Reexamining Modified Labeling Theory: A Sample of Incarcerated Women With Mental Illness

• Published date: 01 October 2023
• DOI: http://doi.org/10.1177/00938548231187419
• Author: Sarah E. King,Hayden P. Smith
• Date: 01 October 2023
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 10, October 2023, 1565 –1583.

DOI: https://doi.org/10.1177/00938548231187419

Article reuse guidelines: sagepub.com/journals-permissions

© 2023 International Association for Correctional and Forensic Psychology

1565

REEXAMINING MODIFIED LABELING THEORY

A Sample of Incarcerated Women With Mental Illness

SARAH E. KING

Lander University

HAYDEN P. SMITH

University of South Carolina

The current study reexamines modified labeling theory with a sample of 15 women incarcerated in two medium-security

prisons and who have a diagnosable mental illness. Life history calendars (LHC) were employed to document traumatic

histories and a host of risks and needs. Qualitative findings indicate that these women negotiated labels of mental illness and

incarceration. The labeling process, particularly self-concept, self-esteem, and stigma, emerged as driving forces for criminal

behavior, dysfunctional interpersonal relationships, and decision-making. Participants negotiated the label of mental illness,

while making meaning of early and continued trauma. These findings are explained with reference to trauma-informed care

(TIC), improved staff training, and the role of language. This study offers evidence that labeling concepts may serve as a

language foundation for providing trauma-informed services.

Keywords: incarcerated women; modified labeling theory; mental illness; prison; trauma-informed care (TIC)

It has long been noted that incarcerated women are diagnosed with higher rates of mental

illness when compared with their incarcerated male counterparts (Bronson & Berzofsky,

2017). Of women who are incarcerated in state prison, 66% have been found to have a men-

tal illness compared with 35% of men in state prison, while 68% of women incarcerated in

jail have been found to have a mental illness compared with 41% of men in jail (Bronson &

Berzofsky, 2017). While these differences have been attributed to social factors such as

stereotypes underlying masculinity/femininity, a willingness to self-report symptoms and

seek treatment, the externalization or internalization of negative emotions, and the avail-

ability of mental health resources, they warrant further scholarly attention. This is a particu-

larly salient issue as correctional systems are now operating as default mental health

facilities for a substantial portion of society (Smith, 2022). Previous research suggests that

AUTHORS’ NOTE: The authors declare that they have no relevant or material financial interests that relate

to the research described in this article. The authors also have no conflict of interests regarding this research.

Correspondence concerning this article should be addressed to Hayden P. Smith, Department of Criminology

and Criminal Justice, University of South Carolina, 1305 Greene Street, Columbia, SC, 29208; e-mail:

Smithhp@mailbox.sc.edu.

1187419CJBXXX10.1177/00938548231187419Criminal Justice and BehaviorKing, Smith /

research-article2023

1566 CRIMINAL JUSTICE AND BEHAVIOR

the impact of the symptoms of mental illness affect individuals in a variety of ways, particu-

larly as it relates to stigmatization and self-conceptualization (Kroska & Harkness, 2006,

2008; Link et al., 1989). Regarding gender, it is important to understand how mental illness

affects the identity of women before and during incarceration.

The effect of a label on an individual has been described and explained primarily through

labeling theory, which posits that when an individual is labeled a deviant or a criminal, they

adopt that self-concept and behave in a devious or criminal manner (see Mead, 1934; Rosenberg,

1979). An extension of labeling theory, modified labeling theory, addresses how the “mentally

ill” label affects an individual. Specifically, a negative self-concept resulting from mental illness

stigmatization can result in poor health and life outcomes (Kroska & Harkness, 2008; Wright

et al., 2000). While modified labeling theory stems from labeling theory (which has been largely

applied to deviant or criminal populations), modified labeling theory has yet to be fully applied

to a female correctional population. Applying modified labeling theory to a population of incar-

cerated women with mental illness could provide insight into how their mental illness has

impacted them and how it has affected their overall identity, decision-making processes, and

thus guide policy and therapeutic interventions. Moreover, for women incarcerated in prison,

research can often be stifled by life histories that are complex, confusing, and traumatic.

To address these gaps, the current study analyzes the meaning of mental illness to incar-

cerated women in a sample of 15 women with diagnosable mental illness who are housed

in a medium-security prison. By following the central tenets of labeling theory, specifically

modified labeling theory, the current study examines the perceptions of these women. To

measure the considerable histories of the participants, a Life History Calendar methodology

is used, where a schema of key events and developmental categories are established during

intensive semi-structured interviews.

LABELING THEORY

Behavior that is considered within the dichotomies of normal/deviant or legal/criminal

varies across countries and cultures, making labels and the definitions attached to the labels

subjective. Becker (1963) argued that those in positions of moral authority, such as legisla-

tures, create the rules and laws defining what is deviant. This is a necessary part of society

from a functionalist perspective because that moral authority would exist even in a “society

of saints,” where any behavior outside of social norms would be met with punishment

designed to preserve social order. The negative reactions to deviance and/or crime from

society inform those who commit deviant acts that this behavior is unacceptable, which

helps maintain order (Durkheim, 1993/1893). Labeling theory, which was developed from

Durkheim’s functionalist approach, recognizes that the purpose of the deviant and criminal

label is to maintain societal order; however, it contends that the labeling process results in

additional deviant and criminal behavior (see Erikson, 1962).

According to labeling theory, deviance consists of two categories: primary and second-

ary. Primary deviance is the initial action committed by an individual that can result in

being labeled a deviant or receive legal sanctions. Secondary deviance is deviant behavior

that is a product of being labeled a deviant and is at the center of labeling theory (Lemert,

1951). Under secondary deviance, when an individual violates the law, they are labeled a

criminal even when they have been law-abiding any other time. Therefore, while correcting

a person’s behavior may be one of the primary purposes of punishment, the person is instead