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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 that, although even the most deviant social actors engage frequently in conventional routine behaviors, they tend to exhibit moments of deviation as a measure of the kind of persons they really are. In his research, Erikson demonstrated via an examination of the Salem witchcraft trials that this very selective labeling serves a societal purpose of helping a community define its social and moral boundaries so that they could develop a sense of group identity. That is, labeling some individuals via interpretations of their behaviors or appearances as outliers served to define the rest of the group as a community.

The third question regarding the interpretation of deviancy through labeling involved the reasons or process of deciding whether a behavior or appearance was sufficiently different to warrant the label of deviant. Edwin Lemert (1967) established the concepts of primary and secondary deviance to address this question. Primary deviance refers to initial acts of deviance that arise from original causes like social or cultural factors or psychological and physiological limitations. He believed that these were often situational, transient, and idiosyncratic, and therefore they could be dismissed by others. In these situations, these individuals experienced only minor consequences that impacted their persons and their status, social relationships, and future behaviors. Secondary deviance, however, was more severe. Lemert defined this level of deviancy as occurring when society’s negative response to a person’s initial deviance (e.g., stigmatizing, punishing, segregating the offender) caused fundamental changes in the person’s status, self‐identity, or personality. In these cases, there is an explicit response involving societal reactions to the deviant behavior or appearance; this results in the “secondary deviant’s life and identity (being) organized around the facts of deviance” (Lemert, 1967, p. 41). Tied into the distinction between primary and secondary deviancy was the fact that the most important societal reaction, the one that often triggered secondary deviancy, was the response of social institutions of control—the criminal justice system, special education regulations, mental health institutions—that are legitimated by the state (Goffman, 1964; Lemert, 1967).

Given this theoretical orientation and the work of others, Howard Becker investigated labeling as a theoretical social construct in his 1963 book Outsiders: Studies in the Sociology of Deviance. In this book, Becker was especially interested in the construct of deviancy in society—why some acts are thought to be deviant and who has the power to label individuals and/or their behavior as deviant. Becker examined the impact of such labeling on society and the individual. Based upon his work, he believed that labeling is a sociopolitical act, since his research indicated that once a label has been assigned, how we respond to the label (and the underlying acts that characterize it) depends on whether the label and its underlying actions have become sanctioned within the society. He believed that it is not the label or the actions of the individual so labeled that are deviant, but rather, the responses of society that defines it as such. Importantly, Becker believed that the responses of the powerful in the society (e.g., judges, legislators, physicians, diagnosticians) often determine how we are expected to view such labels and the actions that are characteristic of the labels.

Becker, led by symbolic interactionism, made two primary contributions to labeling theory, and his work, though somewhat controversial, is the primary current standard for labeling theory. The two major contributions were, first, that he offered an explicit labeling definition of deviance: “…deviance is not a quality of the act the person commits, but rather, a consequence of the application by others of rules and sanctions to an offender” (1963, p. 9). His second contribution was that he expanded the scope of societal reactions to encompass the creation and enforcement of social rules. Basically, this meant that the creation of deviancy begins not at the point when a person violates some rule, but earlier when social groups first create those rules. Becker also contrasted the positions he staked out for labeling theory with conventional theories of deviance. This enabled a greater constructivist orientation.

Based upon this work in sociology, labeling theory has become an important mechanism for understanding how and why the labeling of individuals as deviant or the assigning of a diagnostic label (in the case of speech‐language pathologists) may result in unintended consequences. Erikson summed up labeling theory succinctly when he argued that “Deviance (as a basis of labeling) is not a property inherent in certain forms of behavior; it is a property conferred upon those forms by the audiences which directly or indirectly witness them” (1962, p. 311).