Module 4—The social meanings of the

body, health and illness

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

Resource material readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–3

Further readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–3

Erving Goffman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–4

Asylum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–4
Stigma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–6
Labelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–7

Review questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–9

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–9

Key concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12–10

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.

Resource material readings

Reading 12–1 Williams 1987

pp. 134–164

Further readings

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,
pp. 435–470 (Chapter 16: Social and Psychological Issues).
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,
pp. 182–189.
Szasz, T. (1960). The myth of mental illness. American Psychologist, 15, pp. 113–118.

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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

His central concerns are:

1. the process of hospitalisation
2. the mortification process in the hospital, and
3. the adjustment and recovery process in the hospital.
He argues that the beginning of the process of hospitalisation is a social
one, as hospitalisation involves a number of considerations, such as the
visibility of the “abnormal behaviour” and the socio-economic status of
the patient, regardless of the psychological beginning of the mental illness.
He was not concerned about what was going on in the head of the mental
patient. He observed that hospital regimes undermine the patient’s
“civilian self” by prescribing every aspect of how to behave. This involves
stripping and the loss of personal possessions, and a constant review of
the patient’s behaviour. Goffman terms this the process of mortification
and argues that it is based upon a psychiatric view of the self rather than a
social one. Goffman observes that patients adjust to the hospital by
regaining some sort of control over their selves, for example, by using
toilet paper to roll cigarettes or enrolling for therapy in order to make
sexual contact with the opposite sex. He argues that these may seem quite
bizarre from a psychiatric point of view, but from a sociological point of
view these are reactions by the patients to what has been taken away from
them.

Reading 12–1 Williams 1987

pp. 134–137

Sociologists who are influenced by the works of Goffman argue that in

terms of medical care, the process of institutionalisation can have many
negative effects. This is because the rationale of the effective management
of the institution overrides the more general concerns of patient welfare.
Admittedly, patients in institutions do have available to them medical
support and facilities not readily available outside the institution.
However, the overall environment of the medical institution has been
found to have negative consequences for patients’ health and speed of
recovery. This is especially so for lower class, and economically poor,
patients who have to rely on poorly equipped public hospitals. Conversely,
if the environment improved, so did the patients’ general health and
well-being. This has been shown to be the case with schizophrenic
patients in a mental hospital.
Institutionalisation can also have negative effects on other types of
patients—the chronically ill, the aged, or alcoholics. Due to the increasing
poverty of many elderly people in Australia, and their subsequent

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Goffman’s theory of stigmatisation and labelling: Consequences for health and illness

deterioration in health, state institutions and private nursing homes have

become favourite options for the care of the elderly and infirm. The high
costs of this care, together with the generally miserable conditions in
many of these places, mean that the elderly tend to develop chronic
physical and mental illness (especially mental depression) rather than
living out their lives in a caring and friendly environment (Russell &
Schofield 1986, pp. 182–189).
Mechanic (1978, p. 455) has found that differences in admission to clinics
for alcoholics have a dramatic effect on the patient’s expectations of
improvement. While only nine percent of the voluntary patients reported
that they expected to drink again when leaving the facility, thirty-seven
percent of the involuntary patients reported an intention to drink again.
Another problem that emerges from institutionalism in medicine is that
many patients tend to become dependent on the institution and vulnerable
to long-term stay. This is apparent with patients who do not have strong
personal, family or job ties, or are vulnerable because they live in poverty,
because of their age, or because they lack social interests (Mechanic 1978,
pp. 454–455).

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.

Reading 12–1 Williams 1987

pp. 137–161

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)

Many of the problems in psychiatric diagnosis and treatment are clarified

in the article by Rosenham (1973). His study shows that once a patient is
labelled as mentally ill, there is very little that person can do to shake off
this label—that is, to go from insane back to sane. This was apparent
especially in the confines of the psychiatric hospital. In his research he
sent teams of “pseudo-patients” (pretending to be “hearing voices”) to
various hospitals and then analysed the reports of their experiences.
Among the significant findings in his research were:
1. the normal were not detectably sane
2. the psychodiagnostic label tended to override all displays of “normal”
behaviour once admitted into the institution
3. the extent to which staff avoided responding to patients’ inquiries, and
4. the immense degree of powerlessness and depersonalisation of
patients.
In other words, Rosenham’s research shows that once the label of “insane”
is attached then patients are treated as less than human, even to the extent
of them being subjected to depersonalisation and being shunned.

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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 12–2 Is mental illness a physiological condition or simply a misinterpretation of

the patient’s actions?

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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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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