How Mental Illness Is Labelled and Stigmatised (AQA A-Level Sociology): Revision Notes
How Mental Illness Is Labelled and Stigmatised
Introduction to labelling and stigmatisation
Mental illness labelling and stigmatisation represents a major area of sociological study, particularly within the interactionist perspective. This approach examines how society's response to mental illness can create additional problems for individuals beyond their original condition. The process involves understanding how negative labels become attached to people with mental health problems and how this affects their social interactions and life opportunities.
The interactionist approach focuses on the social construction of mental illness, suggesting that society's response can be as damaging as the original condition itself.
Goffman's theory of stigma
Erving Goffman (1968) conducted groundbreaking research through participant observation in an American psychiatric hospital. His work revealed how the labelling process operates within institutional settings and contributes to the social construction of mental illness.
Spurious interaction
Goffman introduced the concept of spurious interaction to describe how mentally ill patients are treated within hospital settings. This occurs when all behaviour displayed by patients is interpreted through the lens of their mental illness diagnosis, rather than being taken at face value.
Supporting Evidence: Rosenhan (1973) found that when pseudo-patients (people pretending to have symptoms) were admitted to psychiatric hospitals, their normal behaviour was frequently ignored or reinterpreted to fit medical staff's expectations of mental illness.
The two-stage career process
Goffman argued that mental patients undergo a distinctive "career" development in two key stages:
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Mortification of self - The individual's previous identity is systematically dismantled as they are processed through the institutional system. Their former sense of self dies as they are assigned a new identity as a "mental patient."
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Adoption of adjustment modes - Individuals learn to adapt to institutional life through various coping strategies that help them survive day-to-day existence, though often at the cost of their individuality and authentic self-expression.
Understanding stigma
Stigma refers to the negative label of shame that marks a person out as different from others in society. Goffman's seminal work "Stigma" (1963) established the theoretical foundation for understanding how mental illness stigma operates.
Goffman described mental illness as one of the most deeply discrediting and socially damaging forms of stigma. Writing in the 1960s, he observed how people with mental illnesses began with normal rights and relationships but gradually lost both through the stigmatisation process.
The interactionist perspective
Interactionists focus on how biomedical mental health practices inadvertently contribute to negative labelling and stigmatisation of patients. This perspective emphasises Weber's concept of verstehen - understanding social phenomena from the patient's viewpoint rather than solely from the medical profession's perspective.
Verstehen means understanding social action from the actor's own perspective, allowing researchers to gain insight into the lived experience of mental health patients rather than just clinical observations.
The interactionist approach examines roles, actions, and meanings within mental health settings, revealing how institutional processes can compound the difficulties faced by people with mental health problems.
Goffman's institutional research
Research Study: Goffman's "Asylums" (1961)
Participants: Staff and patients in American psychiatric institutions
Aim: To examine the process of institutionalisation and how people negotiate new identities in situations of powerlessness
Procedure: Participant observation within psychiatric hospital settings
Findings: Identified spurious interaction, mortification of self, and the development of institutional careers among patients
Evaluation - Strengths:
- Provided detailed insights into institutional processes
- Influenced deinstitutionalisation movement
- Used verstehen approach
Evaluation - Weaknesses:
- Based on 1960s institutional practices
- Limited generalisability
- Observer effect possible in participant observation
Goffman's work is widely credited with beginning the process of deinstitutionalisation in mental health care.
Cultural representations
The influence of Goffman's work extended beyond academia into popular culture. Ken Kesey's novel "One Flew Over the Cuckoo's Nest" (1962) drew inspiration from Goffman's book "Asylums" (1961).
The story illustrates how institutional processes can construct "madness" through increasing medicalisation and personality control, showing how a sane individual can be transformed through institutional labelling.
Legal framework and protections
The Equality Act (2010) makes it illegal to discriminate directly or indirectly against people with mental health problems in public services, employment, education, housing, and transport. This legislation represents an attempt to combat the discriminatory effects of mental health stigma through legal protection.
Contemporary evidence of stigma
Despite legal protections, research by the Mental Health Foundation (2014) demonstrates that social stigma attached to mental health problems remains substantial. Current evidence shows that people with mental health conditions face discrimination not only from wider society but also from families, friends, and employers.
The stigmatisation process can worsen existing mental health problems and create barriers to accessing help, treatment, and recovery. This creates a cyclical effect where stigma compounds the original difficulties.
Recent research findings
Research published by the CentreForum Mental Health Commission reveals the extent of ongoing discrimination. Despite the Mental Health (Discrimination) Act becoming law in 2011, substantial problems persist:
Employment Discrimination Statistics:
- 60% of people with mental health problems feel unfairly treated when job searching
- 75% avoid applying for certain positions due to concerns about employer responses
- 60% avoid educational or training opportunities because of their condition
- 60% worry about workplace treatment if their condition became known
Social Isolation and Concealment:
- 90% conceal their condition from others
- 75% avoid close personal relationships
These statistics demonstrate that legal protection alone is insufficient to eliminate the real-world effects of mental health stigma and discrimination.
Connection to broader theories
Labelling theory supports the social constructionist definition of mental illness, offering a critique of the biomedical model's realist approach. This perspective suggests that mental illness is not simply a medical condition but is also shaped by social processes of labelling and response.
Key Points to Remember:
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Stigma creates a negative label of shame that marks people with mental illness as different and can be more damaging than the original condition
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Goffman's two-stage process shows how institutional treatment leads to mortification of self followed by adoption of survival strategies
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Spurious interaction means all behaviour is interpreted through the mental illness label rather than taken at face value
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Contemporary research shows 60-90% of people with mental health problems still face discrimination despite legal protections
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The interactionist perspective emphasises understanding mental illness from the patient's viewpoint using verstehen rather than just the medical model