We often make automatic judgments of "symptomatic" behavior: delusions, far example, show that one is mentally ill. The theory of labeling/normalizing urges caution in making these judgments because of possible effects on social relationships and thereby on self. (Scheff 1999). There is a social-emotional component in interaction that can be managed independently of the content. Equal care is needed to avoid both labeling andenabling (ignoring behavior that should be corrected). An episode in a current film provides a vivid illustration.

Currently those who are thought to be mentally ill are labeled with little consideration of the details of their situation Prescribers of psychotropic drugs have little incentive to sift through the case details (For a film that exaggerates this point, see Numb). Drugging often carries with it labeling and rejection, although rejection may be subtle.

Labeling theory suggests that it is often better to normalize unconventional behavior, rather than treating it (Scheff 1999). This is not to say that one should always normalize. Automatic responses, whether labeling or normalizing, are equally undesirable. We need to decrease automatic responses of both kinds. Automatic normalizing often results in enabling, automatic labeling often results in social and/or self rejection.

The recent film Lars and the Real Girl presents a relevant fable. Although a comedy, it also teaches how unconventionality might be managed without social side-effects. Early in the film, because Lars has been treating a life-size doll as a real person, his brother, Gus, and sister-in-law, Karin, bring him to their family doctor.

...Doctor: Has Lars been functional, does he go to work, wash, dress himself?

Gus: So far.

Doctor: Has he had any violent episodes?

Karin: Never... 

This dialogue establishes limits to normalizing: able to take care of self, unlikely to harm self or others.

Gus: Can you fix him?

Doctor: I don't believe he's psychotic or schizophrenic...What we call mental illness isn't always just an illness. It can be a communication, it can be a way to work something out.

(The key normalizing statement: Lars is not abnormal, he is just communicating)

In this fable, Lars has been scripted to find an unconventional doctor. For drama and comedy, the film enlists the whole community to help. But in real life, fewer people would be needed; even one might be enough. Jay Neugeboren (1999) investigated many cases in which there was recovery from what had been diagnosed as "serious mental illness." The common thread was that at least one person treated the afflicted one with respect, sticking by him or her.

There have been innumerable systematic studies of the individual risks of drug treatment. Have there been any of social risks, or of the risks of non-treatment? In many cases, a social treatment may be cheaper, less risky, and more effective than a medical one, as the film implies.

References

Neugeboren, Jay. 1999. Transforming Madness. New York: William Morrow

Scheff, Thomas.1999. Being Mentally Ill. Hawthorne, New York: Aldine