Chapter 25, by Karen Lê and Jennifer Mozeiko, deals with traumatic brain injury (TBI). A major focus of the chapter is the complex and dynamic nature of discourse, and how TBI disrupts discourse in its many facets. The authors suggest that the impairments seen in TBI may be ascribed to disruptions in cognitive systems, or they may be viewed as manifestations of underlying pragmatic impairments. The potential causes are not only of theoretical importance but have clinical implications as well.
The final chapter, by Nicole Müller and Zaneta Mok, covers the wide area of dementia and its impact on communication. The authors describe the more common dementia types, risk factors for dementia, and diagnosis, assessment, and intervention. They go on to consider bilingualism and dementia, and conclude with a section on interactional approaches.
This Handbook presents current research and thinking across the wide range of topics falling under the heading of language and speech disorders. It will prove invaluable to those working with communication impairments and those just entering the field alike. In this second edition we have taken the opportunity to update the chapters and, in some cases, to redirect the main emphasis in a topic. We are confident that the current collection reflects the current status of this important field of investigation.
1 Labeling as a Sociocultural Process in Communicative Disorders
JACK S. DAMICO1, NICOLE MÜLLER2,, AND MARTIN J. BALL3
1 University of Colorado, Boulder, CO, USA
2 University College Cork, Ireland, and Linköping University, Sweden
3 Bangor University, Wales
1.1 Introduction
As a discipline oriented to communication, learning and social action, speech‐language pathologists are increasingly cognizant of the fact that our discipline stands with several other disciplines as firmly located within the social sciences. While we must acknowledge our debts to psychology, education, and medicine, our theoretical orientation over the past 30 years has been influenced by linguistics, sociology, and anthropology. In parallel with the other social sciences, our research methodologies and our clinical practices are progressively increasing our focus on naturalistic inquiry, authentic social contexts, interpretive and interactional perspectives, and the qualitative research paradigm (Duchan, 2010; Goodwin, 2014). This increased turn to the social sciences holds many advantages for our discipline. One of these advantages is how we can adopt aspects of social action theory to understand the complex process of labeling.
The term labeling within the human and social sciences refers to the tendency of providing an appraisal and/or a descriptor of others based upon any deviation from the perceived norm that is sufficient to garner attention (Matsueda, 2014); the typical outcome of labeling is some sort of categorization that creates differentiation. Social scientists have recognized that this process is ubiquitous in society. We are constantly observing and appraising others from our normative and interpretive perspectives. We note features of an individual’s appearance and behavior, and if even a subtle deviation from the perceived norm is identified, we have a propensity to create and use a label as mental shorthand. For example, if someone is observed as experiencing a brief unintelligibility while they are conversing, they may be labeled as exhibiting a communication deficit. Whether this label is accurate or appropriate is beside the point; it is sufficient to recognize that based upon some perceived deviation, there is a tendency to assign a label.
While this tendency toward labeling is common across all social actors, as professionals we formalize this tendency and treat it as a specialized circumstance referred to as “diagnosis” and, as sociologist Howard Becker (1963) has suggested, in such circumstances the label has power to create positive and negative consequences. As a result, care must be taken when assigning labels to others, whether we are in commonplace circumstances or within our professional venues (Conrad, 2007). To understand the impact of labeling and how it functions, this chapter will briefly discuss the social theory behind labeling; describe the role of labeling within the formalized diagnostic process, including some of the mechanisms employed to help establish the practice of assigning diagnostic labels for various perceived deviations; and detail some of the consequences of labeling via diagnostic categories in speech‐language pathology.
1.2 Labeling Theory
To understand the impact of labeling in specialized circumstances, it is helpful to review the theoretical foundation underlying labeling as a social process. Based upon the work of several early sociologists, but especially George Herbert Mead and Charles Horton Cooley, Herbert Blumer (1969) coined the term symbolic interactionism to describe how social interaction is used to create shared meanings within society using common language or symbols. He stated that individuals interpret significant symbols (language) reciprocally and then jointly construct a common interpretation within a context or situation which then calls for a specific meaningful social action. In effect, as Berger and Luckmann suggested in The Social Construction of Reality (1967), our systematic and comprehensible social world is constructed by our mutually agreed‐upon interpretations. An important consequence of this process is that the outcome of any social action is not only the objective behaviors exhibited, but also how the situation and behaviors are defined and interpreted by the interactants. This is a primary reason that society or social reality is an ever‐changing social process, rather than a static structure that consists of unchanging functional positions or stances. Each of us as social actors not only adapt to societal constraints but we also (and continually) contribute to the creation and re‐creation of these constraints (Matsueda, 2014; Shotter, 1993).
Blumer’s work had a significant impact on labeling theory. This idea of constructed societal reality via social interaction and meaning negotiation between individuals was applied to definitions of deviancy, and it was argued that regardless of whether a person is objectively deviant in their appearance or actions, if others defined that person or those actions as deviant, then consequences inherent in the concept of one being “set apart” accrued. Symbolic interactionism implied that the labeling/appraisal of individuals by social groups affects one’s self‐identity; the self is a construction based on appraisals made by significant others (Matsueda, 1992).
The next step for labeling theory was to employ Blumer’s ideas but also to make several facets of the interpretive process inherent in symbolic interactionism more salient. The first question concerning saliency was that if significant others appraise, judge, and create the concept of who or what is deviant, and if this has an impact on the various social actions, including one’s self‐identity, who are these significant others? Research and theory defined these significant others as members of primary groups, such as families and peers, and they were referred to as reference groups since it was understood that they provide an individual with a point of perspective and a comparison group (Matsueda, 1992). By extension, in specific situations or contexts, those individuals with various kinds of societal designations or roles (e.g., speech‐language pathologists in a diagnostic clinic, teachers in a classroom, police officers on a beat) became the reference groups who made decisions on the labeling of deviancies. The second question revolved around the idea of how deviancy was typically formulated. Erikson (1966) discovered that the labeling of deviancy entails a very explicit process of selection. He found