Labeling, Looping, and Social Control: Contextualizing Diagnosis in Mental Health Care

Purpose – To assess labeling and social control of clients in contemporary mental health care organizations.

Methodology/approach – Fifteen months of observation in two multiservice mental health care organizations, interviews with workers and clients, and analysis of organizational documents.

Findings – The organizations used a variety of organizational labels, both official and informal, which served distinct purposes in organizational life and which did not always agree in their construction of the client. Official mental illness diagnosis was a bureaucratic label, while informal labels determined the types of social control to which clients were subjected. Clients who were informally labeled severely mentally ill were subject to integrative social control, while exclusionary social control was applied to those informally seen as not being severely mentally ill. Unlike in classic studies of mental health care, looping processes, in which client behaviors are viewed as symptoms, do not reliably predict the types of labels or social control applied to clients.

Implications – It is important for a sociology of diagnosis to contextualize official diagnosis in the repertoire of organizational labels applied to clients in mental health care, recognizing that it plays a limited but important role in organizational life. Informal labels, which at time conflict with official diagnosis, play a more prominent role in the management of everyday organizational life.