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Goffman’s theory of
stigmatisation and labelling:
Consequences for health and
illness
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
12 Contents
page
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–3
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–9
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–10
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
Objectives
On completion of this chapter it is expected that you will be able to:
explain Erving Goffman’s theory of labelling, stigma, and deviant
identity and the importance of these concepts in understanding health
and illness.
Further readings
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
Erving Goffman
Erving Goffman’s contribution to sociology in general and medical
sociology in particular is well recognised. Goffman was instrumental in
reforming the mental care institutions in America following the
publication of his work Asylum in 1961. Although his contribution to the
sociological perspective known as symbolic interactionism is significant,
our discussion will revolve around those of his works which are directly
related to medical sociology.
Resource Material Reading 12–1 deals with one of Goffman’s major
works: Stigma. However, I will try to provide a brief account of his other
works in the following pages as well. Goffman’s main concern, in all of
his works, is to understand “social reaction” to the “deviant act” (be it
mental illness or other “bizarre behaviour”) as well as the responses of the
person involved to the negative social reaction. What interests him most is
the attribute, trait, or behaviour that symbolically marks the bearer off as
“culturally unacceptable” or “inferior” and has as its subjective referent
the notion of shame or disgrace (Williams 1987, pp. 135–136). In Asylum
and Stigma, he outlines in detail the above issues. If you have a chance,
familiarise yourself with these books.
Asylum
Goffman’s book Asylum (1961) contains a set of essays concerned with
mental hospitals and other institutions. He calls these institutions the
“total institutions”. Total institutions are bureaucratically organised
residential establishments whereby individuals are forced to carry out their
daily activities of sleeping, eating and playing with the same people and
under the same authority. He cites examples of hospitals, army barracks
and prisons as being total institutions. People can be both voluntarily
(army camp) or forcibly (prison) admitted into a total institution. Asylum
is his most famous study of a total institution.
Goffman’s concern was to develop a sociological view of the structure of
self and he argued that this can be studied in a situation like a total
institution where self is being stripped off. In other words, he believed that
what is normal can be understood by examining what is socially labelled
as abnormal. In asylums he found that the “moral career of the mental
patient” was given to the patients by the institution and this followed the
mortification of the self under the heavy machinery of the mental hospital.
Although it was not his purpose to study the intricate details of how
mental patients are treated (or mal-treated) in a mental hospital, his
research revealed some very interesting aspects of health care
arrangements in a mental hospital.
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
Stigma
In his book Stigma (1963), Goffman argues that stigma is a relationship of
devaluation in which one individual is disqualified from full social
acceptance. His research focused on the problems generated by stigma for
individuals and groups and on the coping mechanisms they employ.
Stigma can take many forms. It can result from physical deformity,
documentary details (such as a prison record), or context (associating with
“bad company”), or it can be ascribed (by default—e.g. father is a child
molester so son could also be one), or achieved (by becoming a
delinquent). Stigma is inherent in theories of deviance and
non-conformity. It can also be retrospective, or after the event (as in the
case of Lindy Chamberlain being portrayed as “evil”). Stigma, therefore,
is about applying a label to describe someone’s perceived (or otherwise)
non-conformist, degenerate or simply different behaviour.
The value of Goffman’s definition of stigma lies in its applicability as a
conceptual framework, a prototypic blue print for the analysis of
stigmatising illness conditions. Stigmatisation appears in the medical
context very often. It can be apparent for patients with infectious diseases
(AIDS, Hepatitis-B) or for those with physical deformities (loss of a limb,
crippled). It can arise because of chronic illness (a “weak” or “sickly”
person) or from one’s medical record, which may prevent future
employment. Inherent in the process of stigmatisation is the issue of social
control. Stigmatising patients and the sick is one of society’s ways of
controlling their actions and activities. In some cases, the label is never
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
removed and so the person can never be fully socially accepted (e.g. AIDS
patients, the physically handicapped).
Within the medical institution itself (e.g. a hospital) stigma also plays a
role in determining the attitude toward patients. Alcoholics and
drug-addicts are stigmatised as having a weak character or disposition.
Simply being ill can attract a patronising attitude. Patients are often
ignored when asking questions or seeking to clarify information regarding
their condition or treatment. This is no doubt an outcome of the
bureaucratic nature of the institution (seeking to streamline treatment) and
of medical dominance in which doctors and other staff seek to control
patients.
Labelling
Goffman’s Stigma is based on the sociological concepts of labelling and
deviance. Labelling is recognised as an important social process by social
interactionists. It refers to the process of how labels are constructed and
applied to certain individuals or groups in order to curtail or denigrate
their actions. Thus labelling theory, as it has come to be known,
concentrates on how deviance is constructed and controlled in society.
Stigma, as we have seen, plays an important role in the post-labelling
phase. Once labelled as deviant, the individual faces all sorts of social
reactions ranging from ostracism and ridicule to pity or anger.
Inherent in labelling theory is the notion that deviance depends much upon
who, what and how an act or individual is defined as deviant. Labelling
theory sees deviance as a relative condition. That is, what is “deviant” to
you or me may not be deviant to other groups or individuals. It all depends
on the standards that we hold. In many cases, the individual may be acting
perfectly rationally according to his/her own standards, but not according
to the standards set by the wider society. Interactionists thus seek to
understand the meaning behind individual actions and behaviour and, in
so doing, they often give important insights into the way power and
control are exercised in our society and in social situations.
The significance of labelling theory is apparent when we examine mental
illness. The investigation of mental illness as something other than purely
a disease or neurological defect came to prominence in the 1950s and
1960s. The radical nature of this approach is summed up in the article
“The myth of mental illness” (Szasz 1960). Szasz’s view is that mental
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
illness is really a name (or label) applied to people who have problems in
their lives. For instance, mental stress emanates from the nature of one’s
job rather than being caused by some disorder in the brain. Illness,
whether bodily or mental, he says, involves deviation from some clearly
defined norm. The question, though, is “who defines the norm?”.
Deviation from norms is a relative condition.
Psychiatry, he argues, poses many ethical problems as it is in the situation
of defining what actions are “normal” and what “unnatural”. As such,
“mental illness” becomes a legal and moral problem, and not a medical
prerogative. Based as it is on the medical model, psychiatry ignores the
obvious social and emotional problems that may lead to mental distress
and fatigue. He concludes this interesting article by saying:
The notion of mental illness thus serves mainly to obscure the
everyday fact that life for most people is a continuous struggle, not for
biological survival, but for a “place in the sun”, “peace of mind”, or
some other human value.
(Szasz 1960, p. 118)
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
Review questions
REVIEW QUESTION 12–1 How does the process of labelling illness affect the diagnosis and
treatment that the patient receives?
REVIEW QUESTION 12–3 Does the medical establishment have too much power in defining disease
and illness?
Conclusion
Labelling, institutionalism and stigmatisation can be powerful ingredients
in the interaction between patients and medical hierarchies. This is
especially clear when mental illness is the complaint. Research shows that
in many cases the label of “insane” is unwarranted and points to the fact
that mental illness is more of a social construction by powerful groups
(e.g. psychiatrists) than a soundly definable disease of the brain.
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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness
Nevertheless, studies have shown the extent to which the “mental patient”
is subject to unjustifiable control once admitted to the psychiatric hospital.
Interactionist research has provided convincing evidence to suggest that
hospitals treat patients more according to the needs of the institutional
hierarchy (“the bureaucracy”) and the opinions of doctors (“the experts”)
than to the needs of the patients in terms of proper diagnosis, treatment
and care. Yet despite this, this research tends to focus too much on
individual or institutional constraints. It does not reveal the extent to
which broader social forces impinge on and determine the various political
and ideological relationships such as those between doctor and patient,
patient and the institution or doctors and the institution. Moreover, it does
not show how social inequality is reproduced within the medical
hierarchy. Interactionist research only alludes to some of these broader
issues without actually clarifying them to any detailed extent.
Key concepts
Total institution
Stigma
Labelling
References
Goffman, E. (1961:1991). Asylums. Harmondsworth, Middlesex: Penguin Books.
Goffman, E. (1961:1990). Stigma. Harmondsworth, Middlesex: Penguin Books.
Mechanic, D. (1978). Medical sociology (2nd ed.). New York: The Free Press.
Rosenham, D. (1973). On being sane in insane places. Science, 179, January,
pp. 250–258.
Russell, C. & Schofield, T. (1986). Where it hurts. Sydney: Allen & Unwin.
Szasz, T. (1960). The myth of mental illness. American Psychologist, 15, pp. 113–118.
Wing, J. & Brown, G. (1978) Institutionalism and schizophrenia: Summary,
discussion and conclusions. In D. Tuckett & J. Kaufert (Eds.), Basic readings in
medical sociology (pp. 204–212). London: Tavistock.
Williams, S. (1987). Goffman, interactionism, and the management of stigma in
everyday life. In G. Scambler (Ed.), Sociological theory and medical sociology.
London & New York: Tavistock.
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