Re: terms (Psychiatrists, State,Liberty and Schizophrenia)

Robert White (rwhite@superior.carleton.ca)
3 Oct 96 00:37:32 GMT

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Pfohl, S.J. (1985)_Images of Deviance and Social Control_
McGraw-Hill, Inc.

A Labeling Theory of Mental Illness
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Thomas J. Scheff
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"Scheff defines mental illness as a type of residual deviance, a
catchall category for a variety of behaviors which violate the
rules of everyday social interaction. Such violations include
inappropriate gestures and postures, and inappropriate ways of
looking, talking, or positioning one's body in relation to other
people. People who act in such a fashion may be thought of as odd.
They may even be labeled as mentally ill, but not always. What
determines whether this will happen? Scheff formulates nine pro-
positions which guide the labeling process. The core of Scheff's
theory is that without labeling most residual rule-breaking will
be ignored or denied and pass away as a matter of transitory sign-
ificance. It is labeling that fixes a residual rule-breaker into
a stereotypical career as a mentally ill person. This is underscored
in Scheff's ninth proposition, which states that 'labeling is the
single most important cause in residual deviance.'

But what causes labeling? According to Scheff seven factors are
important: the degree of rule breaking, the amount of rule breaking,
the visibility of rule breaking, the power of the rule-breaker, the
social distance between the rule-breaker and control agents, the
tolerance level of a particular community, and the availability of
alternative non-deviant roles. The first two variables, degree and
amount of rule-breaking, are characteristics of the individual being
labeled. The last five are social factors which exist independently
of an act of rule-breaking. The logic of Scheff's thesis is this--
that labeling may be regarded as the single most important cause of
a career in residual deviance if the last five variables outweigh
the influence of the first two. Social contingencies, in other words,
are said to be more important than the bizarre behavior of the deviant.

Scheff tested his labeling theory in a two-phase study of psychiatric
decision-making. The initial phase (obtaining independent psychiatric
ratings of candidates for involuntary commitment to a mental hospital)
uncovered high levels of clinical uncertainty regarding the mental
state of patients examined. Despite such uncertainty, Scheff observed
196 consecutive cases in which 'patients' were committed anyway. From
this Scheff inferred that there was a presumption of illness behind
the work of psychiatric labelers.

Why do psychiatric examiners presume illness on the part of patients
being considered for involuntary commitment? David Mechanic attributes
this predisposition for medical labeling to the professional socialization
of psychiatrists as physicians and to the pressing time constraints of
hospital work. Scheff identifies three additional factors--financial,
ideological, and political. Paid on a per case basis, psychiatrists
have a financial incentive to process cases quickly. Ideologically,
several features of the so-called medical model reinforce the tendency
to see illness. One is the belief that, like other diseases, mental
illness will get progressively worse unless detected and treated. Another
assumes that a finding of illness is not irreversible and that the
results of a little treatment will be neutral at worst. Political
considerations also encourage psychiatrists to be "safe rather than sorry."
Of major concern is the fear of public censure for releasing patients
who later act violently. Visions of newspaper headlines reading
"Psychiatrist Released Killer" most undoubtedly pass through a
clinician's mind."
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   ----------------------------------------- Carleton University ----------

               Robert G. White               Dept. of Psychology   

                                             Ottawa, Ontario. CANADA

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