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Concepts of health, wellbeing and illness, and the aetiology of illness: Section 4. Concepts of primary and secondary deviance

This section covers:

1. Labelling theory and deviance

2. Primary and secondary deviance

1.  Labelling theory and deviance

The concepts of labelling and stigma derive from the interactionist sociological perspective described above, and focus on the importance of the symbolic meanings of health and illness. That is the shared social connotations and imagery that are associated with particular events and objects and upon which our actions are largely based. Labelling as a sociological construct has been used to inform medical practice since the 1960s in order to draw attention to the view that the experience of 'being sick' has both social as well as physical consequences. 

Becker's (1963) original work on the social basis of deviance argues that, 'social groups create deviance by making the rules whose infraction constitutes deviance'. Applying these 'rules of deviance' to individuals or groups means labelling them as 'outsiders'. He goes on to argue that, 'deviance is not a quality that lies in the behaviour itself, but in the interaction between the person who commits an act and those that respond to it'. The 'deviant' is therefore the one to whom the label has successfully been applied. Behaviour that is labelled as deviating in some way from the 'norm' necessarily involves the value judgements of those powerful individuals who are in a position to impose such labels. Labelling theory focuses less on the 'deviant act' itself, and more upon the societal reaction to that particular behaviour.


2.  Primary and secondary deviance

Lemert's (1967) work followed on from Becker's insights in recognising the importance of the reactions of others in the explanation of deviance, whilst drawing a distinction between 'primary' and 'secondary' deviance. Primary deviance is seen to consist of deviant acts (with any amount of causes) before they are publicly labelled, and has 'only marginal implications for the status and psychic structure of the person concerned'. Secondary deviance is much more significant because it alters a person's self-regard and social roles. This follows the public identification of a person as deviant, and the individual's response to this negative societal reaction (a judgement of social 'normality'). It is in direct response to this labelling that the person changes their behaviour in accordance with the label; the label constituting a 'self-fulfilling prophecy'. 

In the case of sickness, primary deviance represents the illness experience. The process of secondary deviance is constituted through the act of diagnosis wherein doctors engage in a process of classification through which people are either labelled ill (deviant from the 'norm') or healthy. It is because these disease labels carry such widely shared public stereotypes that the behaviour-change characteristic of secondary deviance occurs:

Labelling as a means of creating diseases, must be distinguished from the cause of diseases. So, whether the biological state of an individual is a 'disease' or not, is established by the doctor when the diagnosis or label is given to the patient (Armstrong: 1989:35)

© I Crinson 2007, Lina Martino 2017