A sociological perspective on labeling in mental retardation.

The recent literature on labeling in mental retardation is reviewed and a conceptual scheme based on Scheff s model is presented for future study of the labeling problem. The issue of the medicalization or demedicalization of mental retardation is discussed in light of P.L. 94-142. Since the 1960s, legislators, administrators, educators, clinicians, parents, and others, have shown much concern for the harmful effects of labeling a mentally retarded individual. An intensive review of the literature on this problem leads to much confusion. For the clinician, labeling is part of the diagnostic procedure. Diagnosis is often dependent on the proposed or actual disposition of the case and becomes more accurate when treatment procedures are available and tested. As treatment procedures are proven, more diagnoses seem to be made allowing the procedures to be used. Diagnostic reliability is strongly related to the severity of disorder with diagnostic reliability increasing as symptomatology is more evident and specified: the diagnosis of severely and profoundly mentally retarded individuals is very accurate; in moderate mental retardation diagnoses the reliability begins to decline; and, for mild mental retardation diagnostic reliability is very low. Mercer (1973) has presented evidence suggesting that mild retardation labels are inappropriately applied to many minority low income children. In these instances diagnostic reliability appears directly related to socioeconomic status. A clinical diagnosis differs from a research diagnosis. The latter is the collection of information on a sample of people with classification playing a part. Researchers often define a disorder being studied and diagnose the sample respondents on the basis of an objective series of criteria (Rowitz 1974a). Actually, researchers in mental retardation use clinical diagnosis in studies of treated prevalence or service use. Research diagnosis is used in many community surveys. Labeling occurs in both instances; however, its meaning differs in each of the previous examples. Much discussion of mental retardation labeling relates to the attachment of a deviant tag or status to an individual whose behavior does not appear * This paper is a revised version of the presidential address given at the American Academy on Mental Retardation meetings in Denver, Colorado on May 14, 1978. normal to the identifier of the problem (Rowitz 1974b). Labeling does not occur in a social vacuum and it is a process which needs to be viewed in the larger perspective of a community social system. Individuals designated mentally retarded are often termed deviant as are mentally ill persons or drug addicts who as well do not fit into the mainstream of society. Glaser (1971) referred to deviance as an individual's attributes or actions regarded as objectionable in a particular social setting. There are many types of behavior following this pattern but not labeled deviant—many eccentricities are tolerated. Either the degree of or the extreme nature of an action seems to warrant the label deviant. Erikson (1962) says deviance is not a property inherent in the action or attributes of a given individual. As the label deviance is conferred upon the acts or attributes of an individual by the audiences viewing the acts, deviance becomes a sociological problem in origin (Becker, 1963). If the label deviant is successfully applied, these individuals become deviant because of the attachment of the label. The sociological assumption is that the individual will usually also accept the label deviant. MacMillan (1977) has correctly argued that the traditional sociological perspective on labeling is oversimplified. A number of factors may influence the labeling of an individual as mentally retarded and affect the impact of the label on the individual: (a) The individual's pre-labeling experiences such as family experience, peer group experience, and school experience; (b) The effects of more than one stigmatic label on the individual—e.g. mentally retarded and juvenile delinquent; (c) The effects of informal labeling by friends and neighbors; (d) The psychological impact on the individual of the formal identification of mental retardation by the school; (e) The reaction of the child's family to the mental retardation label; (f) The actual label used in contrast to the several possible names for the same set of problems, (p. 266-270)