Erving 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.