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Labels are necessary; practical aids in communicating, classifying and counting. They are as helpful (and as dangerous) as sharp knives in a kitchen and saws in the workshop.

In a clinical career focused on the care of patients with seizures, one of my frequent (and usually joyful) responsibilities was to tell people that their episodes of neurological dysfunction were not due to epilepsy. These encounters would on occasion prove difficult if the patient had carried the erroneous diagnosis of epilepsy for a number of years, on rare occasion for a great many years. Then a happy moment would instead be one spent trying to diminish the distress and anger felt by a patient newly aware that some ill-defined event in their earlier life was likely not a seizure and that for years they’d taken antiepileptic drugs needlessly, exercised care with driving, swimming, bathing etc. unnecessarily, and endured the psychological stigmata of both their own and others’ making of being “epileptic".

Through these experiences I acquired a distrust of diagnostic labels, a sense that they were too quickly sought by patients and applied by physicians, and a belief that their validity should be reassessed with regularity and discipline. What can be said by me about epilepsy applies to no end of other clinical conditions. Labels are necessary; practical aids in communicating, classifying and counting. They are as helpful (and as dangerous) as sharp knives in a kitchen and saws in the workshop.

I wonder why we are so skillful at ignoring product warning labels that don’t smell right or seem overblown, if not outright silly, yet will oversubscribe to a diagnostic label of a disease or psychological state. Last week, I spoke to a physician distressed that he’d been called “burnt out” by a physician supervisor. His distress was valid - he did not meet my criteria for burnout. I suspect that softer less pejorative language for his situation-specific career distress would have made it easier for him to accept the offer of assistance, and lessened the secondary discord between him and his boss.

A world free of labels is unrealistic. The onus is on he who labels to apply with caution, to accept that even with the greatest of care we’ll be wrong some percentage of the time, to display a willingness to reassess in the light of time or new information, and to have the humility to point out these caveats to he who is being labeled.