|Asylums: Essays on the Social Situation of Mental Patients and Other Inmates|
|Country||The United States|
|Subject||Sociology, social psychology|
Asylums: Essays on the Social Situation of Mental Patients and Other Inmates is a 1961 book by sociologist Erving Goffman. Asylums was a key text in the development of deinstitutionalization. The book is one of the first sociological examinations of the social situation of mental patients, the hospital. Based on his participant observation field work, the book details Goffman's theory of the "total institution" (principally in the example he gives, as the title of the book indicates, mental institutions) and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor," suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them.
Research places and approach
From Autumn 1954 to the end of 1957 Goffman was a visiting member of the Laboratory of Socio-environmental Studies of the National Institute of Mental Health in Bethesda, Maryland and did some brief studies of ward behavior in the National Institutes of Health Clinical Center.:ix In 1955-1956 he did a year's field work at St. Elizabeths Hospital, Washington, D.C., a federal institution of somewhat over 7000 inmates, with three quarters of them drawn from the District of Columbia.:ix Goffman posed as a pseudo-employee of St. Elizabeths Hospital for a year, an assistant of the athletic director, and collected ethnographic data on selected aspects of patients’ social life. He stated that it was necessary for him to present a ‘partisan view’ in order to portray the patient's situation faithfully. As with most participant observation studies, controls, measurements, and statistical evidence were not used.
The key focus of the book is not the world of the staff but the world of the patient. Goffman admitted that he arrived at the hospital with no great respect for the agencies involved with psychiatric practice nor for the discipline of psychiatry. He hoped that Asylums would demonstrate the gap between what psychiatrists actually do and what they said about what they do.:103
The book includes four essays: Characteristics of Total Institutions (1957), The Moral Career of the Mental Patient (1959), The Underlife of a Public Institution: A Study of Ways of Making Out in a Mental Hospital, The Medical Model and Mental Hospitalization: Some Notes on the Vicissitudes of the Tinkering Trades.:150
The first essay, On the Characteristics of Total Institutions, is a general examination of social life in these settings, drawing on two examples which characterize involuntary membership — prisons and mental hospitals. There the schemes detailed in the following essays are stated and their place in the broader whole suggested.:150
The second essay, The Moral Career of the Mental Patient, views the early effects of institutionalization on the social relationships which the person possessed before he became an inmate.:150
The third essay, The Underlife of a Public Institution, is concerned with the attachment which the inmate is expected to manifest to his dwelling and, in detail, with the way in which inmates can introduce some distance between themselves and these expectations.:150
The final essay, The Medical Model and Mental Hospitalization, shifts attention back to the professional staffs to view, in relation to psychiatric hospitals, the role of the medical perspective in presenting to the inmate the facts of his situation.:150
In Asylums, Goffman is mainly engrossed with the details of having been hospitalized to a psychiatric hospital and the nature and effects of the process he defines as ‘institutionalization’.:150 He describes how the institutionalisation process socialises people into the role of a good patient, someone ‘dull, harmless and inconspicuous’, which in turn reinforces notions of chronicity in severe mental illness. A basic process of Goffman's asylums is mortification of self. A patient's notions of self are subjected to a dramatic change for the worse due to the debilitating atmosphere in all total institutions, regardless of how therapeutic or non-therapeutic a hospital is. While people come from a social context in which they have some sense of a personal identity and occupy different roles, these aspects of their lives are systematically stripped from them as their sense of themselves are mortified, pathogolized and negated, leading to what Goffman defines as ‘disculturation’.:154 Rather than curing or reducing the illness, this process leads to demoralization, skill deterioration and role dispossession and renders people less capable of managing life in the outward world.:154 In addition to disculturation from their identity and previous roles, acculturating inmates to life in a total institution does little, if anything, in preparing them for the contingencies they will encounter once again after discharge and prepares them only for remaining within the setting.:154 Goffman concludes from his investigation that taking a mentally ill person out of his or her life context, hospitalizing him or her to a psychiatric hospital and then returning the person to the same life context is similar to taking a drowning man out of a lake, teaching him how to ride a bicycle and putting him back into the lake.:154 In the inpatient phase, patients come to realize that society has forsaken them. Goffman states that inmates in total institutions have a strong feeling that time spent there is time taken from one's life or time wasted. Human needs are handled in an impersonal and bureaucratic mode. The social distance between the staff and inmates is great, and each group tends to be unfriendly toward the other.
The book concludes that adjusting the inmates to their role has at least as much importance as "curing" them. In the essay "Notes on the Tinkering Trades," Goffman concluded that the "medicalization" of mental illness and the various treatment modalities are offshoots of the 19th century and the Industrial Revolution and that the so-called "medical model" for treating patients was a variation on the way trades- and craftsmen of the late 19th century repaired clocks and other mechanical objects: in the confines of a shop or store, contents and routine of which remained a mystery to the customer.
College students are frequently given Goffman's book or parts of it as required reading for various courses. In articles and bibliographies for books social scientists often mention Asylums, as attested to by the Social Science Citation Index. The book has been influential in formulating decisions as to mental health policy and has been cited in legal cases involving patients. Over the years, chapters and excerpts have often been republished in anthologies and readers.
Similar books and views
Asylums is one of a number of books which came out in the 1950s and 1960s which explored the characteristics of psychiatric hospitals which impinged upon patients and affected the course of their illness. The most prominent examples are works by Stanton and Schwartz (1954), Belknap (1956), Dunham and Weinberg (1960), Strauss et al. (1964), and Scheff (1966). These studies are analogous in that they all relied on qualitative data in describing the meaning of psychiatric hospitalization for patients, criticized the psychiatric hospital and charged that it had a harmful effect on them. The hospital was usually portrayed as an authoritarian system that forces patients to define themselves as mentally ill, change their behavior and thinking, adjust to institutional life, accept restrictions and suffer humiliations. Belknap (1956), Dunham and Weifiberg (1960), Goffman (1961), Cumming and Cumming (1962) pointed out the fact that closed institutional regimes, with their common accompaniments of neglect, pauperism, and authoritarianism, were not only inhumane but harmful.
Franco Basaglia, a leading Italian psychiatrist who inspired and was the architect of the psychiatric reform in Italy, also defined mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents, and patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism.
American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony, authoritarianism, and the primacy of institutional needs over those of the persons it was ostensibly there to serve-the patients.
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