The Tyranny of Labels
Or: Ode to the Nameless Bird
By David E. McCarty, MD, FAASM (But you can call me Dave)
15 August 2025
"The moment you tell a child the name of a bird, the child will never see that bird again."
—attributed to Jiddu Krishnamurti by Eckhart Tolle
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“JUST BIRDS”
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Picture this: you’ve been waiting for weeks to see me.
When you walk into the exam room, you’ve got that mix of hope and exhaustion I’ve learned to recognize—the way a person looks when they’ve been fighting a shadow in the dark, and they think deliverance is near.
We sit down.
You hand me a folder with your sleep study. I scroll through it while you tell me your story: bone-deep fatigue, falling asleep in meetings, that sick dread every afternoon when you know your brain’s about to leave you stranded.
The study says your 4% (CMS) Apnea-Hypopnea Index (AHI) is 4.2. Dr. Obvious, the physician who wrote the report, pronounced his verdict without hesitation: “This study is negative for the diagnosis of Obstructive Sleep Apnea, with a normal CMS AHI of 4.2/hr.”
BOOM! Mic drop moment! You are not sick!
On the one hand: HUZZAH! The doctor says the test is negative! Everyone should celebrate, as if the test for cancer came back clean!
YAY! YOU DON’T HAVE A DISEASE!
But…that’s not how it feels to you, sitting here in front of me, eyes bleary, nights shattered, dreams a forgotten long-ago memory. You were hoping for some explanation, some assistance, some direction forward in your yearning to sleep well, and feel good.
The negative study feels like a dismissal.
You’ve come to me to ask what you should do.
I set the folder down. You’re looking at me like someone waiting for a judge to read a verdict.
I think about Krishnamurti’s famous teaching. I think about what happens when the complexity of human experience gets reduced to a label.
I take a breath.
I’ve got some med-splaining to do.
See, if I were practicing medicine by label alone, I’d repeat what Dr. Obvious said in the report—"Good news! You’re normal!” I’d exclaim, while reaching for my referral rolodex for licensed psychiatrists, someone…anyone I could logically scoot you off to. I’d congratulate you on your “normal” AHI and send you away, relieved that some other specialist would be your baby-sitter for the rest of the journey.
Whew! What a relief! (for me, anyway!)
Krishnamurti would say that in that moment, the living bird was stripped away, replaced with a plastic figurine stamped Normal Sleep Study.
I’m pretty sure that’s what Krishnamurti was talking about, anyway, when he warned that the moment we name the bird, we stop seeing it. The name becomes a cage. We mistake the label for the thing itself. In my world, the label is a billing code.
The trick is this: sometimes it’s a passport to care, and sometimes it’s a wall you can’t climb.
Depending on who you are, it’s a different problem.
That’s where the fun begins.
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The Search-Satisficing Trap
It’s a funny thing to think about, but mistakes in medical decision-making HAPPEN.
Not funny: HA HA!, but funny…ODD.
There are lots of ways mistakes happen in medical diagnostics! One of the most common mistakes we see in our label-based world is one called a search satisficing error—stopping the investigation as soon as the first “satisfactory” answer appears that seems “sufficient” to solve the dilemma. Feel crummy during the day? Hmm. Do you snore? Yes? AHA! I know what that is!
BOOM! You’ve just been labeled!
Never mind the fact that your symptoms are coming from a hundred and one non-apnea and non-airway sources!
Your label is now your destiny.
The efficiency machine hands you a treatment.
Not surprisingly, it does not improve your symptoms. Thus, begins hundreds of thousands of haggard journeys from treatment to treatment, all focused on the label, all destined to fail.
(The bird is nowhere around.)
Or: alternatively—you’re sleepy, you snore, you feel lousy, but your study is “negative” for Sleep Apnea (because the score didn’t cross a certain payor’s threshold)--as in the vignette above! See, when we present insurance coverage criteria as diagnostic ground truth, we may be following the “rules,” and we may be making our process economically smoother, but we lose sight of the foundation.
The narrative (bird) is replaced with a diagnosis (label).
This, it would seem, is where all the trouble begins. As Krishnamurti reminds us, when we label something, we fail to see it anymore…we are separated from the thing such that we can’t experience it, as a thing-in-itself.
We become blinded, at least partially.
But are labels, as presented here, necessarily “bad”? Does the shorthand make us “un-enlightened”…less-than…diminished?
Only without circumspection, Life-Fans!
The late cultural anthropologist Mary Douglas would tell us that label-making comes from the deep, human drive towards environmental classification: societies create systems of “purity” and “danger” by drawing boundaries around what is in and what is out.
Labels give the illusion of control. They are a way of managing uncertainty, which is to say a way of navigating fear.
Labels let us manage the risk of life by keeping categories neat. In clinical medicine, the art of “labeling” also conveniently allows medical professionals to share a common language. This practice ostensibly allows us to all talk about the same thing.
The problem is: they also tempt us into forgetting that the world is always messier than our maps, and that our view of complexity is necessarily limited by our vantage point and our experience.
The problems begin when the label takes on a life of its own…when the label replaces the thing in itself. When we’ve named the bird.
So: if labels make us blind, but labels are functionally necessary…where does this leave us? What happens when you notice this strange friction, and say Whaaaaaa?
This is where we pause a moment, and think about what happens when we fight back…when the “labels” motivate us enough to try to change the system…
Cue “street-wise” funky music as we travel back in time…to my angrier punk-rock days…
BOM CHICKA POW WOW…..
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Rock Throwing and the Silence It Creates
Let’s start here:
Rule-followers who systematically blow off their patients in the name of insurance coverage criteria really used to get my goat!!
I mean: full-on red-faced rants! Angry eyes! Disparaging under-my-breath comments! Heaving sighs about the Incompetence of Others!
Intellectual rock throwing, come on!!!! Let the games begin!! Rock throwing used to be one of my favorite all-time indoor sports!
It’s true, I shamefully admit, I spent years of my career “throwing rocks” (intellectually-speaking) at the profiteers and algorithm-followers in my midst—those who used the labels to move people through the system quickly, without the dignity of real listening…
…I would weep with maudlin ardor about all the poor souls that this type of strategy left behind…
…I’ll admit: it was…um…satisfying for a while, this indignance, this being “right” all the time! There’s a sense of accomplishment there, fighting The Man, and being the One in The Trenches!...
…but the glory comes at a cost.
See, rock throwing has a side effect…it makes the silos you’re bombarding pathologically deaf to everything you say. It was humbling and humiliating. My own rock-throwing made me an utterly feckless teacher.
It’s a funny paradox, from a cosmic perspective. The louder (and more irate) one gets about one’s passions, the more other folks throw shade and walk away, twirling their index fingers around their temples and rolling their collective eyes. It’s a Chinese finger-trap. The more you protest, the worse it gets!
Welcome to the AM radio talk circuit: You’re now NOISE nobody can hear unless they already agree with you…
Naturally, when people can’t hear each other, no truth gets through.
The silos become permanent.
Mary Douglas would call this a problem of pollution: once a person or group is labeled as other, their whole perspective becomes contaminated in our minds. We stop listening. We turn them OFF. No matter what they say, we’ve decided it’s not worth hearing.
Krishnamurti, in contrast, invites us to stand in that space before the label—before the separation—and really look.
But how does one do that?
Krishnamurti invites us to be completely unstructured and approach the world with no labels at all, a strategy that would arguably make collaborative medical care impossible, devolving structure into chaos.
What solution, then, to this paradox?
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Enter Dave Snowden
Complexity-sensemaking scientist Dave Snowden takes it one step further, positing you can impose a structured approach upon the complexity.
According to Snowden, interacting with a complex system requires a sort of scaffolding, allowing exploration, without collapsing into chaos.
That’s where narrative comes in.
Narrative. Storytelling. Capturing the complexity *enough* to build structure to act, without pretending we’ve captured the whole truth.
Allowing for the unfolding.
It’s structure that allows curiosity and co-discovery of an emerging non-linear trajectory toward deeper understanding of the whole, which in my world means health and healing.
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ENSTRUCTURING the Mystery
This is where I live. This is the twilight zone I work in: between the need for structure and the need to preserve mystery and curiosity.
If we abandon labels entirely, we lose the ability to coordinate care, to bill for services, to gather data. But if we cling to them as the whole truth, we kill the living bird.
The Five Finger Approach and the Five Reasons to Treat were my attempts to “ENSTRUCTURE” curiosity—to give provider and patient a shared map that doesn’t end the search, but extends it, providing a scaffolding for it to occur.
Instead of collapsing the patient’s experience into one code, it keeps a wider landscape of sleep medicine in view, to allow sense-making in five different domains: circadian misalignment, pharmacologic, medical, psychiatric/psychosocial, and primary sleep diagnoses.
It’s a tool for co-seeing, meant to be shared with the patient, allowing for co-discovery.
When we work this way, the patient’s NARRATIVE stays in foveal focus.
We don’t stop at AHI < 5 = Normal.
We keep looking at the living bird: the patient’s lived experience, their physiology, the moving parts that don’t fit neatly into the box.
So we come back home: NARRATIVE.
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From Silo to Collaboration
Real collaboration means putting away the rocks and giving the throwing arm a rest.
It means acknowledging that even the profiteers have something to teach us—efficiency, scale, reach—while insisting they listen to what healers know about dignity, agency, and harm. Kinda like crows teaching crows: peers sharing tools freely, so the knowledge spreads laterally instead of being guarded at the top.
In the clinic, that looks like a patient walking out the door not with a label, but with a framework for discovery. They know their own Five Reasons to Treat, they’ve visited The Five Finger Approach mountain. They understand their specific moving parts active in their problem, and they’ve got language to advocate for themselves in any silo they enter.
That’s empowerment. That’s personal agency.
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Krishnamurti would say that in that moment, by engaging the patient’s narrative, we’ve avoided the tyranny of the label. We’ve kept the bird alive in their hand. And Mary Douglas might smile, because we’ve respected the need for boundaries without letting those boundaries calcify into blindness.
The challenge—and the joy—is to keep walking—arm in arm—in that twilight zone, where structure serves curiosity, and the shared journey keeps us human.
How do I know this?
Well (tee-hee!!)…let’s just say a little bird told me!
Kind mojo,
Dave
David E. McCarty MD FAASM
Boulder Colorado 15 August 2025
Further Exploration
Eckhart Tolle. Breaking the Habit of Negative Thinking and Self-Talk. Unabridged audio edition. Boulder, CO: Sounds True, 2022. ISBN 978-1988649191
Mary Douglas, Purity and Danger: An Analysis of the Concepts of Pollution and Taboo (London: Routledge, 1966)
David J Snowden. “Sense Making in a Complex and Complicated World.” Emergence: Complexity & Organization 6, no. 1–2 (2004): 46–54.
David E. McCarty, “Beyond Ockham’s Razor: Redefining Problem-Solving in Clinical Sleep Medicine Using a Five-Finger Approach,” Journal of Clinical Sleep Medicine 6, no. 3 (2010): 292–96.
David E. McCarty and Ellen Stothard, Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them (BookBaby Press, New Jersey, 2022).