A view on hospitalisation

Goffman.jpgErving Goffman spent a year working in St Elizabeth’s Psychiatric Hospital in Washington DC, ostensibly as a physical education assistant. In reality, he was a sociologist studying the social situations of patients and staff.

The following is a thought-provoking view on the reasons for hospitalisation from his classic 1961 book Asylums (p126), which he wrote as a result of his undercover study.

Some of these contingencies [that lead to hospitalisation] in the mental patient’s career have been suggested, if not explored, such as socio-economic status, visibility of the offence, proximity to a mental hospital, amount of treatment facilities available, community regard for the type of treatment given in available hospitals and so on.

For information about other contingencies, one must rely on atrocity tales: a psychotic man is tolerated by his wife until she finds herself a boyfriend, or by his adult children until they move from a house to an apartment; an alcoholic is sent to a mental hospital because the jail is full and a drug addict because he declines to avail himself of psychiatric treatment on the outside; a rebellious adolescent daughter can no longer be managed at home because she now threatens to have an open affair with an unsuitable companion; and so on.

Correspondingly there is an equally important set of contingencies causing the person to by-pass this fate. And should the person enter hospital, still another set of contingencies will help determine whether he is to obtain a discharge – such as the desire of his family to return, the availability of a ‘manageable’ job, and so on.

The society’s official view is that inmates of mental hospitals are there primarily because they are suffering from mental illness. However, in the degree that the ‘mentally ill’ outside hospitals numerically approach or surpass those inside hospitals, one could say that mental patients suffer not from mental illness, but from contingencies.

Link to life and work biography of Erving Goffman.
Link to extracts from Goffman’s books (including Asylums).

2 Comments

  1. Posted September 8, 2005 at 9:03 pm | Permalink

    the industry of psychology is(appears to be) a way for a group of people to sustain themselves by delivering the mechanism of hospitals, drugs and consultation to the community. the industry is a closed shop of self-regulation (ama)and profit-making that fails to adress the ongoing problemof mental health in society. with the trend toward medication this situation will only continue.

  2. Elizabeth_R
    Posted September 9, 2005 at 7:41 pm | Permalink

    There are so many ways to rebut that, yet I don’t know if I even want to bother, seeing as I’ve done
    it so many times. Here’s an idea: read the blog entry regarding the discussion of the definition of mental illness in London.
    Hospitals & drugs? That is a privilege mostly reserved and doled out by medical doctors and psychiatrists, not psychologists who go through different education, training, and practice. Psychologists aren’t even allowed to prescribe medical drugs! Profit making? Find me a science or endeavor of any sort that isn’t profit-making. Of course there is an ongoing mental health problem but guess what? The people in charge will, more often than not, put their funding elsewhere — like cancer. Not saying we shouldn’t study cancer, of course, but that there is considerably less funding in psychological research. Not to mention we are years behind — because our society greatly influences what we can and cannot research and only recently have mental illnesses gained the credibility they need to merit real scientific research.
    Trend towards medication? Read the psychology research, Dr — a lot of it suggests the exact opposite: that clients with therapy do better than those with drugs, in the long term. Anecdotal evidence has been confirming that for years, and now we have the research to support it. I think the biggest problem in psyc, which leads to perceptions just like yours – is that people don’t know where to go for psychological services. They end up going to their family doctor and being given a steady stream of Prozac.
    Too bad some people just don’t know better.


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