There are at least three implications that should emerge from this realization of our role as advocates when dealing with the social complexity of labeling. First, we should acknowledge and strive to deal with labels as complex phenomena. Labels are not simple, direct, or objective. They are powerful sociocultural artifacts that transmit biases, assumptions, and facts. They are also catalysts in the construction of both positive and negative consequences. To effectively elicit the positive consequences and reduce the negatives ones, we must recognize the constructive nature of these labels and the fact that they are often context‐dependent, and at least partly context‐created. For example, a quantifiable impairment such as age‐related reduction in hearing (even within “age‐normal” limits) may constitute a career‐destroying handicap for the conductor of a symphony orchestra, but not for someone in a different walk of life. Consequently, as clinicians we should not simply reify labels and consider them as “absolute,” objective categories. Rather, we should carefully consider how important it is to properly identify actual difficulties, determine the severity and context‐dependence of the labeled difficulties, and avoid the tendency to label without addressing the complexity and obtaining definite and objective data to support a diagnosis.
Second, we should strive to avoid the most basic negative consequences of labeling that occur when relying solely on the label. Rather, we should strive to thoroughly describe the difficulties that underlie the label. This means not only carefully documenting actual behaviors and their impact on the context, but also determining how the context impacts the behaviors and whether there are other emergent factors that must be adequately described and addressed (Perkins, 2005). Rather than orienting to symptoms to determine labels, we should orient to the skills, abilities, and strategies that can determine functional adequacy within the relative communicative and learning contexts. Darley (1975) had this in mind when he suggested that, when diagnosing aphasia, we focus on ability not labels, and his chapter “Aphasia without adjectives” still offers relevant advice 45 years after its publication.
Finally, we must be circumspect with our current conceptualizations and practices. By employing a more sociocultural orientation when focusing on diagnosis and labeling, we can turn our analytic powers to the very contexts and assumptions that we often take for granted when working with labels, so that we can better serve the needs of our clients.
The focus of this chapter has been the process of labeling and how it is impacted by sociocultural processes and how, in turn, our practices are then impacted by the labels that we employ. There is of course much support in the professional literature for the process of labeling. Such support tends to focus on the positive consequences, while downplaying the negative ones. As competent professionals, however, we must consider the potential for both. Certainly, the practicing professional should strive to reduce the negative consequences of labeling whenever possible. As we discussed in an earlier publication (Damico et al., 2004), we need to be able to contextualize a diagnosis or label, and then we should strive to discover the reality behind the label and the individuality of each client’s condition. This will enhance our service delivery in the field of speech and language disorders.
REFERENCES
1 Abberley, P. (1987). The concept of oppression and the development of a social theory of disability. Disability, Handicap, & Society, 2(1), 5–19.
2 American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders, DSM‐III (3rd ed.). Washington, DC: Author.
3 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, DSM‐IV (4th ed.). Washington, DC: Author.
4 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM‐5 (5th ed.). Washington, DC: American Psychiatric Association.
5 Apple, M. W. (1982). Education and power. Boston, MA: Routledge & Kegan Paul.
6 Archer, M., & Green, L. (1996). Classification of learning difficulties. In S. Kriegler & P. Englebrecht (Eds.), Perspectives on learning difficulties. Hartfield, SA: Van Schaik.
7 Artiles, A. J., Higareda, H., Rueda, R., & Salazar, J. J. (2005). Within‐group diversity in minority disproportionate representation: English language learners in urban school districts. Exceptional Children, 71, 283–300.
8 Artiles, A. J., & Ortiz, A. A. (2002). English language learners with special education needs: Identification, assessment, and instruction. McHenry, IL: Delta Systems.
9 Aspel, A. D., Willis, W. G., & Faust, D. (1998). School psychologists’ diagnostic decision‐making processes: Objective‐subjective discrepancies. Journal of School Psychology, 36, 137–149.
10 Augustine, L. E., & Damico, J. S. (1995). Attention deficit hyperactivity disorder: The scope of the problem. Seminars in Speech and Language, 16(4), 243–258.
11 Bagatell, N. (2010). From cure to community: Transforming notions of autism. Ethos, 38(1), 33–55.
12 Baker, J. (2008). Mercury, vaccines, and autism. American Journal of Public Health, 98(2), 244–254.
13 Balint, M. (1957). The doctor, his patient, and the illness. New York, NY: International Universities Press.
14 Barsky, A., & Boros, J. F. (1995). Somatization and medicalization in the era of managed care. Journal of the American Medical Association, 274, 1931–1934.
15 Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. New York, NY: The Free Press.
16 Berger, P. L., & Luckmann, T. (1967). The social construction of reality: A treatise in the sociology of knowledge. New York, NY: Anchor.
17 Bernstein, B. (1996). Pedagogy, symbolic control and identity. London, UK: Taylor & Francis.
18 Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice‐Hall.
19 Boxer, R., Challen, M., & McCarthy, M. (1991). Developing an assessment framework: The distinctive contribution of the educational psychologist. Educational Psychology in Practice, 7, 30–34.
20 Bradley, R. H., & Corwyn, R. F. (2002). Socioeconomic status and child development. Annual Review of Psychology, 53, 371–399.
21 Brantlinger, E. (1997). Using ideology: Cases of nonrecognition of the politics of research and practice in special education. Review of Educational Research, 67(4), 425–459.
22 Brechin, A. (1999). Understandings of learning disability. In J. Swain & S. French (Eds.), Therapy and learning difficulties: Advocacy, participation, and partnership. Oxford, UK: Butterworth Heinemann.
23 Brinton, B., & Fujiki, M. (2010). Principles of assessment and intervention. In J. S. Damico, N. Müller, & M. J. Ball (Eds.), The handbook of language and speech disorders (pp. 131–150). Chichester, UK: Wiley‐Blackwell.
24 Broadfoot, P. (1994). Educational assessment: The myth of measurement. Bristol, UK: University of Bristol.
25 Broadfoot, P. (1996). Education, assessment, and society. Buckingham, UK: Open University Press.
26 Broom, D. H., & Woodward, R. V. (1996). Medicalization reconsidered: Toward a collaborative approach to care. Sociology of Health and Illness, 18, 357–378.
27 Brown, P. (1995). Naming and framing: The social construction of diagnosis and illness. Journal of Health and Social Behavior, 35(Extra Issue), 34–52.
28 Bruner, J. S. (1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.
29 Bruner, J. S. (1990). Acts of meaning. Cambridge, MA: Harvard University Press.
30 Bruner, J. S. (1991). The narrative construction of reality. Critical Inquiry, 18(Autumn), 1–21.
31 Bussing,