ban ambiguous, taking responsibility and refusing explanations of their behaviors." John Henry Mackay (1985) writes about a gay hustler in Berlin adopting such a solution: "What was self-evident, natural, and not the least sick did not require an excuse through an explanation.… It was love just like any other love. Whoever could not or would not accept it as love was mistaken." Modified labeling theory Bruce Link and colleagues (1989) had conducted several studies which point to the influence that labeling can have on mental patients. Through these studies, taking place in 1987, 1989, and 1997, Link advanced a "modified labeling theory" indicating that expectations of labeling can have a large negative effect, that these expectations often cause patients to withdraw from society, and that those labeled as having a mental disorder are constantly being rejected from society in seemingly minor ways but that, when taken as a whole, all of these small slights can drastically alter their self concepts. They come to both anticipate and perceive negative societal reactions to them, and this potentially damages their quality of life. Modified labeling theory has been described as a "sophisticated social-psychological model of 'why labels matter. In 2000, results from a prospective two-year study of patients discharged from a mental hospital (in the context of deinstitutionalization) showed that stigma was a powerful and persistent force in their lives, and that experiences of social rejection were a persistent source of social stress. Efforts to cope with labels, such as not telling anyone, educating people about mental distress/disorder, withdrawing from stigmatizing situations, could result in further social isolation and reinforce negative self-concepts. Sometimes an identity as a low self-esteem minority in society would be accepted. The stigma was associated with diminished motivation and ability to "make it in mainstream society" and with "a state of social and psychological vulnerability to prolonged and recurrent problems". There was an up and down pattern in self-esteem, however, and it was suggested that, rather than simply gradual erosion of self-worth and increasing self-deprecating tendencies, people were sometimes managing, but struggling, to maintain consistent feelings of self-worth. Ultimately, "a cadre of patients had developed an entrenched, negative view of themselves, and their experiences of rejection appear to be a key element in the construction of these self-related feelings" and "hostile neighbourhoods may not only affect their self-concept but may also ultimately impact the patient's mental health status and