Social stigma is largely a means of control by society over the individual, exercised through membership in a specific social group. When one suffers stigmatization, your “social identity, or membership in some social category, calls into question [your] full humanity—[you are] devalued, spoiled, or flawed in the eyes of others” (Crocker, Major, & Steele, 1998, p. 504). With stigma, there is a cost in several areas: “personally, interpersonally, and socially” (Heatherton, 2000, 1). As a result, when a person is stigmatized, there is great personal cost.
Stigma can work to begin shaping the identity of the individual. When the people around you negatively perceive you, it is easy for a person to begin conceptualizing themselves in that manner. Lemert (1951) touches on this when he explains that “in a culture where a child is taught sharp distinctions between ‘good’ women and ‘bad’ women, a single act of questionable morality might conceivably have a profound meaning for the girl so indulging” (93). A girl who has crossed over the line separating appropriate (or “good”) behavior and inappropriate (or “bad”) behavior will begin to reconceptualize her sense of self. Her lens will shift to that of those around her. And sometimes, the more one is stigmatized with a label, the more that person will adopt and own it. This is especially the case if the person realizes “there are rewards, as well as penalties deriving from such a role” (Lemert, 1951, p. 93).
The identity of someone with mental illness can also be shaped by the stigma of the diagnosis as well. In fact, Dubin and Fink (1992) explain, “Stigma against mentally ill persons is so pervasive it affects every aspect of their lives. It brings a multitude of problems from insurance, to housing, to jobs” (1). The stigma surrounding mental illness is not a facet of our new, modern society. Throughout history, stigma has attached itself to all forms of mental illness. Although we are far from the days when mental illness was believed to be a form of demon possession, we still tend to view patients as “constitutionally weak, dangerous, and responsible for their own plight” (Dubin & Fink, 1992, 1).
It is bad enough when other people view you as aberrant or peculiar. But it is even worse when one begins to see themselves in that way. Goffman (1959) suggests that viewing yourself as losing touch with your sanity “would seem to be one of the pervasively threatening things that can happen to the self in our society” (421). The natural response to a realization regarding the possible degeneration of one’s sanity is the inclination to hide it from others. In fact, Goffman (1959) observed this:
Coupled with the person’s disintegrative re-evaluation of himself will be the new, almost equally pervasive circumstance of attempting to conceal from others what he takes to be the new fundamental facts about himself, and attempting to discover whether others too have discovered them. (p. 421)
Once a label of mental illness is attached, the dynamic in interpersonal relationships shifts. The patient is no longer just managing their own response to mental illness and the stigma, but the response and reaction of their loved ones. In the film, Unbreakable Minds, adult, Randy, is seen in frequent conflict with his parents for control over his mental health and subsequent treatment. Randy dislikes the side effects of the medication used to treat his schizophrenia. After years of struggle, Randy has fashioned a conceptualization of himself—including the diagnosis—but feels that his loved ones have not. He would like to forgo the medication to be able to feel like himself. He explains, “I could be schizophrenic and be happy if it weren’t for this medication.” But for other patients, it is the realization that there is something wrong with them that brings the most pain. Brad, another schizophrenic featured in Unbreakable Minds, struggles with concern that he is going to lose his grip on sanity at any moment. His mother, Betty, shares with the camera: “Sometimes I wish, and God forgive me, that if he were sicker he would find happiness because he wouldn’t know normal.” Many patients diagnosed with a mental illness find that the stigma is crushing. They begin to have lower expectations. As Rob in Unbreakable Minds comments, “I would just like to feel good about myself… I don’t think that is too much to ask of life.” Yet for many carrying the stigma of a mental health diagnosis that may be more than they can ever hope to enjoy.
As troubling as it is to realize that the stigma attached to an illness a patient has no control over can dominate their whole lives, it is more troubling when we factor in the inherent miscalculations in diagnosing mental illness, and in discerning the sane from the not sane. The less we are exposed to behaviors, the more peculiar they become. “Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted” (Rosenhan, 1975, p.12). Also, we must consider the cultural relevancy of normalcy. As Rosenhan pointed out, in 1934 Benedict demonstrated the concepts we use in one society to suggest that this behavior is normal and this behavior is abnormal are not, in fact, unanimous (1). You cannot get a total consensus even within the same society, let alone when you travel to another culture. “What is viewed as normal in one culture may be seen as quite aberrant in another. Thus, notions of normality and abnormality may not be quite as accurate as people believe they are” (Rosenhan, 1975, p. 1). Thus, diagnosing is clearly an opinion, not a science. There are seldom black and white answers to the questions of crafting a diagnosis. Even though diagnosis of a mental illness is nothing more than one or more mental health professionals’ opinions, society continues to behave as though a diagnosis of mental illness is written in stone. In fact, it is merely one person’s—or multiple people’s—opinion of another person’s mental health.
Rosenhan (1975) also found that once a patient is placed into a mental health facility, “we cannot distinguish the sane from the insane” (p. 12). The mere placement and occupation of space so riddled with the out-of-the-ordinary alter the behavior of the patient. This is, in fact, a normal response to an abnormal situation. In the experiment detailed by Rosenhan, her “pseudopatients” became quite nervous upon admission solely because “none… believed they would be admitted so easily” (3). We can assume there may have been moments of questioning one’s own sanity just from the sheer ease with which they gained admission to the facility.
Indeed, the film Quiet Rage: The Stanford Prison Experiment demonstrated that even insane, healthy individuals, the placement into an abnormal and unpleasant circumstance can evoke behavior and facets of personalities unseen in typical settings. The experiment demonstrated that this happens even when everyone participating is aware that the conditions are not real or permanent. It took only one day for the participants acting as prisoners to riot. This experiment is an excellent demonstration of stigma, as the prisoners were never imprisoned due to presumed guilt, yet they accepted their stigma as inferior members of society. The participants working as “guards” in the experiment utilized psychological tactics—such as new identity based upon a prison number—to control the group at large. Even the professor in charge of the experiment himself was swept into the pretend conditions of the experiment. Although he was given the role of prison superintendent, he permitted abuse to take place on the “prisoners” participating in the experiment. No one is immune to the psychological impact of being subjected to abnormal conditions.
It is not difficult to extend this metaphor of roles and responses to abnormal conditions to psychiatric treatment settings. Dubin and Fink (1992) point out that the entire nature of the setting itself does little more than establish stigma for the patient. For example, “patients have to be in bed by 9 or 10 o’clock. Yet most people do not go to bed at this time. Those patients who do not comply are given sleeping medications or seen as non-compliant and resistant to treatment” (2). The rigid rules and roles can quickly allow the patients to take on the stigma and own it—as previously discussed in Lemert—and create an “us-versus-them” mentality among the patients. Take the example in the film, Girl, Interrupted, the sociopath, Lisa, convinces the mildly suicidal, Susanna, to resistant treatment and even trade her medications with other patients. Once people become labeled as deviant, abnormal, or atypical, they can quickly begin to embrace the label—especially if they feel they cannot shed it.
Labeling is a big part of how stigma is applied and how a person’s identity is shaped. “Linked with conflict theory, labeling theory shows how those with the power to label someone deviant and impose sanctions wield great power in determining deviance” Anderson & Taylor, 2005, p. 179). Once the person has been labeled as deviant, they find it difficult to resume a non-deviant identity. Thus, their new concept is that of deviant identity, which as we discussed before, has some rewards. Essentially, the person demonstrates a behavior that is considered abnormal; it is recognized and labeled by someone else. At this point, secondary deviance, which is a developmental stage wherein a person internalizes their deviant identity, comes into play. The person no longer questions its validity, but fully accepts it as part of who they are. In terms of the person diagnosed with a mental illness, secondary deviance plays a key role. Bowers (1998 ) explains: “sometimes a deviant act is identified as evidence of mental illness and the deviant person receives psychiatric treatment [and a label]. Because he is then treated by others around him as mentally ill, he begins to fulfill their expectations and behaves in a way consonant with that role” (20). In fact, labels can do more to harm a patient and interfere with treatment than they can assist a patient in providing context for their behavior and feelings. We’ve previously discussed the profound social stigma as a result of a mental health label.
Labeling does not merely apply to mental illness, however. We can see impact of labeling throughout society, but especially in the criminal justice arena. In fact, differential enforcement is a factor in the outcome for many citizens. The law is applied differently to those with power and status than it is to those who are powerless. What is even further unfair is that once someone has been labeled deviant in the bureaucracy that is our criminal justice system, that person is singled out and treated differently from that moment forward. So if someone were to be labeled deviant unfairly—or prematurely—they could not only suffer unfair treatment but be railroaded into criminal consequences they do not deserve. Additionally, the person may take on a new deviant identity due to the labeling.
The biggest critiques of labeling theory center upon the fact that some people feel a person’s nature more strongly influences their response than anything else. Additionally, there is evidence to suggest that deviant behavior persists over time even in the absence of a label.
It seems obvious that the point and purpose of labeling are to serve society, not the individual. The individual gets little out of being labeled other than stigmatization and an altered sense of identity. The obvious solution is to begin to address individual situations and behaviors rather than trying to use a blanket one-size-fits-all approach to mental health, criminal justice, or behavior modification. The experiments discussed here show the power and weight of labels. Once labeled, the individual will take on the assumed characteristics of the label—for better or for worse.
As precarious as the diagnosis and treatment of the mentally ill is in our society today, more care should be taken before assigning diagnoses to patients. More focus should be placed on handling individual behaviors and concerns than determining a name for the set of behaviors as a whole.
References
Anderson, M.L. & Taylor, H.F. (2005). Sociology: Understanding a diverse society. Belmont, CA: Wadsworth Publishing.
Angelico, I.L. (Producer), & Neidik, A.J. (Producer and Director). (2005). Unbreakable Minds [Motion picture]. Canada: DLI Productions.
Bowers, L. (1998). The societal nature of mental illness. New York: Routledge.
Crocker, J., Major, B., & Steele, C. (1998). Social stigma. In Gilbert, D., Fiske, S. T., & Lindzey, G. (Eds.), The Handbook of social psychology (4th ed., Vol. 2, pp. 504-553). New York: McGraw Hill.
Dubin, W.R. & Fink, P.J. (1992). “Effects of stigma on psychiatric treatment.” In Fink, P.J. & Tasman, A. (Eds.) Stigma and mental illness. Washington, DC: American Psychiatric Press.
Goffman, E. (1959). “The moral career of the mental patient.” Psychiatry. 22. 123-142.
Heatherton, T.F. (2000). The social psychology of stigma. New York: Guilford Press.
Lemert, E.M. (1951). “Primary and secondary deviation.” In Social pathology: A systematic approach to the theory of sociopathic behavior. (75-78). New York:McGraw-Hill.
Musen, K. & Zimbardo, P.G. [Directors] (1991). Quiet rage: The Stanford prison study. [Video recording]. Stanford, CA: Psychology Department, Stanford University.
Rosenhan, D. (1975). “On being sane in insane places.”