Exploring on-campus use of mental health labels

Much has been said about mental health terminology and diagnostic labels having become "part of the cultural landscape", as Neil Armstrong and colleagues at King's College London and the University of Oxford put it.

Their new paper offers an exploration of how and why students use mental health labels in the context of universities. In it, the team shows that the use of mental health labels can be "flexible, fluid, and contextual", and serve a practical role as "campus technologies". Reports provided by students paint a picture of complex, slippery, and shifting use of diagnostic terminology — which often proves useful in ways that we might not automatically expect.

The team used an ethnographic approach for this research, meaning it sought to explore student experiences in their own context. The study was also co-produced — two of the authors, Laura Beswick and Marta Ortega Vega, are themselves students. The idea for the project came during a training workshop on ethnography, in which the students explored what to them felt like "obvious" truths about diagnostic labels that nevertheless were unexplored in the literature. The team interviewed other students on their own experiences before discussing their findings and writing together once a week. 

Labels were somewhat contentious for students; some found great utility in having a specific label for their condition, stating that it "helped [them] make sense of experiences, and validates distress". For these students, advice or comments about mental health from outside the medical profession were seen with a degree of scepticism.

Others shared their feelings that medicalised terms often seem to be the only thing that move universities to provide support to students — which was sometimes a source of frustration. One student noted that you "can't approach [staff] saying 'I'm having a really bad time I need support', the fact that you need to evidence it with mental health professionals makes it so hard to access it in a timely manner." 

The participants noted that requests for tools and procedures such as mitigating circumstances forms or deadline extensions are often "not accepted" without an official medical diagnosis, whilst more informal language ("stressed", for example) also carries less weight. As the team writes, "students... frequently told us that they feel that if they did not adopt labels their personal experiences of distress would be invalidated or somehow not count." This suggests that labels are imposed on students in order to access things they may need — once again highlighting the ambivalent relationship many have with these terms. 

The authors stressed, however, that gaining needed support from their institutions was not the only reason that students employ mental health labels in their daily lives. Often, they were used in more social contexts.

Throughout the analyses, humour also emerged as a main theme. Some felt it was okay — even cathartic and helpful — to make jokes about their own mental health ("I'm overdrawn, but if I tell the bank I was manic, they'll have to let me off"), while others felt this was trivialising and disrespectful. 

Using mental health labels could also, at times, "protect against, rather than cause, social ostracisation." Examples here included a group of friends being anxious about coursework — here, not being distressed can actually alienate students as they fail to meet perceived norms within the social group. The students described that labels can also provide a way of "being vulnerable without being vulnerable": by describing yourself as 'unwell', students were able to avoid more difficult conversations or conflicts, moving away from deeper discussions about how they really feel and towards a label that can help them connect with others, albeit superficially. 

Similarly, some argued that using labels could add to somebody's appeal in dating: they highlighted the so-called 'soft boy' or 'e boy' archetype, in which some men use poor mental health as a way to seem more distant and thus desirable. Similarly, some student reported that discussion of mental health labels can also make them feel closer to others romantically. Here, the team argues, "categories that in other contexts might be stigmatising, here bring competitive advantage."

The ethnography raises an interesting point: not only are students labelled by institutions including mental health services and universities, but many also regularly find everyday social and practical utility in labels. This exploration makes it clear that labels can produce a number of effects, ranging from harmful and stigmatising to positive and generative. And the student participants themselves shifted between these contradictions — sometimes multiple times within the same interview. 

While an ethnography with a small sample size cannot necessarily be generalised, the fact that this work was co-produced is a strength and adds to the richness of the findings described — future research into labels, no matter what form it takes methodologically, could benefit from such an approach. 

Read the paper in full.