From the Stickiness of Labels to Seeing What Sticks: The Diagnostic Economy in Psychiatric Outreach

• In Event: 444 - Section on Disability and Society Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 03. Labels and Diagnoses: How Much Do They Matter For Self-Concept?

Abstract

A primary claim of labeling theory and descendent approaches to human classification is that deviant labels are highly consequential and "sticky.” This article examines psychiatric labeling in urban mental health and homeless outreach to argue that, rather than the “stickiness” noted by labeling theorists and more recent analysts of mental illness stigma, certain institutional arrangements push workers to label large swaths of individuals and “see what sticks.” This is because potential patients are legally empowered to refuse care and the label, and street-level workers are unsure of how higher-level gatekeepers will ration limited resources to the initially labeled. In street outreach, diagnoses of serious mental illness are profoundly decoupled from formal goals of classification and treatment, and function primarily in an inter-organizational economy of resource linkage. Under political pressure to remove encampments from contested urban space, and with limited housing resources tied to psychiatric diagnosis, street level workers manipulate categories to process the “regular homeless” but receive pushback from gatekeepers screening for the "truly ill." Labels may have brief instrumental relevance before being tossed to the side, and only under specific conditions seem to influence self-concept. Building on the longstanding Goffmanian concern with the “contingencies” of who is labeled, I further theorize the institutional contingencies of when those labels become 1) activated for individuals, and 2) bureaucratically actionable.

Author

• Neil Gong, UCLA