought a tub of ice cream to the table to serve dessert. But before I could share out the frozen treat one of my guests stopped me in my tracks. The ice cream was dairy, and we had just eaten a meaty meal. I was shocked at so nearly contravening an important Jewish dietary law and of nearly poisoning my dairy intolerant stepfather in the process. The milky and non-dairy ice cream tubs were very similar in style with only a small label alerting the purchaser to the all-important difference in ingredients. Since then, the food production companies have adapted and now the entire packaging for milky and non-dairy ice creams look distinct. For those who are not familiar with our traditions, this seems incongruent. Milk is just one of the many ingredients in the ice cream. Often there is much more sugar and flavourings than milk. However, that key ingredient defines the status of the entire product and informs our decisions about when and whether we use it. And the all-important label alerts us to this status.
We’ve all heard it; we’ve all read it – Labels are for jars not people. Jami works hard to remove the stigma of mental ill health from our communities. It emphasises that judging a person purely by their diagnosis risks viewing them in only one particular, single way. This overlooks all the richness, personality and variety that exist in the entire person. At the same time, in my work as a therapist, I have noticed that people have different attitudes about how and why they use labels to describe themselves and their families. And these are not always as straightforward as we might think.
For many of my clients, when they receive a diagnosis or label, it comes with a wave of relief. Many families who are told that their child has ADHD feel that they can finally put a name to a set of behaviours that they previously found to be profoundly confusing.
I once met a patient, in his forties, who had been suffering with nightmares and flashbacks for many years. When he was told that he was experiencing PTSD (post-traumatic stress disorder) due to a significant trauma in his early life, he felt deeply validated and relieved. Finally, there was an explanation for his experiences that had been inexplicable and perplexing until that point. Similarly, many diagnoses and labels help families avoid blame for aspects of their behaviour. A mother who was told that their son had ASD (Autistic Spectrum Disorder – a condition which involves social communication difficulties) could stop feeling guilty that she could not convince him to attend playdates. A father whose son has ADHD did not feel as bad that he cannot sit still when they try to revise. So, labels are often helpful. They are shorthand to provide explanations of behaviour and experiences and they can easily inform others of the difficulties that somebody might be going through.
When I was working in East London I was involved in a large professionals meeting. Psychiatrists, social workers, therapists and support workers were all present as well as the service user who was a young, single mother. At the beginning of the meeting everybody wrote their names on a name card and included their role and qualifications so that we would all be able to identify each other. The service user waited as everyone proudly defined their jobs and then she wrote her own card and presented it to the table. This young mother had clearly written her name on her card, like everyone else. And then, mimicking all the professionals’ proud credentials she had written a series of letters that referred to the diagnoses that she had been given: “PTSD, ADHD, Anxiety, Depression”. There was an awkward silence in the room. And then, relieved at seeing the young woman’s wry smile, some of us laughed with her. Her message was insightful as well as poignant. We all naturally judge others by their titles and roles. This vulnerable mother was telling everyone that we will almost definitely judge her by the reports that describe her. She was telling us that just as we professionals realise that we are so much more than our job titles, we can realise that she is so much more than her difficult situation and mental ill health. She was both inviting inevitable labelling while at the same time, warning us to be informed by more than just that.
Like the dairy ice cream, sometimes we must base our decisions around a particular ingredient. Maybe, a person cannot attend a particular event because they have ASD. Perhaps someone else requires extra awareness and support because they have bipolar disorder. Often, a person needs to share their diagnosis in order to receive the necessary specialist support or medication. Sometimes, for the person to receive the help that they need, the entire packaging must be completely distinct and the label as clear as possible. I believe that we should not shy away from using labels to inform and to guide others to support us appropriately. Yet at the same time, I also believe, that labelling should have a warning label of its own – use labels to inform, not to conclude. Labels are helpful to tell us one piece of information about another human being. Yet these should be read only against a backdrop of the many beautiful and intricate stories that make up that person’s life.