The Concept of Normalizing: Neither Labeling nor Enabling
by Thomas J. Scheff (June 2010)
Instances and General Ideas: Parts and Wholes, NER, April 2010.]
Labeling theory suggests that in some cases a better way might be normalizing those who break the residual (unstated) rules, rather than labeling, ridiculing or rejecting them. This is not to say that one should always normalize. Automatic responses, whether labeling or normalizing, are equally undesirable. Labeling/normalization theory suggests that we need to decrease automatic responses of both kinds. Automatic normalizing can result in enabling, automatic labeling can result in social rejection.
Normalizing in a Film and in Real Life
Early in the session, the Doctor asks:
Has Lars been functional, does he go to work, wash, dress himself?
This dialogue establishes limits the film sets to normalizing: able to take care of self, unlikely to harm self or others. However, there are many other limits that must be set in order to avoid enabling. For example, does he take drugs? In the educational context, to be discussed below, the teacher must take care to accept the student without confirming their mistakes.
(Preliminary normalizing statement, rejecting diagnosis)
In this fable, Lars has been scripted to find an extraordinarily unconventional doctor. Not prescribing psychdrugs for symptomatic patients now amounts to heresy, or at least is not acceptable practice. I have a psychiatrist friend who is a real life Dr. Dagmar. She left her first and only fulltime job under pressure because she normalized rather than prescribing psychdrugs.
For example, she treated a young man who unable to keep still, complained of restlessness, fidgeted, rocked from foot to foot, and paced. She told him and his employer that he was not mentally ill, but drugged by the antidepressant he was taking (Prozac), which proved to be correct. Lest this instance seem too obvious, I know of many similar cases where the presiding physician decided that the problem was not too much drug, but too little. A vast difference of outlook separates the great majority of labeling physicians from the few normalizing ones.
[1].
Until recently, I hadn’t realized that in the actual dialogue, in order to normalize suspect behavior, the healer must specifically translate the discourse out of the labeling mode and into the normalizing mode, and be prepared to accept the consequences from the world of automatic labeling. In the fictional case, the doctor said, in effect, you are not mentally ill, you are just communicating. In the real case, the psychiatrist said, you are not mentally ill, you are just drugged.
Inadvertent Normalizing
It is ironic that because I didn’t understand the actual look of normalization, I didn’t recognize it occurring in my own next study. At the time that my book was being first published (1966), I observed a series of very brief recoveries from depression. As a visiting researcher at Shenley Hospital (UK) in 1965, I was present for all intake interviews of male patients for 6 months: 83 patients in all. Of this number 70 patients were sixty or older.
The comments that follow concern the older men. Every one of them presented as deeply depressed in their speech and manner. However, to my surprise, there were moments in some of the interviews that seemed miracles of recovery. It took many years for me to understand what I had observed in terms of labeling theory.
Many of the patients were virtually silent, or gave one-word answers. Long before I came, some of the interviewing psychiatrists had found a way of getting more response to their questions. In the interviews I observed, 41 of the patients were asked about their activity during WWII. For 20 of those asked this question, the responses shocked me. As they begin to describe their activities during the war, their behavior and appearance underwent a transformation.
Those who changed in the greatest degree sat up, raised their voice to a normal level instead of whispering, held their head up and looked directly at the psychiatrist, usually for the first time in the interview. The speed of their speech picked up, often to a normal rate, and became clear and coherent, virtually free of long pauses. Their facial expression became lively and showed more color. Each of them seemed like a different, younger, person.
The majority changed to a lesser extent, but in the same direction. I witnessed 20 awakenings, some very pronounced, however temporary. The psychiatrists told me that they had seen it happen many times. After witnessing the phenomenon many times, like the psychiatrists, I also lost interest.
Many years later, because of my work on shame, I proposed a partial explanation (2001): depression involves the complete repression of painful emotions (such as shame, grief, fear, and anger), and lack of a single secure bond. The memory of the patients’ earlier acceptance as valued members of a nation at war relived the feeling of acceptance. This feeling generated pride that counteracted the shame part of their depression.
Telling the psychiatrist about belonging to a community during WWII had been enough to remove the shame of being outcasts. Conveying to the psychiatrist that “once we were kings,” had momentarily relieved their shame and therefore their depressive mood.
When the psychiatrists asked the depressed outcast men about their experience during WWII, they were inadvertently normalizing the patients, returning them, for just a few moments, to what it felt like to be an accepted member of society, rather than labeled and rejected. My recent article on depression (2009) explained some of the implications for social, rather than medical treatment of mental illness.
However, because I had not used enough concrete instances in my theory, I still had not recognized the way the psychiatrists’ question could be interpreted in terms of labeling theory. The psychiatrists’ intentions were to continue to label the patients: “You are mentally ill, so I need more information to assist me with your diagnosis.” However, twenty of the patients understood the meaning as normalizing:”You are socially acceptable now if you were ever accepted even once as a valuable member of a community.” Perhaps a long-term therapy based on this and other social ideas might do better than just temporary recoveries.
Two Examples from Other Fields
A psychotherapist in bereavement and end of life care told me this story. The first time she met a new patient with dementia from brain cancer, the patient said to her: O, my! What have you done to your hair? At this point a relative might have argued: Oh Mom, I’m not Jenny, I’m Victoria. The therapist, instead of arguing, made a gesture of absentmindedly straightening her hair with her hand, saying: I haven’t been able to do a thing with it! They both laughed, and proceeded to have a lively session punctuated with laughing and crying. (For an argument that catharsis lives, see Scheff 2007).
The final example comes from the field of education. My UCSB colleague (Weissglass 2009) also teaches math in an elementary school for underprivileged children. He explains his method:
I ask students leading questions about mathematical situations in order to help them discover, understand, and become proficient in mathematics. The basic principle is that when asked to explain a wrong answer, students will discover their mistakes, and by working together as a group, develop their understanding.
A key aspect is not quite described; the teacher usually tries to save students from the automatic embarrassment of a wrong answer. One question: How many sides does this milk carton have? He is prepared to normalize many of the different answers by having thought ahead: your answer is about the visible side, outside, flat, etc. His method seeks to avoid automatic judgments: students are not always wrong, just as teachers are not always right. More importantly, in the long run, social acceptance, rather than automatic rejection, might improve our schools and our society. Teachers can learn to give corrective responses without putting the students down: normalizing without enabling.
An example from my own student days. A senior in physics, I had one professor that I particularly respected. I thought that he respected me also. However, one day when I went to the blackboard prepared to grind out the answer to the problem he had given me, I thought of an intuitive answer that was correct. My professor was so astounded that he said, Did Jim (the star student) tell you that? The beginning of the end of my love affair with physics: he had labeled me as a plodder and embarrassed me in front of the class.
Conclusion
References:
Fuller, Robert W. 2003 Somebodies and Nobodies. Gabriola Island, BC: New Society.
Goffman, E. 1964. Behavior in Public Places. New York: Free Press.
Neugeboren, Jay. 1999. Transforming Madness. New York: William Morrow
___ _________2001. Social Components in Depression. Psychiatry. 64, 3, 212-224. Fall
____________ 2007. Catharsis and Other Heresies. Journal of Social, Evolutionary and Cultural Psychology. 1 (3), 98-113
Thomas J. Scheff is Professor Emeritus, Dept. of Sociology, at the University of California at Santa Barbara.
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