Labeling

Labeling by Family, Friends, and the Public Like individuals, families only reluctantly label their members mentally ill. Instead, families can deny that a problem exists by convincing themselves that their relative’s be- havior does not depart greatly from the norm. If they do recognize that a prob- lem exists, they can convince themselves that their relative is lazy, a drunkard, “nervous,” responding normally to stress, or experiencing physical problems

rather than mental illness. Finally, families might recognize that their relative is experiencing mental problems but define those problems as temporary or unimportant.

Two factors explain how and why families can long ignore behavior that oth- ers would label mental illness. First, those who share cultural values, close personal relationships, and similar behavior patterns have a context for interpreting unusual behavior and therefore can interpret behavior as meaningful more easily than outsiders could. Second, families often hesitate to label one of their own for fear others will reject or devalue both the individual and the family. As a result, families have a strong motive to develop alternative and less stigmatizing explanations for problematic behavior.

Moreover, even when relatives and other intimates define an individual as mentally ill, they don’t necessarily bring the individual to treatment. Instead, they can continue to protect the individual against social sanctions through a process Lynch refers to as accommodation. Accommodation refers to “inter- actional techniques that people use to manage persons they view as persistent sources of trouble” and to avoid conflict, such as humoring problematic individu- als or minimizing contact with them.

Nevertheless, despite these attempts to normalize and accommodate men- tal illness, families and friends may eventually conclude that an individual needs treatment. At that point, they must either get the individual to agree or coerce the individual into getting treatment despite his or her active resistance. One study of persons seeking care for a serious mental illness for the first time found that 42% had actively sought care and 23% had been coerced (Pescosolido, Gardner, and Lubell, 1998). Coercion was most common among those with bipolar disorder, who often enjoyed the “highs” of mania even though others regarded them as seriously disturbed, and among those with large, tight social networks. In an- other 31% of cases, families “muddled through”: Either the individuals went along with treatment decisions made by others without accepting or rejecting those decisions, or no one in the family seemed to have been in charge of the decision- making process.