engage frequently in conventional routine behaviors, they tend to exhibit moments of deviation as a measure of the kind of persons they really are. In his research, Erikson demonstrated via an examination of the Salem witchcraft trials that this very selective labeling serves a societal purpose of helping a community define its social and moral boundaries so that they could develop a sense of group identity. That is, labeling some individuals via interpretations of their behaviors or appearances as outliers served to define the rest of the group as a community.
The third question regarding the interpretation of deviancy through labeling involved the reasons or process of deciding whether a behavior or appearance was sufficiently different to warrant the label of deviant. Edwin Lemert (1967) established the concepts of primary and secondary deviance to address this question. Primary deviance refers to initial acts of deviance that arise from original causes like social or cultural factors or psychological and physiological limitations. He believed that these were often situational, transient, and idiosyncratic, and therefore they could be dismissed by others. In these situations, these individuals experienced only minor consequences that impacted their persons and their status, social relationships, and future behaviors. Secondary deviance, however, was more severe. Lemert defined this level of deviancy as occurring when society’s negative response to a person’s initial deviance (e.g., stigmatizing, punishing, segregating the offender) caused fundamental changes in the person’s status, self‐identity, or personality. In these cases, there is an explicit response involving societal reactions to the deviant behavior or appearance; this results in the “secondary deviant’s life and identity (being) organized around the facts of deviance” (Lemert, 1967, p. 41). Tied into the distinction between primary and secondary deviancy was the fact that the most important societal reaction, the one that often triggered secondary deviancy, was the response of social institutions of control—the criminal justice system, special education regulations, mental health institutions—that are legitimated by the state (Goffman, 1964; Lemert, 1967).
Given this theoretical orientation and the work of others, Howard Becker investigated labeling as a theoretical social construct in his 1963 book Outsiders: Studies in the Sociology of Deviance. In this book, Becker was especially interested in the construct of deviancy in society—why some acts are thought to be deviant and who has the power to label individuals and/or their behavior as deviant. Becker examined the impact of such labeling on society and the individual. Based upon his work, he believed that labeling is a sociopolitical act, since his research indicated that once a label has been assigned, how we respond to the label (and the underlying acts that characterize it) depends on whether the label and its underlying actions have become sanctioned within the society. He believed that it is not the label or the actions of the individual so labeled that are deviant, but rather, the responses of society that defines it as such. Importantly, Becker believed that the responses of the powerful in the society (e.g., judges, legislators, physicians, diagnosticians) often determine how we are expected to view such labels and the actions that are characteristic of the labels.
Becker, led by symbolic interactionism, made two primary contributions to labeling theory, and his work, though somewhat controversial, is the primary current standard for labeling theory. The two major contributions were, first, that he offered an explicit labeling definition of deviance: “…deviance is not a quality of the act the person commits, but rather, a consequence of the application by others of rules and sanctions to an offender” (1963, p. 9). His second contribution was that he expanded the scope of societal reactions to encompass the creation and enforcement of social rules. Basically, this meant that the creation of deviancy begins not at the point when a person violates some rule, but earlier when social groups first create those rules. Becker also contrasted the positions he staked out for labeling theory with conventional theories of deviance. This enabled a greater constructivist orientation.
Based upon this work in sociology, labeling theory has become an important mechanism for understanding how and why the labeling of individuals as deviant or the assigning of a diagnostic label (in the case of speech‐language pathologists) may result in unintended consequences. Erikson summed up labeling theory succinctly when he argued that “Deviance (as a basis of labeling) is not a property inherent in certain forms of behavior; it is a property conferred upon those forms by the audiences which directly or indirectly witness them” (1962, p. 311).
1.3 Labeling within a Diagnostic Process
Based upon labeling theory, it is clear that this social process is active in the diagnostic process within which speech‐language pathologists are frequently engaged; labeling as a specialized circumstance is most evident in the educational and clinical disciplines during those events referred to as “diagnosis.” Since the early 1960s, but especially since the widespread funding of special education in the United States, there has been a tendency to refer students to special education for language‐based learning problems and for communication disorders of various kinds (e.g., Department of Education [DoE], 2002; Kretschmer, 1991; Richardson & Parker, 1993). Similarly, adults with various communication problems are also referred in order to initiate rehabilitation (e.g., Edwards & Bastiaanse, 2007; McDonald, 2007; Thompkins, Marshall, & Phillips, 1980). When an individual (or their caretaker) is in search of an explanation for mental, physical, emotional, or behavioral differences, or when someone seeks assistance with learning or adaptive problems, this individual undergoes a diagnostic process (Flower, 1984). The referral for this evaluation is followed by an assessment process that is intended to provide a diagnostic label.
There have been numerous discussions on the process of evaluation in communication disorders. In general, the process is as follows: (a) a referral is made to the speech‐language pathologist (SLP) by a teacher, nurse, physician, administrator, another professional, or family member; (b) the SLP reviews the referral and determines the types of information that should be collected; (c) an appointment is made for the SLP to evaluate the referred individual in a setting chosen by the professional; (d) a set of tests and other diagnostic procedures are chosen for the assessment session; (e) the assessment is completed at the appointed time(s); (f) the data from the assessment session are combined with any other data obtained by the SLP to provide diagnostic interpretation involving differential and descriptive diagnosis; and (g) a diagnostic label or category is assigned. Once the diagnosis is assigned, then other decisions addressing educational and/or therapeutic issues are considered and implemented.
Following Matsueda (1992) and the idea of reference groups that employ societal mechanisms to justify the diagnostic process and the resulting labels assigned, there are various sanctioned instruments and documents that are employed to justify and legitimize the diagnostic process. Within the diagnostic realm, the first mechanisms of influence developed by individuals in positions of power are instruments like the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, the classifications and position papers published by the American Speech‐Language‐Hearing Association, and codified laws and regulations sanctioned by governmental entities. These documents and codes create an expectation of societal support and need for those perceived deviancies characterized as communication disorders. However, there are other ways that diagnostic labeling is implemented and supported in society: medicalization and diagnostic legitimization. A brief discussion of these two primary and influential mechanisms will demonstrate the subjective nature and the power of labeling.
1.3.1 Medicalization
Perhaps the most salient demonstration of a mechanism of symbolic interactionism and its impact on labeling at the societal level involves what has been termed “medicalization theory” (Williams & Calnan, 1996). This explanatory mechanism involves the impact of society and its values acting through a particular societal institution—medicine—to create new diagnostic categories or to redefine or expand old categories according to current sociocultural values and beliefs (Conrad, 2007; Halpern, 1990; Zola, 1972). In addition to the extension of medical boundaries, in the process of medicalization, nonmedical problems become defined and labeled as medical problems, usually as disorders or illnesses. For example, over the past 40 years there have been numerous new medical