"On The Spectrum" The Evolving Terminology Around Mental Health

The names we give things have power. They can influence the way people think about concepts, impart subconscious context, and imbue a sense of belonging when done well. As therapists, we’re always learning and evolving how to best address our patients and the conditions that they deal with. Though the DSM-V provides a framework for different psychological states and their symptoms, we acknowledge that there is a wide variety of ways these states can manifest. No two patients are the same, and in acknowledging this we also must think critically about the way we talk about their mental health. In a recent conversation with a friend, we talked about what it means to be ‘on the spectrum’. This led to a conversation that made me think deeply about the terms we use to identify different conditions, and what the public might not know. At our practice, we try to lead with empathy and meet clients where they are. Still, we also believe it’s our responsibility to educate our clients by helping them understand themselves and erase stigma that surrounds mental health struggles. So today, we want to talk about what it means to be ‘on the spectrum’ and how that terminology has evolved over the years.

Let’s begin by defining some terminology. The term ‘spectrum’ has undergone many different contexts, though typically associated with autism in the modern day. A Swiss psychologist, Eugen Bleuler, coined the term ‘autism’ in 1911 but originally considered it a symptom of schizophrenia. From there, an Austrian-American psychologist, Leo Kanner, distinguished autism as its own entity in 1943. Despite this, there was still a missing link in understanding those with conditions that had overlapping symptoms or were missing what were considered defining traits of autism or schizophrenia. Bleur was able to coin the term ‘spectrum’ to describe patients who suffered from various degrees of what he believed to be schizophrenic trait, including autism. This narrow usage of ‘spectrum’ persisted and was linked to autism in the DSM-V as recently as 2000. As you might know, autism as a condition has a wide variety of potential manifestations, ranging from verbal and social differences, variable sensory needs, savant syndrome or special interests, and executive dysfunction. These traits will not all be present in all individuals, making it difficult to diagnose or define as a whole. Due to these variations, the name has been revised to ‘autism spectrum disorder’ or ASD. This has cemented the idea that being ‘on the spectrum’ is always linked to autism, however, modern psychologists are now using a spectrum as a way to better gauge their patients, regardless of what condition they have.

In short, ‘spectrum’ is a word used to indicate that an individual is somewhere within the defined parameters of a psychological condition. This can apply to many facets of mental health, such as depression, anxiety, sensory needs, autism, Aspergers, schizophrenia, and more but this is not the only way to describe this concept. Judy Singer, an autistic psychologist, coined the term “neurodiverse” which enveloped all people with variations in how their brains work or how they perceive the world. Neurodiverse became the popular term as it helped destigmatize a generally negative association with various mental health conditions and learning deficits. It was meant to be a direct combatant to negative terminology such as ‘neuro-deficit’ or ‘developmentally delayed’. That being said, as we are learning more about the mind, it’s become increasingly important to not conform to rigid standards or force people into boxes. It’s been commonly understood that many traits exist on a spectrum and that human nature is not as finite as some might like to imagine.

Take sexuality for example, many people may exist in a space where they are gay, or straight, however many people are somewhere in between, meaning they might be between two extremes, or prefer one but choose the other occasionally due to various conditions. The same has been used to describe gender expression with the gender binary (boy and girl) serving as two extremes on a continuum of gender expression. Even personality traits like introversion and extroversion can be looked at in this way- true introverts and extroverts do exist but most people find a middle ground or exist somewhere between the extremes.Tying this back into mental health, we know that some who struggle with depression need medical intervention and counseling to function, but others may just have periods of low mood. Both of these qualify as depression, but both are at different points on the spectrum and thus need different care. A patient doesn’t have to display extreme symptoms to be considered for a mental health struggle; everyone will bear these experiences differently, so we should treat the diagnosis and treatment for these individuals as such.

You may be thinking that speaking about things generally is counterintuitive as it’s human nature to sort or compartmentalize. We want to put a name to a thing and try to understand it. This is an integral facet of human nature, and a way we define our identity, process our emotions, and seek solutions. However, this solution prevents going to extremes, or slapping a name on several symptoms and calling it a day as it can also be damaging if not done right. Just as everyone has different personalities, and manifestations of their mental health everyone will need different care. This calls for a more delicate balance in the way we talk about and categorize mental health conditions that we as healthcare professionals strive for with each discovery. Most importantly, as we work with mental health patients every day, we listen to their experiences, learn their preferences, and become more attuned to what does and doesn’t work. There are amazing psychology professionals in the field who are neurodivergent and on the spectrum who continue to revolutionize the field and make it a better place for everyone to receive care. It is a goal of ours, and many others like us, to work with patients and find language that destigmatizes mental health struggles, and that honors the identity of the community. We hope that we can raise awareness for those who may have family members or friends on the spectrum, or who are part of the neurodivergent community that there is power in names. Through compassion and education, you too can play a part in a better tomorrow where no one has to fit into a box that has grown too small for them.