MSc in Mental HealthMental Health & Social Policy: MSc in Mental Health Mental Health & Social Policy Lecture 7: The critical sociology of mental health 2: Erving Goffman Asylums and total institutions


Erving Goffman: Asylums: Erving Goffman: Asylums Each moral career, and behind this, each self, occurs within the confines of an institutional system….The self in this sense is not a property of the person to whom it is attributed, but dwells rather in the pattern of social control that is exerted in connection with the person by himself and those around him. This special kind of institutional arrangement does not so much support the self as constitute it. Goffman (1961, p154)


Erving Goffman Asylums: Erving Goffman Asylums Every institution captures something of the time and interests of its members and provides something of a world for them; in brief every institution has encompassing tendencies. (Goffman 1968: 15)


The Total Institution: The Total Institution “A total institution may be defined as a place of residence and work where a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered routine of life.” Goffman (1968)


Total Institutions: Total Institutions 5 broad categories For the incapable and harmless (e.g. old peoples’ homes) For the incapable and contaminated ( e.g. Mental hospitals) For the threatening (e.g. Jails) For instrumental purposes (e.g Army Barracks) For retreat and training (e.g. Convents)


Characteristics of a Total Institution: Characteristics of a Total Institution All aspects of life in the same place Large number of people treated the same way All phases of the day are tightly scheduled In mental hospitals the ‘medical service model’ tends to be applied Total institutions tend to embody a theory of ‘human nature’


Social relations in the Total Institution: Social relations in the Total Institution …there is a basic split between a large managed group conveniently called inmates and a small supervisory staff…Each grouping tends to conceive of the other in terms of narrow hostile stereotypes…Staff tend to feel superior and righteous; inmates tend, in some ways at least, to feel inferior, weak, blameworthy , and guilty. Goffman (1968)


Interaction in Total Institutions: Interaction in Total Institutions Social mobility between strata grossly restricted Social distance often great and formally prescribed Control of communication between levels (e.g. nurses act as mediators for doctor patient interaction) Passage of information restricted


‘Work’ in a total institution: ‘Work’ in a total institution Essential needs planned and catered for Lowered structural significance of work incentives Different motives for work and attitudes to it Extremes of boredom and demoralisation


The “Inmate World” :Mortification experiences: The “Inmate World” : Mortification experiences Civil ‘death’ Dispossession of property Role dispossession Violation of privacy


The Inmate World:Contaminative exposure: The Inmate World: Contaminative exposure Violation of informational preserve Group or individual ‘confession’ Physical contamination Medication Forced social relationships


Slide12: Role responses in the Total Institution Situational withdrawal Intransigence Colonization Conversion


The Privilege System: The Privilege System Consists of a relatively few components put together with rational intent Clearly proclaimed to the participants. Cooperation is obtained from persons who often have cause to be uncooperative ‘House’ Rules Rewards and punishments


The “Staff World”: The “Staff World” Human standards vs. institutional efficiency Not typically seen as a service relationship Inmates as ‘products’ ‘People work’ with ‘objects’ which happen to be people


People work in Total Institutions: People work in Total Institutions Chain of ‘information receipts’ Consideration of statuses and relationships in outside world ‘Recalcitrance’ ‘Gripes’ Dangers of intimacy leading to burn out


Hospital Underlife: Hospital Underlife Make-do’s Use of available artefacts for ‘unofficial’ purposes Working the system Space Out of bounds Surveillance space Free space/group territories/personal space


Implications for social policy: Implications for social policy How do we maximise the ‘curative’ elements of confinement without also creating the conditions for stigmatic institutionalisation? How do we reconcile bureaucratic/institutional demands with inmate needs and safety?


Further Reading: Further Reading Goffman E (1961) Asylums: Essays on the social situation of mental patients and other inmates Harmondsworth: Penguin Goffman E (1968) Stigma Notes on the management of spoiled identity Harmondsworth: Penguin Manning P (1992) Erving Goffman and Modern Sociology, Cambridge: Polity