Mind Your Labels
Let's talk about criminology. Why? Labels can be harmful.
Labelling Theory
Why do people commit crimes?
Criminology tries to answer that question and many theories attempt to explain why people engage in criminality. One theory that has particularly interesting applications to discussions about diabetes and discrimination is labelling theory.
Labelling theory contends that formal labels placed on offenders influence their likelihood to continue offending. In other words, if I call you a criminal, process you through the criminal justice system as a criminal, and charge you with offenses under the criminal code that label you, for example, as a thief—a person who has committed the crime of theft—then you are stuck with that label for life.
Frank Tannenbaum had served time in prison as a conscientious objector and coined the phrase “dramatization of evil” to describe the tendency of authorities to label someone a delinquent with the result of the person internalizing the label. He also thought that “we treat people in terms of the categories into which they are placed rather than in the fullness of their humanity.”1
The power of this societal label is extremely strong and often stigmatizes an individual to the point where they internalize the label.
I know what you’re thinking. So be it, you might say. That’s what the criminal justice system is there for, right? But what if it’s a self-perpetuating system? Wouldn’t you rather that people not engage in the criminality in the first place? Wouldn’t you rather that people become law-abiding citizens? Do you really want that kid who made a mistake to end up in jail and learn how to become a worse criminal when they get out?
Human beings may respond according to the definitions that are placed upon their behaviour by others, particularly by those in power, such as court judges or physicians. Repeated acts of criminality (also known as recidivism) could be the consequence of a formal label because tags such as “criminal,” “juvenile delinquent” or “thief” eventually alter an individual’s self-image to the point where they begin to identify with the label and act accordingly. 2
This is all heavy stuff, I know.
Order in the court!
Power Brokers
Labelling theorists contend that only groups in power are the ones who define formal laws at the expense of those who are unable to effect change. If we take the example of the criminal justice system, we see that those lacking sufficient power—such as minorities—are most likely labeled as criminals, and are disproportionately represented in prison.3
People who are executives at pharmaceutical companies who are engaged in overcharging for insulin and profiting from it, for example, are not. Why this double-standard? Why is one type of theft just fine and another results in serious criminal consequences?
This also has to do with the visibility of the crime and its enforceability. Fraud might happen as a white-collar crime, but a theft in the street is more likely to result in a conviction for the offender as it’s more visible. Moreover, those who lack the necessary resources are more likely to be labelled since they cannot hire competent lawyers to successfully defend themselves against charges.
“Deviants” & “Outsiders”
As Howard Becker puts it:
… social groups create deviance by making the rules whose infraction constitutes deviance, and by applying those rules to particular people and labelling them as outsiders. 4
These “outsiders” are pushed to the margins of society. Labelling theorists argue that a person labelled as a criminal is more likely to continue reinforcing such behaviour, as they are not only shunned by conformist peers, but are accepted into the groups who are already labelled criminal, pushing them further away from people who might reinforce a more positive definition of self.
Labelling theory has some validity—many practitioners within the criminal justice system are making more of an effort not to stigmatize those who may be more sensitive to labels, such as young people formerly called “juvenile delinquents.” Many treatment and prevention programs now attempt to build positive self-images instead of creating negative tags, which to some degree suggests labels can be harmful.
We all to some extent internalize the labels others apply to us—especially labels applied by those in power. We even rely on stereotypical notions of who a person is by their appearance, and, as I’ve argued, by their connections to roles of status and scientific legitimacy. As Wilson and Rachal have written with regard to politicians, you could:
Dress a person in a three-piece suit, let him grow a beard, and what he says will prove more believable to most audiences than the same message delivered by the same person dressed in jeans and looking casual and unimpressive.5
This means to say the same message coming from the mouth of a physician and coming from a person with diabetes is seen in different ways—one carries more authority and legitimacy than the other. It’s more about public perceptions and assumptions about people who occupy a position of power—bias—than it is about the accuracy of the message.
Labelling theory extends beyond criminology—its ideas resurface in areas such as the health care system. The practice of medicine, like the justice system, has a habit of labelling people through diagnosis and beyond.
The "Diabetic" Label
If I am labeled at diagnosis as a “diabetic” (most T1Ds are diagnosed at an impressionable age, usually in their teens) and treated as only a diabetic, and am not encouraged or motivated to be anything more than this, the labelling can be detrimental as I might internalize this identity and not allow myself to break free from seeing myself only as this label. If this is continually reinforced through my daily interactions, it might eclipse the reality of more positive aspects of my personality.
It is especially debilitating when it’s a chronic condition, because the person must confront it continually through checkups at the doctors, visits with the pharmacist, family members, friends and even each day through blood monitoring and multiple insulin injections.
Breaking away from the label “diabetic” is easier said than done. The actual diagnosis and naming of the medical condition is problematic also—the terminology carries with it a legacy of science, misunderstandings and confusion. For example, a child who is on an insulin pump with a CGM and a senior citizen who takes pills and adjusts his or her diet are both labelled “diabetic” as if both experience the same things following diagnosis.
Diabetes covers a wide range of conditions and treatments and is not adequately dealt with by one label from the medical community. A more comprehensive approach to diabetes might be in order—an approach that would allow people to experience life without the negative labels.
I was christened as “diabetic” by an authoritative physician at diagnosis when I was sixteen. A whole set of stigmatizing baggage that I didn’t even know existed came along with the actual physical condition.
While applying this label isn’t considered as drastic as the process of law enforcement labelling a criminal, it has a similar negative connotation in that it brands someone as a disease, rather than recognizing the fullness of their humanity. It stigmatizes and causes very real damage. I would rather be considered on my character than as a physiological condition.
The label may even have the adverse effect of an individual rebelling against the condition or not seeking medical treatment from fear of reprimand from the physician.
We’re people who happen to have diabetes. We’re not “diabetics.”
Thank you for reading this substack. I appreciate that you’re here! I am doing my best to manage the highs and lows of diabetes. Now it’s time to go for a walk in the spring rain.
Tannenbaum, Frank (1938) Crime and the Community, Ginn and Company, p.165
Edwin Lemert divided the labelling process into primary and secondary labelling processes—the first doesn’t usually translate into social stigma by law enforcement, because it is undetected or unrecognized as deviant; it is the second labelling process by authorities that can confirm a commitment to antisocial actions, because the deviance has been committed as a result of the label. Lemert, Edwin M. (1951) Social Pathology, McGraw-Hill
Shoemaker Donald J., (1996) Theories of Delinquency, 3rd. ed.: An Examination of Explanations of Delinquent Behaviour, Oxford University Press, p. 192
Becker, Howard S. (1963) Outsiders: Studies in the Sociology of Deviance, The Free Press, p.9
Wilson, J.Q. & P. Rachal (1977) “Can the Government Regulate Itself?” The Public Interest, 46, p. 3–14 as quoted in Binder, A., Gilbert G. & B. Dickson (1988) Juvenile Delinquency: Historical, Cultural, and Legal Perspectives, Macmillan Publishing, p.164