Being Mentally Ill by Thomas J. Scheff is considered a key contribution to labelling theory and the sociology of mental deviance. Building on the theoretical insights of Howard S. Becker and Erving Goffman, Scheff argues that “mental illness” is not (only) a biologically or medically defined condition, but is significantly shaped by social processes of labelling. The work thus bridges psychological, psychiatric, and criminological perspectives.
Key Points
Thomas J. Scheff – Being Mentally Ill
Main proponent: Thomas J. Scheff (1929-2025)
First published: 1966
Country: USA
Core idea: Mental illness is not only a medical issue but socially constructed; psychiatric diagnoses are often based on normative judgments
Foundation for: Labelling theory, critical psychiatry, medical sociology, criminology
Related theories: Labelling Theory, Total Institutions (Goffman), StigmaA social mark of disgrace that discredits individuals or groups based on perceived deviance. (Goffman), Secondary DevianceDeviance refers to behaviors, beliefs, or characteristics that violate social norms and provoke negative social reactions. (Lemert)
Core Idea: Mental Illness as a Label
Scheff’s central thesis is that mental illness is less an objectively identifiable pathology and more a socially assigned status. Psychiatric diagnosis is not solely based on medical criteria but is deeply intertwined with social norms and expectations. Individuals who behave in deviant ways—appearing emotionally unstable, unpredictable, or non-conforming—are labelled as “mentally ill.” This label affects not only how others perceive them but also how they perceive themselves—a process closely related to Goffman’s concept of stigma.
Term: Residual Rule-Breaking
Scheff uses the term „residual rule-breaking“ to describe behaviors that violate implicit social rules but cannot be clearly categorized as norm violations. These diffuse infractions are particularly susceptible to psychiatric labelling.
Primary and Secondary Deviant Reactions
Drawing on Edwin Lemert’s concept of secondary deviance, Scheff distinguishes between:
- Primary deviance: Behavior considered unusual but not yet labelled.
- Secondary deviance: Behavior that arises in response to the social label of “mentally ill”—such as internalizing the patient role, withdrawal, or symptom intensification.
The diagnosis thus becomes a self-fulfilling prophecy. The individual behaves as expected—not because they are inherently ill, but because they are treated as such.
Institutional Reinforcement: The Role of Psychiatric Institutions
Scheff builds on Goffman’s concept of the total institution as developed in Asylums (1961). He analyzes how psychiatric facilities reinforce deviant labels by structuring daily life in ways that deprive individuals of autonomy and social roles.
Admission to a psychiatric facility signals to others that the person is indeed mentally ill. The social environment responds accordingly, while the patient increasingly identifies with the imposed role.
According to Scheff, psychiatric treatment can be stigmatizing and chronicizing—not because of its content, but because of its structure: loss of social roles, external control, and isolation foster withdrawal and entrench the illness status.
Critique of Medical Dominance
Scheff criticizes the dominant medical discourse on mental illness for ignoring social causes and meanings. In his view, biological models overlook contextual factors such as poverty, social isolation, family conflict, or cultural norms. Sociology, by contrast, can reveal how deviance is defined, interpreted, and sanctioned—and how these processes contribute to the production of psychological abnormality.
Relevance for Criminology
Scheff’s theory is not limited to psychiatry. It is also applicable to criminology: legally relevant deviance (e.g., violence, impulsive crimes, or rule-breaking by mentally unstable individuals) is often pathologized. The boundary between “deviant” and “ill” is fluid—especially when behavior is seen as irrational or uncontrollable.
Goffman’s and Scheff’s ideas also resonate in contexts such as forensic psychiatry, preventive detention, and assessments of criminal responsibility. By focusing on social labelling rather than objective pathology, Scheff offers a critical counterpoint to conventional psychiatric explanations of criminal behavior.
Example: Criminalization and Labelling in the Context of Drug Use
Scheff’s theory can also be applied to the criminalization of drug use. Deviant behavior—such as consuming illegal substances—is often not only punished legally but also pathologized. Medical diagnoses like “substance use disorder” or “addiction” contribute to labelling users as ill or incapable. From a sociological perspective, these are not purely biological conditions but social attributions that reflect norms and power structures.
As Scheff argues, the combination of criminal conviction and medical stigma can hinder social integration and promote deviant careers. Debates around decriminalization and harm reduction reflect this tension between control and recognition.
Reception and Criticism
Scheff’s work has been influential in critical sociology and the anti-psychiatry movement. Critics argue, however, that he overemphasizes social construction and neglects potential biological underpinnings of mental illness. Others question whether his theory adequately distinguishes between genuine mental disorders and social labelling.
Nevertheless, Being Mentally Ill is widely regarded as a pioneering work that fundamentally changed the discourse on mental illness—especially concerning power dynamics, social control, and institutional influence.
Further Reading: Scheff and Restorative Justice
In later works, Thomas J. Scheff connects his theory of social labelling with the concept of restorative justice. Together with Suzanne Retzinger, he emphasizes the key role of emotions like shame and rage in social conflict—emotions often suppressed or intensified in conventional legal proceedings. Restorative approaches, such as community conferencing or victim-offender mediation, instead promote dialogue and reintegration.
Scheff sees these methods as a practical way to mitigate the negative effects of stigma, encourage accountability, and strengthen social bonds. His approach aligns closely with Braithwaite’s theory of reintegrative shaming and the idea of a healing, relationship-centered legal culture (therapeutic jurisprudence).
Further reading: Thomas J. Scheff & Suzanne Retzinger (1991): Emotions and Violence: Shame and Rage in Destructive Conflicts
References
- Scheff, T. J. (1966). Being Mentally Ill: A Sociological Theory. Chicago: Aldine.
- Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs: Prentice-Hall.
- Lemert, E. (1951). Social Pathology. New York: McGraw-Hill.
- Rosenhan, D. (1973). On Being Sane in Insane Places. Science, 179(4070), 250–258.
