Concepts of Health and Illness: Section 3. Labelling and Stigma

The concepts of labelling and stigma derive from the interactionist sociological perspective described above, and focus on the importance of the symbolic meanings of health and illness. That is the shared social connotations and imagery that are associated with particular events and objects and upon which our actions are largely based. Labelling as a sociological construct has been used to inform medical practice since the 1960s in order to draw attention to the view that the experience of 'being sick' has both social as well as physical consequences.

Labelling theory:

Becker's (1963) original work on the social basis of deviance argues that, 'social groups create deviance by making the rules whose infraction constitutes deviance'. Applying these 'rules of deviance' to individuals or groups means labelling them as 'outsiders'. He goes on to argue that, 'deviance is not a quality that lies in the behaviour itself, but in the interaction between the person who commits an act and those that respond to it'. The 'deviant' is therefore the one to whom the label has successfully been applied. Behaviour that is labelled as deviating in some way from the 'norm' necessarily involves the value judgements of those powerful individuals who are in a position to impose such labels. Labelling theory focuses less on the 'deviantact' itself, and more upon the societal reaction to that particular behaviour.

Lemert's (1967) work followed on from Becker's insights in recognising the importance of the reaction of others in the explanation of deviance, whilst drawing a distinction between 'primary' and 'secondary' deviance. Primary deviance is seen to consist of deviant acts (with any amount of causes) before they are publicly labelled, and has '…only marginal implications for the status and psychic structure of the person concerned'. Secondary deviance is much more significant because it alters a person's self-regard and social roles. This follows the public identification of a person as deviant, and the individual's response to this negative societal reaction (a judgement of social 'normality'). It is in direct response to this labelling that the person changes their behaviour in accordance with the label; the label constituting a 'self-fulfilling prophecy'.

In the case of sickness, primary deviance represents the illness experience. The process of secondary deviance is constituted through the act of diagnosis wherein doctors engage in a process of classification through which people are either labelled ill (deviant from the 'norm') or healthy. It is because these disease labels carry such widely shared public stereotypes that the behaviour-change characteristic of secondary deviance occurs:

Labelling as a means of creating diseases, must be distinguished from the cause of diseases. So whether the biological state of an individual is a 'disease' or not, is established by the doctor when the diagnosis or label is given to the patient (Armstrong: 1989:35)

Stigma

Goffman's (1968) work is less concerned with the social process of labelling a particular action or pathological state as deviant, than with the stigmatising consequences of that process for an individual - what he referred to as 'The management of everyday life'.

All of us, including health professionals, because the medical model does not exist in a cultural vacuum, perceive certain conditions and disabilities as particularly stigmatising; an obvious example of this being HIV/AIDS. Thus when a disease label is attached to a person, the very label itself has the power to 'spoil the sufferer's identity' (Goffman:1968); both personal and social. The social stigma that results from this labelling process, derives not only from societal reaction which may produce actual discriminatory experiences ('enacted stigma'), but also the 'imagined' social reaction which can drastically change a person's self-identity ('felt stigma'):

'The stigmatised individual may be able to hide the discrediting attribute from others but cannot do so from him or herself'(Goffman:1967)

The impact of labelling and its consequences for stigmatisation can be represented as a negative feedback circle, which results in greater and greater diminution of social participation - this process is diagrammatically represented in figure 1 below.

So for example, meeting the care needs of a child with a disability not only has a significant impact upon family members pre-existing work and social life patterns, but in addition families may also experience what is termed `courtesy stigma' (or 'stigma by association') because of their direct relationship to the child. The family will then may have to cope with their own feelings of shame or guilt, and may attempt to distance themselves in various ways from the disability.

In the case of diagnosing mental illness, the power to label is a significant one and is entrusted to the psychiatrist. Once an individual has been diagnosed as mentally ill,  labelling theory would assert that the patient becomes stripped of their old identity and a new one is ascribed to them. A process which usually leads to the labelled person internalising this new identity and social status, so taking on the role (`master status') of the psychiatric patient with all its associated set of role expectations. Stigmatisation would then follow, which has the effect of excluding the labelled `psychiatric patient' from normal interactions. In this case, labelling theory focuses attention on the ethnocentric assumptions about `normal' behaviour held by psychiatrists resulted in the misattribution of labels such as schizophrenia. This approach does not challenge the `fact' that high rates of psychopathology exist among black and Irish people, it simply claims that the wrong label is being applied with important consequences for these patients self-identity.

© I Crinson 2007