Unchaining Prometheus: Does a caste allocation hypothesis begin to explain the pervasive effects of diagnostic labelling and stigma on service users?

One of the aims of this review will be to draw upon Wright and colleagues' (2000) claim that the ‘labelling’ field needs theoretical development. By comparing and contrasting the two main approaches to understanding diagnostic practices, Modified Labelling Theory (MLT; Scheff, 1999; Wright et al, 2000) and the medical model (Wolff, 1991); we can further hypothesise on the social function of diagnostic practices. The three main areas of conceptual overlap between MLT and the medical model are as follows.1) Psychological processes play a key role.2) Diagnosed individuals are interpersonally (or culturally) diverse and tend to challenge implicit (‘unspoken’) social norms.3) This diversity may increasingly result in the labelled being socially excluded, under the guise of being ‘violent’, ‘odd’ or ‘deviant’.Karpman's (1968) drama cycle offers a social cognitive model that explains the co‐dependant social function of the violent persecutor role. When the roles become unjustifiably (ie. Large et al, 2008; Fazel et al, 2009) pervasive and stymied (as in the case of labelled individuals), labelling becomes understood as functioning as analogous to a caste system. This innovative hypothesis could generate both research impetus, as well as implications for clinical practice.