#6 - Sleep, Drink & Eat: Time to Drop the Labels?

SLEEP

That’s Just Lazy Writing

In 2006, I was told off.

Told off by a reviewer for writing the word ‘insomniac’ throughout my manuscript I submitted to a scientific journal.

“The correct term is ‘person experiencing insomnia’, not ‘insomniac’”.

This was one of those teaching moments that I luckily grabbed. But why is this so important?

As I learned, if someone is labelled as an insomniac, then they are an insomniac. It defines who they are. Forms a part of their identity. Almost like it is with them for the rest of their lives.

But, someone experiencing insomnia means the person and the experience can be separate, and not indefinitely bound together.

And the science matches the latter. Some people can float in and out of experiencing insomnia. People can experience insomnia, and then without treatment, they do not experience it. And they don’t experience insomnia for many months, or even many years, or even many decades. Even if they have some periods of insomnia during these years and decades, the majority of the time they are not experiencing insomnia. So if they float in and out of experiencing insomnia, that does not justify the ‘insomniac’ label as it’s not a lifelong affliction.

On the flip side, if someone adopts the label that they are an insomniac, this can be interpreted as them having this thing for the rest of their lives and that it will not go away. This leads to hopelessness, and depression - two things that can perpetuate the insomnia experience.

So as I learned, using the term ‘insomniac’ is just lazy writing.

But this issue doesn’t just pertain to the ‘sleep world’

DRINK

Possibly the most pervasive label in mental health lives in the ‘drinking world’, where there’s also a debate about using the word ‘alcoholic’ for people who are experiencing an alcohol dependency.

For example, declaring that one is an ‘alcoholic’ forms part of Alcoholics Anonymous (AA), defined as both a program and a fellowship. To further quote (actually, screenshot) the text from Not-God:

Whilst there is a spiritual basis underlying AA, and a strong sense that AA has helped millions of people, the last Cochrane review in 2009 stated that “No experimental studies unequivocally demonstrated the effectiveness of AA”. So then how does it work? It is stated to be due to “peer support” and “role modelling” of successful recovery from alcohol dependency (Kelly et al., 2017). Yet, like virtually all treatment programs, AA is not 100% perfect, and not suited to all people. As such, there have been other non-medical services in our technological era, where online coaching coupled with online support groups has provided an alternative to AA.

Although there is overlap between AA and online coaching (ie, peer support, role modelling), there is a distinct difference - whilst the AA program encompasses an admission that a person is an ‘alcoholic’, other services have deemed that this label not be used to define their clients.

Here we could say “so what?” and “each to their own” - but there have been some from the AA fellowship who have made claims like (yep, another screenshot):

At WINK, we’re scientists. And we know that when rodents are placed on a spinning wheel for days, they are prevented from sleeping, and eventually one organ after another eventually fails and the rodent dies (thus, where the idea of not getting enough sleep can kill you comes from). Yet, when humans try to break the world record for staying awake the longest, they fail (then again, they live to see another day). Unlike the ‘drinking world’, the ‘sleep world’ has more of a consensus to separate the person from the experience.

So let’s see if the above quote is true, as it implies that (not) labelling is a matter of life or death.

At the beginning of a research project, there is the idea. So let’s take a look at the idea of NOT labelling oneself as an alcoholic leads to death.

This not only means looking at the evidence for A (not calling oneself an alcoholic) causes B (death), but also the alternative evidence of whether A (not calling oneself an alcoholic) causes C (living).

Now it’s extremely-hard to near-impossible to find evidence for A causing B. That’s because data of people refusing to call themselves an alcoholic is not listed as evidence on systematic databases (eg, death certificates). This leaves only anecdotal evidence, where people would claim that someone they know refused to call themselves an alcoholic and they died because of this (ie, an alcohol-related reason and not some other cause). We cannot find such evidence, so we encourage anyone reading this to let us know if they do.

On the flip side, there is potentially some evidence for A causing C - that not calling oneself an alcoholic leads to living. A Google Scholar search for meta-analyses (ie, a study that analyses data from many other studies) for alcohol treatment shows that professional services (ie, from medical doctors who use pharmacology, or psychologists that use psychological therapies) work. And these professionals use diagnostic classifications from the DSM (Diagnostic and Statistical Manual) or the ICD (International Classification of Disorders). In these diagnostic manuals, the correct term is ‘Alcohol Use Disorder’ (AUD) - (this term separates the disorder from the person).

Because there is scientific evidence for A (not labelling) causing C (living), this means that A (not labelling) causing B (death) is not 100% true. This is not to say that those in the AA fellowship should change their practices, but it does suggest that they ‘practice what they preach’ by refraining from outwardly attacking other services, and in the quote from Not God, “To be an alcoholic within Alcoholics Anonymous” (emphasis added).

EAT

Amongst the mental health disorders, eating disorders are one of the most deadly disorders, with high mortality rates.

For a long time, the terms ‘anorexic’ and ‘bulimic’ have been used as labels for people suffering from an eating disorder.

Whilst there is not an AA version for eating disorders, there is plenty of scientific evidence from health professionals (who use diagnoses that separate the person from the experience) that medical and psychological treatments work (and thus prevent an early-timed death). Thus, based on the arguments above in the ‘drinking world’, the ‘eating world’ also provides evidence of A causing C (ie, that not calling oneself an anorexic or bulimic leads to living).

Time to Drop the Labels?

In the ‘sleep and eating worlds’ we’re arriving at our destination - that is, not insisting on self-labelling. We see the value in separating the experience from the person. The ‘drinking world’ has a long way to come - but if professional services (who use diagnoses), AA (who promote self-labelling within their fellowship), and online services (who promote not self-labelling) focus their energies into their clients, then hopefully society will arrive at it’s destination where it will sleep more, eat healthier, and not drink poisons.