Wicked Labels, and the Power of Narrative in Mental Health Nursing

As the musical and film, Wicked (based upon the novel by Maguire 1995), takes us firmly by the hand, and once more leads us down the yellow brick road, its cultural resonance has become irrefutable. The film in particular has drawn online vitriol from alt-right media, prompting accusations that it is ‘woke’ (Maltby 2024) and that it promotes an ‘LGBTQ agenda’ (Williams 2024). Undoubtedly, at the heart of the cacophony surrounding Wicked are the film's central themes of identity and marginalisation, particularly at those intersections of race, gender and sexual orientation; the politics of which no doubt contribute to experiences of exclusion. Amongst the many positive film reviews, Johnson (2025, np) remarks upon how Wicked speaks ‘directly to viewers’ personal experiences of exclusion, self-affirmation, and activism’ in response to authoritarianism. Indeed, our own observations here are that the film Wicked, especially when juxtaposed with the Wizard of Oz, also offers a powerful allegory for the ‘othering’ of those experiencing mental ill-health and distress. It is impossible, for instance, to overlook the film's overt examination of belonging and the construction of difference against an oppressive backdrop of patriarchal and paternalistic power structures; themes that are also of direct relevance to contemporary mental health services and nursing care. Our paper draws upon social constructionism and Wicked as an allegory to consider how diagnostic labels are less objective, pre-existing entities, as they are narratives arising from social, political and cultural processes. When considered within the context of mental ill-health and distress, we argue here that the social construction of ‘wickedness’ in Wicked mirrors dominant psychiatric discourse, processes of psychiatrisation and their harmful effects. Further, despite the two films' contrasting responses to systemic oppression1 we suggest that when viewed together, they reinforce both the importance of seeing beyond damaging and pejorative diagnostic labels and the restorative role of narrative within this context. For the sake of clarity, while our title uses the term ‘wicked’ in a direct reference to the musical and film, we also acknowledge that the intractable themes of labelling, marginalisation and othering explored in our paper are also illustrative of those ‘wicked problems’ posed by Rittel and Webber (1973). It is not our intention, however, to directly engage with this theoretical framework here. Instead, our paper will consider related notions of abjection, biopower and testimonial injustice in respect of narrative and damaging psychiatric discourse. Our own position here is not one of antipsychiatry, per se. Rather, it is in pulling back the curtain and explicating these crucial themes where we hope to both make sense of them and consider their pertinence to contemporary mental health nursing practice. We begin this paper with the claim that the Wicked Witch of the West represents a physical embodiment of the marginalised ‘other’. While in the original Wizard of Oz film, the Wicked Witch is a feared and maligned figure, labelled as dangerous and unpredictable, the film, Wicked, subverts this portrayal, viewing the witch in a more sympathetic light. In a similar vein to other villain-revisionist backstories, she is instead portrayed as a product of an intolerant society that has misunderstood and ostracised her rather than a symbol of inherent evil. Indeed, through Wicked, we are introduced to a more humane representation of the witch. She is granted a name, ‘Elphaba’, which immediately humanises her, and through the film, we become witnesses to her vulnerabilities and experiences of trauma. Born of an extramarital affair, shunned by family members and peers alike due to her unusual skin colour, while also being blamed for the death of her mother and disability of her sister, Wicked's Elphaba is positioned as a tragic victim of circumstance who was ostracised from an early age. Yet, despite her own marginalisation, she is initially sympathetic towards those groups who are similarly oppressed and excluded at the hands of the great and powerful Oz, even travelling to the Emerald City to advocate for their liberation. Meanwhile, in both films, the Wizard masquerades as a benevolent ruler, all while manipulating others using spectacle and propaganda to maintain his power. The Wizard's actions here are those of the ‘moral entrepreneur’ (Becker 1963), who, driven by personal and political interests, identifies certain groups as deviant. Seeing through this façade, however, and refusing to comply with his plans, Elphaba is immediately and very publicly denounced by the Wizard. Labelled as ‘wicked’, she is vilified herself and declared a common enemy of Oz, thus also serving political ends by becoming a focal point for societal fears. And it is in controlling this narrative and sealing Elphaba's eventual fate as the Wicked Witch of the West where the Wizard distracts from the true source of oppression, ensuring that the status quo—social cohesion and existing power structures in Oz—are maintained. In the Wizard of Oz, a ‘good vs. evil’ dichotomy is clearly discernible from the outset, Elphaba situated as diametrically opposed to the ‘good’ citizens of Oz and its seemingly virtuous leader. Through Wicked, however, we come to understand that ‘wickedness’ is less an inherent trait for Elphaba, as it is a label thrust upon her; a social construction, arising initially through intersectional oppression and then further perpetuated by societal fears. Way before she eventually accepts her fate as the Wicked Witch of the West, Elphaba is demonised, denied the common attributes or shared characteristics of her fellow Ozians. We suggest that this social process of ‘othering’, constructing difference as threatening, also aligns with Kristeva's (1982) concept of the abject; a notion that has proved serviceable in consideration of various aspects of psychiatric practice (Johansson and Holmes 2022, 2025; Holmes et al. 2006; Mckeown and Stowell-Smith 2006). Elphaba and her distinctive appearance already embodies the abject, her green skin placing her outside established, normative systems of identity, thus threatening the boundaries of societal norms and prompting public feelings of revulsion. Further, Madam Morrible's suggestion early in the film that Elphaba learns to harness her emotion, frames her burgeoning powers as dangerous forces requiring containment, rather than as legitimate responses to her distress. Nevertheless, it is in the Wizard's eventual construction of her as ‘wicked’, where Elphaba is further set apart from common humanity, given that her ‘wickedness’ is perceived to be disruptive to the symbolic order of Oz. To the citizens of Oz, she becomes regarded as fearful and monstrous, a liminal entity that is uncontainable and ultimately incomprehensible (Shildrick 2002). Yet simultaneously, Elphaba's presence provides the comfort that they are not her, especially when confronted with knowledge of her ‘wickedness’. This process of abjection, where Elphaba is othered and demonised, mirrors the experiences of those with mental ill-health, especially at those intersections of unhelpful diagnostic labels, emotional dysregulation and perceived risk (Wright et al. 2007; Mckeown and Stowell-Smith 2006). The Wizard, meanwhile, represents a figure of unquestioned patriarchal authority, although his power is later revealed to be based on performance and spectacle, rather than any real substance. Here, we suggest that there are clear parallels with bio-psychiatry, which has historically positioned itself as the dominant arbitrator of mental health care (Kolar et al. 2023), and in doing so, has enjoyed considerable political influence and public trust. A lack of established pathophysiology and identifiable biomarkers for illness, however, as well as a poor homogeneity and temporal validity in some diagnostic labels (Kinderman 2015; Pilgrim 2001), means that bio-psychiatry often lacks the evidence to support its scientific legitimacy (Wand 2024; Crowe 2022). Moreover, through its own propaganda (disseminated via diagnostic manuals, professional journals and, latterly, media engagement2), bio-psychiatry continues to construct and reinforce those harmful narratives, which locate the causes of mental ill-health, mental distress and even deviance, as residing within individuals (Bracken et al. 2012). Thus, those experiencing mental ill-health are depicted as being inherently flawed (Goffman 1961) and their behaviours pathologised, rather than their distress being seen as transient and as often arising from social determinants, or through the political and systemic misuse of power (Johnstone et al. 2018). As the psychiatric system, however, organises to project an image of itself as rationally defensible and efficacious, in doing so, it bolsters public faith that mental illness may be fixed ‘by force’ (Wand 2024, 215) and, perhaps more crucially, that dangerous madness can be contained. In this way, dangerous psychiatrised individuals might also be viewed as abject phenomena, inviting a contradictory public curiosity, coupled with revulsion and fear (Mckeown and Stowell-Smith 2006). Within this context, however, a real hazard for those experiencing mental ill-health is the potential for the attachment of abject identities to be forever extended across wider and wider populations rather than the original extreme minority. Take for instance the ‘personality disorder’ label, which arguably functions as a clear marker of abjection, and as with Elphaba's ‘wickedness’ label, positions individuals as inherently threatening to social norms; their experiences deemed ‘unknowable’, their actions ‘unpredictable’ and testimonies often considered ‘unreliable’ (Pilgrim 2001). This echoes Kristeva's logic that phenomena or actions are identified as abject, where we lack the capability to make sense of them (Kristeva 1982). Despite the contentiousness of some harmful psychiatric labels, however, (Porter et al. 2025; Lamph et al. 2022; Kinderman 2015; Pilgrim 2001), these reductive and apparently authoritative explanatory devices have endured, functioning to maintain social order and the established symbolic framework, thus aligning with Foucault's (1977, 1980) analyses of disciplinary and Biopower. First, the social governance role of psychiatry mandates the protection of the public and the assuaging of public anxieties surrounding risk, through the mechanisms of surveillance, control and the containment of individuals (Kolar et al. 2023). Second, such devices not only define and maintain the boundaries of normality (Becker 1963) but also emphasise what (and who) is considered morally appropriate and acceptable. Through the categorisation and examination of those deemed ‘abnormal’ or ‘deviant’, they also operate, at least in part, as an attempt to wrest some meaning from those inexplicable behaviours, especially where the abject provokes within us an utter incomprehension. Consequently, psychiatric labels serve to defend societies against those physical, moral and psychic threats posed by firmly fixing the ‘other’ at a safe distance from the ‘self’ (Shildrick 2002), or, more pertinently, ‘ourselves’. Hence, concurring with a long line of critics (Rose 1985; Foucault 1977; Becker 1963; Goffman 1961), we suggest that the mental health system exists with an implicit purpose of fulfilling societal and organisational agendas, prioritising the control of risk behaviours and the categorisation and resolution of those symptoms, which provoke visceral responses in the public over meeting the actual needs of those experiencing mental distress. Ultimately, in doing so, however, they reinforce those harmful ‘Normal versus Abnormal’ and ‘Them versus Us’ dichotomies (Haslam and Harding 2024), and such practices risk further generation of iatrogenic harms through the invalidation and re-traumatisation of those in need of help and support (Beale 2022). Thus, prompting our critical reflection here of where it is that ‘wickedness’ actually resides. Moreover, it is mental health nursing's overt collusion with this system, meanwhile, carrying out the ‘dirty work’ of psychiatry (McKeown 2024; Warrender 2021; Godin 2000; Emerson and Pollner 1976), that arguably positions us primarily as agents of social control. As mental health nurses, our role is one that traditionally contributes to the maintenance of the status quo, complicitly enacting institutional power under a rhetoric of benevolence, although one that masks a reality of coercion and control. The potential for engaging in this sort of work therefore forces us to betray our core values as caregivers, thus contributing to our own experiences of workforce alienation (McKeown 2024) and of moral distress (Repenshek 2009; Jameton 1984). Applied to mental health nursing, Elphaba's story prompts us to scrutinise psychiatric discourse, highlighting how for some, diagnostic labels often serve little purpose beyond the maintenance of those systems of oppression that create and enforce said labels. Echoing the historic demonisation of non-conforming women in the 17th-century witch trials, these wicked labels can (and often do) further perpetuate the structural marginalisation of vulnerable groups, especially at those intersections of race, gender and sexual orientation (Dhari et al. 2024). Yet, it is through understanding Elphaba's eventual hostility as the Wicked Witch of the West as being an understandable response to her marginalisation, where we might similarly consider how the responses of those experiencing acute distress, and behaviours, which are deemed ‘challenging’ or ‘undesirable’ by society, are less linked to inherent flaws in biochemistry or personality as bio-psychiatry would have us believe. Behaviours that do not conform to social norms are likely contextual (Johnstone et al. 2018; Moncrieff et al. 2024), representing instead those natural responses to broader socio-political and interpersonal challenges, or perhaps (mal)adaptive strategies developed by individuals to manage intense distress against backdrops of trauma and adversity (Wand 2024). Professionals are therefore likely more efficacious if responding to an individual's identified difficulties and focussing upon the contexts within which these arise, rather than simply their diagnostic label (Kinderman 2015). Elphaba's experiences, however, also highlight the common issue of epistemic injustice in those experiencing mental ill-health, prompting reflection around whose knowledge and perspectives are excluded from our understanding of illness. In particular, testimonial injustice, as initially coined by Fricker (2007) and as applied to those experiencing mental ill-health (Watts 2024; Fisher 2023), occurs where subjective patient experience and stories are said to hold less value than professional judgement and objective ‘hard’ evidence, such as mental state examinations. This issue stems in part from bio-psychiatry's assertions concerning the nature of valid to that which is and (Dhari et al. 2024). injustice is especially where individuals are to a with those or epistemic granted to psychiatry and the wider Fricker A of from or from the further the marginalisation of those already to structural as Elphaba's for instance, is due to her ‘wicked’ label, the of harmful diagnostic labels can often to a systemic of the (Watts 2024), to the testimonies of those carrying such labels to be or et al. 2022). the ‘personality disorder’ label, already for in its and it provokes powerful thus a of personal A of moral is both and a further dichotomy those considered not for their behaviours, therefore deemed of and those considered deemed less Crowe et al. when the issue of testimonial injustice, the importance of narrative is once this in its potential for First, us to beyond wicked labels and the from dominant concerning and those towards more to distress and its (Johnstone et al. 2018). 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Despite their in experiences, and of psychiatric and mental health services are both in the and the of those harmful narratives and practices (Bracken et al. and that have to their own experiences of othering and of social and epistemic Despite some real in and experiences and and of we further suggest that and are especially given that we a part of narratives (Haslam 2024; And it is in this where a to harmful and of (Wright et al. can and be potential has the capability to those psychiatric that natural responses to Ultimately, we suggest that this would also the inherent in our for a sense of meaning and purpose and directly alienation and moral distress the this we that Wicked is more than a Rather, it might be viewed as a socio-political to through which we are to the of authority, and those existing power structures that are through and the marginalisation of Applied to mental health nursing, and especially where the of are we to existing that these are upon unhelpful diagnostic labels and are perpetuated by the and of distress. to this is an of as inherently and and the and of personal narratives that support the of shared across while social of as Elphaba's is a in her own story and a of her own personal narrative and identity of the her experience can be seen as those of mental health and of This of and narrative however, might also a point in our own stories as mental health The especially us that beyond simply it is in both aligning and with of services and groups, where mental health nursing might also its and a sense of we to do so, we are with a to the reductive psychiatric discourse, and become a for systemic The have to is an of the of and and a of this not to this as no or the