Disentangling Mental Illness Labeling Effects from Treatment Effects on Well-Being

The emerging field of Mad Studies has returned attention to deficiencies of the medical model, refocusing scholars on social causes of mental health problems and on consumers'/survivors' experiences of labeling and stigma. These themes echo issues addressed in traditional and modified labeling theories. A fundamental labeling premise is that professional categorization as "mentally ill" is a major determinant of individuals' poorer psychological well-being. However, this relationship has not been tested appropriately because past studies frequently measured formal labeling by a person's involvement in treatment. Treatment involvement can indicate the receipt of potentially beneficial services or harmful categorization with a stigmatizing label. Independent measures of these constructs in the National Comorbidity Survey-Replication enable reexamining traditional and modified labeling hypotheses for individuals with (N = 1,255) and without (N = 4,172) a recurrent clinical disorder. Supporting labeling theory's central proposition, formal labeling was linked to more negative affect and disability days in both groups. These relationships were not spurious products of preexisting serious symptoms, refuting a psychiatric explanation. Treatment involvement effects differed noticeably between the groups, underscoring the need to keep treatment and labeling measures distinct.