Psychiatric Labeling in Be Distinguishable from Insanity by Cues That Are Very Similar to Those Used in the Cross-Cultural Perspective Western World

planation of mental illness, especially with respect to schizophrenia. These cross-cultural investigations suggest that relativism has been exaggerated by labeling theorists and that in widely different cultural and environmental situations sanity appears to Psychiatric Labeling in be distinguishable from insanity by cues that are very similar to those used in the Cross-Cultural Perspective Western world. Similar kinds of disturbed behavior appear The Labeling Orientation to be labeled abnormal in diverse cultures. As Edwin Schur (8) points out, if labeling theory is conceived broadly it is the application of George Herbert Mead's theo- Jane M. Murphy ries about self-other interactions to a definition of social deviance extended to in- clude human problems ranging from crime to blindness. Labeling theory emphasizes In recent years labeling (or societal reac- support from a study reported in Science the social meanings imputed to deviant be- tion) theory has aroused strong interest by David Rosenhan (6), based on the expe- havior and focuses on the unfolding pro- among people concerned with mental ill- riences of eight sane subjects who gained cesses of interaction whereby self-defini- ness. From the perspective of labeling the- admission to psychiatric hospitals, were tion is influenced by others. Further, "it is ory, the salient features of the behavior diagnosed as schizophrenic, and remained a central tenet of the labeling perspective patterns called mental illness in countries as patients an average of 19 days until dis- that neither acts nor individuals are where Western psychiatry is practiced ap- charged as "in remission." Rosenhan ar- 'deviant' in the sense of immutable, 'objec- pear to be as follows: (i) these behaviors gues that "we cannot distinguish insanity tive' reality without reference to processes represent deviations from what is believed from sanity" (6, p. 257). He associates his of social definition." Schur states that on March 13, 2014 to be normal in particular sociocu!Yral work with "anthropological consid- "'this relativism may be viewed as a major groups, (ii) the norms against which the de- erations" and cites Ruth Benedict (7) as an strength" of labeling theory (8, p. 14). viations are identified are different in dif- early contributor to a theme he pursues, \Edwin Lemert's concept of secondary ferent groups, (iii) like other forms of de- which is that "what is viewed as normal in deviance (9) is of critical importance in viation they elicit societal reactions which one culture may be seen as quite aberrant linking self-other considerations to devia- convey disapproval and stigmatization, (iv) in another" (6, p. 250). I: indicates that tions. Secondary deviation occurs when a a label of mental illness applied to a person the perception of behavior as being schizo- person learns the role and accepts the iden- whose behavior is deviant tends to become phrenic is relative to context, for "psychi- tity of a deviant as the basis of his life- fixed, (v) the person labeled as mentally ill atric diagnosis betrays little about the style. It is a response to a response; nega- www.sciencemag.org is thereby encouraged to learn and accept a patient but much about the environment in tive feedback from significant others rein- role identity which perpetuates the stigma- which an observer finds him." He argues forces and stabilizes the behavior that ini- tizing behavior pattern, (vi) individuals that, despite the effort to humanize treat- tially produced it. Applied to criminality, who are powerless in a social group are ment of disturbed people by calling them this idea has created general awareness of more vulnerable to this process than others patients and labeling them mentally ill, the a process whereby a young person on being are, and (vii) because social agencies in attitudes of professionals and the public at labeled a juvenile delinquent may enter a modern industrial society contribute to the large are characterized by "fear, hostility, network of contingencies that lead ulti- Downloaded from labeling process they have the effect of aloofness, suspicion, and dread." Once the mately to his learning criminal activities creating problems for those they treat label of schizophrenia has been applied, and "hardening" as a criminal rather than rather than easing problems. the "diagnosis acts on all of them"- to the correction of behavior. This school of thought lemerged mainly patient, family, and relatives-"as a self- In The Making of Blind Men, Robert within sociology, as an extension of studies fulfilling prophecy. Eventually, the patient Scott points to a similar process regarding of social deviance in which crime and de- himself accepts the diagnosis, with all of its a very different type of deviance (10). If a linquency were originally the major focus surplus meanings and expectations, and person is labeled blind by certain adminis- (1). It is also associated with psychiatry behaves accordingly" (6, p. 254)- trative criteria he is likely to become en- through, for example, Thqmas Szasz and The research to be described here meshed in care-giving agencies that en- R. D. Laing (2). These ideas have come to presents an alternative perspective derived courage him to accept a definition of him- be called a "sociologicgi model" of mental from cross-cultural comparisons, mainly self as helpless and to learn to play the role illness, for they center jj learning and the of two widely separated and distinctly con- of the blind man. These experiences may social construction of norms. They began trasting non-Western groups, Eskimos of even inhibit the use of residual vision. to be formulated about 25 years ago (3), northwest Alaska and Yorubas of rural, Scott shows that institutions for the blind commanded growing attention in the late tropical Nigeria. It is concerned with the vary in the degree to which they encourage 1960's, and have-been influential in recent meanings attached to behaviors which acceptance or rejection of the deviant role major changes in public programs for psy- would be labeled mental illness in our so- and that these differences are related to chiatric care, especially the deinstitutional- ciety. I interpret these data as im- raising The author is associate professor of anthropology in ization which is occurring in a number of portant questions about certain assump- the Harvard School of Public Health, Boston, Massa- in chusetts 02115. A portion of this article was presented states (4, 5). tions the labeling thesis and therefore as at the 1973 meeting of the Atlantic Provinces Psychiat- Several aspects of the theory receive casting doubt on its validity as a major ex- ric Association in Halifax, Nova Scotia. 12 MARCH 1976 1019 differences in the life-style of blind men. nent in what used to be called the culture- contributors to labeling theory: Scheff, Er- Insofar as the labeling concept has been personality studies of anthropology. In ving Goffman, Theodore Sarbin, and Da- employed in this way I believe it is sound fact the influence of culture-personality on vid Mechanic. These references do not en- and has disclosed new and valuable infor- labeling theory is explicitly stated by Le- compass the breadth and elaboration of mation. mert, who was trained jointly in sociology each contributor's own approach to the The application of labeling ideas to and anthropology and who has drawn on problem of mental illness, but they do re- mental illness has tended to take a differ- non-Western studies throughout his career. flect the view of cultural relativity which ent course (11) and has aroused consid- The influence is equally acknowledged by runs throughout the labeling orientation. erable controversy, as indicated, for ex- Rosenhan (6). It seems to me that numbers Scheff says that "the culture of the ample, in the continuing exchange between of proponents of labeling theory assume group provides a vocabulary of terms for Thomas Scheff and Walter Gove et al. (12- that the expanding body of data from non- categorizing many norm violations" (11, 15). One question in this controversy is Western areas has supported the relativist pp. 33, 82). These designate deviations whether mental illness should be consid- propositions put forth by Benedict and such as crime and drunkenness. There is a ered a "pure case" of secondary deviation others in the 1930's and '40's (16). Indeed, residual category of diverse kinds of devia- or a more complex case. Lemert's formu- it was my own assumption when I began -tions which constitute an affront to the un- lation of the concept of secondary devia- anthropological work with Eskimos. I conscious definition of decency and reality tion was influenced by his investigation of thought I would find their conception of uniquely characteristic of each culture. stuttering, and he suggests that stuttering normality and abnormality to be very dif- Scheff posits that the "culture provides no represents the pure case: "Stuttering thus ferent, if not opposite, from that held in explicit label" for these deviations but they far has defied efforts at causative ex- Western culture. This did not prove to be nevertheless take form in the minds of so- planation.... It appears to be exclusively a the case, and my experience is not unique. cietal agents as "stereotypes of insanity." process-product in which, to pursue the Anthropologists who have been conducting When people around a deviant respond to metaphor, normal speech variations, or at field research in recent years using more him in terms of these stereotypes, "his most, minor abnormalities of speech (pri- systematic methods but continuing to amorphous and unstructured rule-break- mary stuttering) can be fed into an inter- work on the relations between individual ing tends to crystallize in conformity to actional or evaluational process and come behavior and cultural context tend to hold these expectations." Scheff further sug- out as secondary stuttering" (9, p.

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