Differential Labeling of Mental Illness by Social Status: A New Look at an Old Problem

Abstract

Whether the higher rates of mental hospitalization and involuntary treatment for marginal social groups are due to differential labeling or simply to the occurrence of higher rates of disorder in these groups remains unresolved. I reexamine this issue with data from the National Comorbidity Survey (N = 5,877) that allow comparisons between disturbed individuals living in the community untreated and disturbed persons who have been hospitalized or seen a professional for their mental health problems under pressure or voluntarily. Contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have been hospitalized or seen a professional against their will. Consistent with self-labeling theory, persons with greater education and those not in poverty are disproportionately present among individuals who sought treatment by choice. Additional analyses show that factors that predict service utilization are important determinants of mental health service use but do not account systematically for status disparities in hospital or outpatient treatment, especially disparities by poverty status. Although I do not confirm a central tenet of labeling theory here, the negative consequences of labeling and stigma continue to be well-supported in the literature.

Exploring Identity Dynamics in Mental Help-Seeking Trajectories: An Ethnographic Study Among Inpatient Service Users of Two Belgian Psychiatric Hospitals

“…It concerned people with a low socioeconomic status and a limited number of valued role identities. Socioeconomic status has previously been identified in relevant literature as a predisposing factor, which influences both peoples' susceptibility to mental health problems (Andersen, 1995)-because of a lifestyle that contains more risks of differential disorders (Gove, 1982, in Thoits, 2005)-and because of their illness behavior (Young, 2004). Differences in socioeconomic status have also been linked to differences in access to qualitative care settings and treatment (e.g.…”

Educational Trajectories and Health over the Life Course: A Role for the DSBN Academy?

“…In addition, individuals with higher educational attainment who do smoke are more likely to quit than their less educated counterparts (Wray et al 1998). Those with higher education are also less likely to have experienced one or more psychiatric conditions in the past year (Mirowsky & Ross, 2003;Thoits, 2005). Furthermore, when individuals of low and high social status experience the same mental health disorders, it is those who have greater educational attainment that are more likely to consult with a practitioner and seek some form of treatment (e.g.…”

“…Furthermore, when individuals of low and high social status experience the same mental health disorders, it is those who have greater educational attainment that are more likely to consult with a practitioner and seek some form of treatment (e.g. Thoits, 2005). Thus, even where class may not be enough to spare individuals from a particular condition, it can facilitate likelihood of treatment, and thus mediate severity.…”

Diagnosis, Achievement , and Social Inequality: The Correlates and Consequences of Children's Mental Health Diagnoses

“…There is an extensive literature on the social construction of mental illness, and its association (or lack thereof) with physiological and biological factors Szasz 1962;Thoits 2005). The social-constructivist view of mental health diagnoses proposes that diagnosis is a reflection of power and social position, in which everyone behaves in ways that could be considered "mentally ill", but only those of low status unable to protect themselves against diagnosis are actually labeled (i.e., diagnosed).…”

“…Moreover, mental health symptoms were included in the analyses, and continued to predict diagnosis status across the stages of the illness career. This study thus follows a long tradition of research which presumes that medical diagnosis, although shaped by social factors, is not simply a social artifact Horwitz 2007;Thoits 2005). The medical aspects of diagnosis are thus a recognized and incorporated dimension of this study, as this project is premised upon the 220 idea that diagnoses exist, are distinct from mental health symptoms, and are informed and indicative of both social and medical conditions.…”