Goffman, Erving. Asylums: Essays on the Social Situation of
Mental Patients and Other Inmates.
On the Characteristics of Total Institutions (1)
Social
establishments - institutions in the everyday sense of that term - are places
such as rooms, suites of rooms, buildings, or plants in which activity of a
particular kind regularly goes on. In
sociology we do not have a very apt way of classifying them. Some establishments, like Grand Central
Station, are open to anyone who is decently behaved; others, like the Union
League Club of New York or the laboratories at
When we review the different institutions in our Western society, we find some that are encompassing to a degree discontinuously greater than the ones next in line. Their encompassing or total character is symbolized by the barrier to social intercourse with the outside and to departure that is often built right into the physical plant, such as locked doors, high walls, barbed wire, cliffs, water, forests, or moors. These establishments I am calling total institutions, and it is their general characteristics I want to explore. (4)
The handling of many human needs by the bureaucratic organization of whole blocks of people-whether or not this is a necessary or effective means of social organization in the circumstances-is the key fact of total institutions. From this follow certain important implications. (6)
When persons are moved in blocks, they can be supervised by personnel whose chief activity is not guidance or periodic inspection (as in many employer-employee relations) but rather surveillance - a seeing to it that everyone does what has been clearly told is required of him, under conditions where one person’s infraction is likely to stand out in relief against the visible, constantly examined compliance of the others. Which comes first, the large blocks of managed people, or the small supervisory staff, is not here at issue; the point is that each is made for the other. (6-7)
In total institutions there is a basic split between a large managed group, conveniently called inmates, and a small supervisory staff. Inmates typically live in the institution and have restricted contact with the world outside the walls; staff often operate on an eight-hour day and are socially integrated into the outside world. Each grouping tends to conceive of the other in terms of narrow hostile stereotypes, staff often seeing inmates as bitter, secretive, and untrustworthy, while inmates often see staff as condescending, highhanded, and mean. Staff tends to feel superior and righteous; inmates tend, in some ways at least to feel inferior, weak, blameworthy, and guilty. (7)
The total institution is a social hybrid, part residential community, part formal organization; therein lies its special sociological interest. There are other reasons for being interested in these establishments, too. In our society, they are the forcing houses for changing persons; each is a natural experiment on what can be done to the self. (12)
The inmate world (12)
It is characteristic of inmates that they come to the institution with a “presenting culture” (to modify a psychiatric phrase) derived from a “home world” - a way of life and a round of activities taken for granted until the point of admission to the institution...Whatever the stability of the recruit’s personal organization, it was part of a wider framework lodged in his civil environment - a round of experience that confirmed a tolerable conception of self and allowed for a set of defensive maneuvers, exercised at his own discretion, for coping with conflicts, discreditings, and failures. (12-13)
The full meaning for the inmate of being “in” or “on the inside” does not exist apart from the special meaning to him of “getting out” or “getting on the outside.” In this sense, total institutions do not really look for cultural victory. They create and sustain a particular kind of tension between the home world and the institutional world and use this persistent tension as strategic leverage in the management of men. (13)
The recruit comes into the establishment with a conception of himself made possible by certain stable social arrangements in his home world. Upon entrance, is immediately stripped of the support provided by these arrangements. In the accurate language of some of our oldest total institutions, begins a series of abasements, degradations, humiliations, and profanations of self. His self is systematically, if often unintentionally, mortified. He begins some radical shifts in his moral career, a career composed of the progressive changes that occur in the beliefs that has concerning himself and significant others. (14)
The inmate, then, finds certain roles are lost to him by virtue of the barrier that separates him from the outside world. The process of entrance typically brings other kinds of loss and mortification as well. We very generally find staff employing what are called admission procedures, such as taking a life history, photographing, weighing, fingerprinting, assigning numbers, searching, listing personal possessions for storage, undressing, bathing, disinfecting, haircutting, issuing institutional clothing, instructing as to rules, and assigning to quarters. Admission procedures might better be called “trimming” or “programming” because in thus being squared away the new arrival allows himself to be shaped and coded into an object that can be fed into the administrative machinery of the establishment, to be worked on smoothly by routine operations. Many of these procedures depend upon attributes such as weight or fingerprints that the individual possesses merely because he is a member of the largest and most abstract of social categories, that of human being. Action taken on the basis of such attributes necessarily ignores most of his previous bases of self-identification. (16)
Because a total institution deals with so many aspects of its inmates’ lives, with the consequent squaring away at admission, there is a special need to obtain initial co-operativeness from the recruit. Staff often feel that a recruit’s readiness to be appropriately deferential in his initial face-to-face encounters with them is a sign that he will take the role of the routinely pliant inmate. (16-17)
Just as the individual can be required to hold his body in a humiliating pose, so he may have to provide humiliating verbal responses. An important instance of this is the forced deference pattern of total institutions; inmates are often required to punctuate their social interaction with staff by verbal acts of deference, such as saying “sir.” Another instance is the necessity to beg, importune, or humbly as for little things such as a light for a cigarette, a drink of water, or permission to use the telephone. (22)
Corresponding to the indignities of speech and action required of the inmate are the indignities of treatment others accord him. The standard examples here are verbal or gestural profanations: staff or fellow inmates call the individual obscene names, curse him, point out his negative attributes, tease him, or talk about him or his fellow inmates as if he were not present. (22-23)
There is another form of mortification in total institutions; beginning with the admission a kind of contaminative exposure occurs. On the outside, the individual can hold objects of self-feeling - such as his body, his immediate actions, his thoughts, and some of his possessions - clear of contact with alien and contaminating things. But in total institutions these territories of the self are violated; the boundary that the individual places between his being and the environment is invaded and the embodiments of the self profaned. (23)
Further, the practice of mixing age, ethnic, and racial groups in prisons and mental hospitals can lead an inmate to feel he is being contaminated by contact with undesirable fellow inmates. (29)
I have suggested that in total institutions he is directed to a multitude of items of conduct - dress, deportment, manners - that constantly occur and constantly come up for judgment. The inmate cannot easily escape from the press of judgmental officials and from the enveloping tissue of constraint. A total institution is like a finishing school, but one that has many refinements and is little refined. I would like to comment on two aspects of this tendency toward a multiplication of actively enforced rulings. (41-42)
First, these rulings are often geared in with an obligation to perform the regulated activity in unison with blocks of fellow inmates. This is what is sometimes called regimentation. (42)
Second, these diffuse rulings occur in an authority system of the echelon kind: any member of the staff class has certain rights to discipline any member of the inmate class, thereby markedly increasing the probability of sanction. (This arrangement, it may be noted, is similar to the one that gives any adult in some small American towns certain rights to correct any child not in the immediate presence of his parents and to demand small services from him.) On the outside, the adult in our society is typically under the authority of a single immediate superior in connection with his work, or the authority of one spouse in connection with domestic duties; the only echelon authority he must face - the police - is typically not constantly or relevantly present, except perhaps in the case of traffic-law enforcement. (42)
In concluding this description of the processes of mortification, three general issues must be raised. (43)
First, total institutions disrupt or defile precisely those actions that in civil society have the role of attesting to the actor and those in his presence that he has some command over his world - that he is a person with “adult” self- determination, autonomy, and freedom of action. A failure to retain this kind of adult executive competency, or at least the symbols of it, can produce in the inmate the terror of feeling radically demoted in the age-grading system. (43)
A margin of self-selected expressive behavior - whether of antagonism, affection, or unconcern is one symbol of self-determination. This evidence of one’s autonomy is weakened by such specific obligations as having to write one letter home a week, or having to refrain from expressing sullenness. It is further weakened when this margin of behavior is used as evidence concerning the state of one’s psychiatric, religious, or political conscience. (43)
There are certain bodily comforts significant to the individual that tend to be lost upon entrance into a total institution - for example, a soft bed or quietness at night. Loss of…comforts is apt to reflect a loss of self-determination, too, for the individual tends to ensure these comforts the moment he has resources to expend. (44)
Loss of self-determination seems to have been ceremonialized in concentration camps; thus we have atrocity tales of prisoners being forced to roll in the mud, stand on their heads in the snow, work at ludicrously useless tasks, swear at themselves, or, in the case of Jewish prisoners, sing anti-semitic songs. A milder version is found in mental hospitals where attendants have been reported forcing a patient who wanted a cigarette to say “pretty please” or jump up for it. In all such cases the inmate is made to display a giving up of his will. Less ceremonialized, but just as extreme, is the embarrassment to one’s autonomy that comes from being locked in a ward, placed in a tight wet pack, or tied in a camisole, and thereby denied the liberty of making small adjustive movements. (44)
The second general consideration is the rationale that is employed for assaults upon the self. This issue tends to place total institutions and their inmates into three different groupings. (45)
In concentration camps and, to a lesser extent, prisons, some mortifications seem to be arranged solely or mainly for their mortifying power, as when a prisoner is urinated on, but here the inmate does not embrace and facilitate his own destruction of self. (46)
In many of the remaining total institutions, mortifications are officially rationalized on other grounds, such as sanitation (in connection with latrine duty), responsibility for life (in connection with forced feeding), combat capacity (in connection with Army rules for personal appearance), “security” (in connection with restrictive prison regulations). (46)
In total institutions of all three varieties, however, the various rationales for mortifying the self are very often merely rationalizations, generated by efforts to manage the daily activity of a large number of persons in a restricted space with a small expenditure of resources. Further, curtailments of the self occur in all three, even where the inmate is willing and the management has ideal concerns for his well-being. (47)
Two issues have been considered: the inmate’s sense of personal inefficacy and the relation of his own desires to the ideal interests of the establishment. The connection between these two issues is variable. Persons can voluntarily elect to enter a total institution and cease thereafter, to their regret, to be able to make such important decisions. In other cases, notably the religious, inmates may begin with and sustain a willful desire to be stripped and cleansed of personal will. Total institutions are fateful for the inmate’s civilian self, although the attachment of the inmate to this civilian self can vary considerably. (47)
The processes of mortification I have been considering have to do with the implications for self that persons oriented to a particular expressive idiom might draw from an individual’s appearance, conduct, and general situation. In this context I want to consider a third and final issue: the relation between this symbolic-interaction framework for considering the fate of the self and the conventional psycho-physiological one centered around the concept of stress. (47)
While the process of mortification goes on, the inmate begins to receive formal and informal instruction in what will here be called the privilege system. In so far as the inmate’s attachment to his civilian self has been shaken by the stripping processes of the institution, it is largely the privilege system that provides a framework for personal reorganization. Three basic elements of the system may be mentioned. (48)
First, there are the “house rules,” a relatively explicit and formal set of prescriptions and proscriptions that lays out the main requirements of inmate conduct. These rules spell out the austere round life of the inmate. Admission procedures, which strip the recruit of his past supports, can be seen as the institution’s way of getting him ready to start living by house rules. (49)
Secondly, against this stark background, a small number of clearly defined rewards or privileges are held out in exchange for obedience to staff action and spirit. It is important to see that many of these potential gratifications are carved out of the flow of support that the inmate had previously taken for granted. On the outside, for example, the inmate probably could unthinkingly decide how he wanted his coffee, whether to light a cigarette, or when to talk; on the inside, such rights may become problematic. (49)
The third element in the privilege system is punishments; these are designated as the consequences of breaking the rules. One set of these punishments consists of the temporary or permanent withdrawal of privileges or the abrogation of the right to try to earn them. In general, the punishments meted out in total institutions are more severe than anything encountered by the inmate in his home world. In any case, conditions in which a few easily controlled privileges are so important are the same conditions in which their withdrawal has a terrible significance. (51)
Something similar in effect to immunization is achieved by inmates who have special compensations inside the institution or special means of being impervious to its assaults. In the early period of the German concentration camps, criminals apparently derived compensative satisfaction from living with middle-class political prisoners. Similarly, the middle-class vocabulary of group psychotherapy and the classless ideology of “psychodynamics” give to some socially ambitious and socially frustrated lower-class mental patients the closest contact with the polite world that they have ever had. Strong religious and political convictions have served to insulate the true believer against the assaults of a total institution. Failure to speak the staff’s language may make the staff give up its efforts at reformation, freeing the non-speaker from certain pressures. (66)
The Staff World (74)
Many total institutions, most of the time, seem to function merely as storage dumps for inmates, but, as previously suggested, they usually present themselves to the public as rational organizations designed consciously, through and through, as effective machines for producing a few officially avowed and officially approved ends. It was also suggested that one frequent official objective is the reformation of inmates in the direction of some ideal standard. This contradiction, between what the institution does and what its officials must say it does, forms the basic context of the staff’s daily activity. (74)
The obligation of the staff to maintain certain humane standards of treatment for inmates presents problems in itself, but a further set of characteristic problems is found in the constant conflict between humane standards on one hand and institutional efficiency on the other. (78)
When we combine the fact that the staff are obliged to maintain certain standards of humane treatment for inmates with the fact that they may come to view inmates as reasonable, responsible creatures who are fitting objects for emotional involvement, we have the context for some of the quite special difficulties of people-work. In mental hospitals, there always seem to be some patients who dramatically act against their own obvious self-interest: they drink water they have themselves polluted; they overstuff on Thanksgiving and Christmas, so that on these days there are bound to be a few ruptured ulcers and clogged esophagi; they rush headfirst against the wall; they tear out their own sutures after a minor operation; they flush down the toilet false teeth, without which they cannot eat and which take months to obtain; or they smash eyeglasses, without which they cannot see. In an effort to frustrate these visibly self-destructive acts, staff members may find themselves forced to manhandle these patients, creating an image of themselves as harsh and coercive just at the moment when they are attempting to prevent someone from doing to himself what they feel no human being should do to anyone. At such times, understandably, it is extremely difficult for the staff to keep their own emotions in control. (83)
Institutional Ceremonies (93)
Some final comments should be added about these institutional ceremonies. They tend to occur with well-spaced periodicity and to give rise to some social excitement. All the groupings in the establishment join in, regardless of rank or position - but are given a place that expresses their position. These ceremonial practices are well suited to a Durkheimian analysis: a society dangerously split into inmates and staff can through these ceremonies hold itself together. The content of these ceremonies supports the same kind of functionalist interpretation. For example, there is often a hint or a splash of rebellion in the role that inmates take in these ceremonies. Whether through a sly article, a satirical sketch, or overfamiliarity during a dance, the subordinate in some way profanes the superordinate. Here we can follow Max Gluckman’s analysis and argue that the very toleration of this skittishness is a sign of the strength of the establishment state. (109)
But a simple functionalist analysis of institutional rituals is not wholly convincing, except in the effect that apparently results occasionally form group therapy. In many cases it is a nice question whether these role releases create any staff-inmate solidarity at all. Staff typically complain to each other of their boredom with these ceremonies and their obligation to participate because of their own noblesse oblige, or worse still, because of that of their superiors. Inmates often participate because, wherever the ceremony is held, they will be more comfortable and less restricted there than where they otherwise would be. Further, inmates sometimes participate to gain the eye of staff and to earn an early release. A total institution perhaps needs collective ceremonies because it is something more than a formal organization; but its ceremonies are often pious and flat, perhaps because it is something less than a community. (110)
There are grounds, then, for claiming that one of the main accomplishments of total institutions is staging a difference between two constructed categories of persons - a difference in social quality and moral character, a difference in perceptions of self and other. Thus every social arrangement in a mental hospital seems to point to the profound difference between a staff doctor and a mental patient; in a prison, between an official and a convict; and in military units (especially elite ones), between officers and men. Here, surely, is a magnificent social achievement, even though the similarity of the players, to which institutional ceremonies attest, can be expected to create some staging problems and therefore some personal strain. (112)
I would like to mention one symptom of these staging problems. In total institutions we characteristically obtain identity anecdotes. Inmates tell of times they were mistaken for staff members and carried off the misidentification for a while, or of times they mistook a staff member for an inmate; staff persons similarly recount times when they were mistaken for inmates. We find identity joking, when a member of one group briefly acts like a member of the other, or briefly treats a co-member as someone of the other category, for the avowed purpose of amusement. Annual skits satirizing staff are one source of this joking; uneventful moments of horseplay during the day are another. And we also find identity scandals, a dwelling on cases where a person started out as a member of the staff, was disgraced in some way, and became a member of the inmate group in the same (so same kind of) institution. I assume these identity concerns point to the difficulty of sustaining a drama of difference between persons who could in many cases reverse roles and play on the other side. (In fact, these persons do engage in playful role reversal.) It is not clear what problems these ceremonies solve, but it is clear what problems they point to. (112)
Qualifications and Conclusions (112)
In a closer study of total institutions it would be important to ask about the typical differentiation of role that occurs within each of the two main groups, and to ask about the institutional function of these more specialized positions. Some of these special roles have been mentioned in discussing special institutional tasks: someone on staff will have to be the official representative of the institution in the councils of the wider society and will have to develop a non-institutional polish in order to do this effectively; someone on staff will have to deal with visitors and other connections of the inmates; someone will have to offer professional services; and someone will have to spend time in relatively close contact with inmates. Someone may even have to provide a personal symbol of the institution for the inmates - a symbol on which they may project many different kinds of emotion. A close treatment of total institutions should give systematic attention to these intra category differences. (113)
One of the most interesting differences among total institutions is to be found in the social fate of their graduates. Typically, these become geographically dispersed; the difference is found in the degree to which structural ties are maintained in spite of this distance. At one end of the scale are the year’s graduates of a particular Benedictine abbey, who not only keep in touch informally but find that for the rest of their lives their occupation and geographical location have been determined by their original membership. At the same end of the scale are ex-cons whose stays in prison orient them to the calling and to the nationwide underworld community that will comprise their lives thereafter. At the other end of the scale, we find enlisted men from the same barracks who melt into private life immediately upon demobilization and even refrain from congregating for regimental reunions. Here, too, are ex-mental patients who studiously avoid all persons and events that might connect them with the hospital. Midway between these extremes we find “old-boy” systems in private schools and graduate universities, which function as optional communities for the distribution of life chances among sets of fellow graduates. (123)
The Moral Career of the Patient
Traditionally the term career has been reserved for those who expect to enjoy the rises laid out within a respectable profession. The term is coming to be used, however, in a broadened sense to refer to any social strand of any person’s course through life. The perspective of natural history is taken: unique outcomes are neglected in favor of such over time as are basic and common to the members of a social category, although occurring independently to each of them. Such a career is not a thing that can be brilliant or disappointing; it can no more be a success than a failure. In this light, I want to consider the mental patient. (127)
One value of the concept of career is its two-sidedness. One side is linked to internal matters held dearly and closely, such as image of self and felt identity; the other side concerns official position, jural relations, and style of life, and is part of a publicly accessible institutional complex. The concept of career, then, allows one to move back and forth between the personal and the public, between the self and its significant society, without having to rely overtly for data upon what the person says, thinks, imagines himself to be. (127)
This paper, then, is an exercise in the institutional approach to the study of self. The main concern will be with the moral aspects of career - that is, the regular sequence of changes that career entails in the person’s self and his framework of imagery for judging himself and others. (127-128)
The category “mental patient” itself will be understood in one strictly sociological sense. In this perspective, the psychiatric view of a person becomes significant only in so far as this view itself alters his social fate - an alteration which seems to become fundamental in our society when, and only when, the person is put through the process of hospitalization. (128)
The Prepatient Phase (131)
I am suggesting that the prepatient starts out with at least a portion of the rights, liberties, and satisfactions of the civilian and ends up on a psychiatric ward stripped of almost everything. The question here is how this stripping is managed. (140)
The Inpatient Phase (146)
The last step in the prepatient’s career can involve his realization - justified or not - that he has been deserted by society and turned out of relationships by those closest to him. Interestingly enough the patient, especially at first admission, may manage to keep himself from coming to the end of this trail, even though in fact he is now in a locked mental-hospital ward. On entering the hospital he may very strongly feel the desire not to be known to anyone as a person who could possibly be reduced to these present circumstances, or as a person who conducted himself in the way he did prior to commitment. Consequently, he may avoid talking to anyone, may stay by himself when possible, and may even be “out of control” or “manic” so as to avoid ratifying any interaction that presses a politely reciprocal role upon him and open him up to what he has become in the eyes of others. When the next-of-relation makes an effort to visit, he may be rejected by mutism, or by the patient’s refusal to enter the visiting room, these strategies sometimes suggesting that the patient still clings to a remnant of relatedness to those who made up his past, and is protecting this remnant from the final destructiveness of dealing with the new people that they have become. (146)
Usually the patient comes to give up this taxing effort at anonymity, at not-hereness, and begins to present himself for conventional social interaction to the hospital community. Thereafter he withdraws only in special ways - by always using his nickname, by signing his contribution to the patient weekly with his initial only, or by using the innocuous “cover” address tactfully provide by some hospitals; or he withdraws only at special times, when, say, a flock of nursing students makes a passing tour of the ward, or when, paroled to the hospital grounds, he suddenly sees he is about to cross the path of a civilian he happens to know from home. Sometimes this making of oneself available is called “settling down” by the attendants. It marks a new stand openly taken and supported by the patient, and resembles the “coming-out” process that occurs in other groupings. (147)
Finally, at the most informal of levels, the lunchtime and coffee-break small talk of staff often turns upon the latest doings of the patient, the gossip level of any social establishment being here intensified by the assumption that everything about him is in some way the proper business of the hospital employee. Theoretically there seems to be no reason why such gossip should not build up the subject instead of tear him down, unless one claims that talk about those not present will always tend to be critical in order to maintain the integrity and prestige of the circle in which the talking occurs. (161)
In general, then, mental hospitals systematically provide for circulation about each patient the kind of information that the patient is likely to try to hide. And in various degrees of detail this information is used daily to puncture his claims. At the admission and diagnostic conferences, he will be asked questions to which he must give wrong answers in order to maintain his self-respect, and then the true answer may be shot back at him. An attendant whom he tells a version of his past and his reason for being in the hospital may smile disbelievingly, or say, “That’s not the way I heard it,” in line with the practical psychiatry of bringing the patient down to reality. (161-162)
The moral career of a person of a given social category involves a standard sequence of changes in his way of conceiving of selves, including, importantly, his own. These half-buried lines of development can be followed by studying his moral experiences - that is, happenings which mark a turning point in the way in which the person views the world - although the particularities of the view may be difficult to establish. And note can be taken of overt tacks or strategies - that is, whatever the hidden and variable nature of his inward attachment to these presentations. By taking note of moral experiences and overt personal stands, one can obtain a relatively objective tracing of relatively subjective matters. (168)
Each moral career, and behind this, each self, occurs within the confines of an institutional system, whether a social establishment such as a mental hospital or a complex of personal and professional relationships. The self, then, can be seen as something that resides in the arrangements prevailing in a social system for its members. 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. (168)
In this paper, two of these institutional arrangements have been considered, by pointing to what happens to the person when these rulings are weakened. The first concerns the felt loyalty of his next-of-relation. The pre-patient’s self is described as a function of the way in which three roles are related, arising and declining in the kinds of affiliation that occur between the next-of-relation and the mediators. The second concerns the protection required by the person for the version of himself which he presents to others, and the way in which the withdrawal of this protection can form a systematic, if unintended, aspect of the working of an establishment. I want to stress that these are only two kinds of institutional rulings from which a self emerges for the participant; others, not considered in this paper, are equally important. (168-169)
In the usual cycle of adult socialization one expects to find alienation and mortification followed by a new set of beliefs about the world and a new way of conceiving of selves. In the case of the mental-hospital patient, this rebirth does sometimes occur, taking the form of a strong belief in the psychiatric perspective, or, briefly at least, a devotion to the social cause of better treatment for mental patients. The moral career of the mental patient has unique interest, however; it can illustrate the possibility that in casting off the raiments of the old self - or in having this cover torn away - the person need not seek a new robe and a new audience before which to cower. Instead he can learn, at least for a time, to practice before all groups the amoral arts of shamelessness. (169)
The Underlife of a Public Institution: A study of Ways of Making Out in a Mental Hospital. (171)
Part One: Introduction
Action and Being
The bonds that tie the individual to social entities of different sorts themselves exhibit common properties. Whether the entity is an ideology, a nation, a trade, a family, a person, or just a conversation, the individual’s involvement in it will have the same general features. He will find himself with obligations: some will be cold, entailing alternatives foregone, work to be done, service rendered, time put in, or money paid; some will be warm, requiring him to feel belongingness, identification, and emotional attachment. Involvement in a social entity, then, entails both a commitment and an attachment. (173)
One cannot think clearly about the claims of commitment or of attachment that a social entity makes on its participants without thinking of the limits felt proper on these claims. An army requires a soldier to be brave but establishes a limit past which his bravery will be above and beyond the call of duty; furthermore, may have a right to compassionate leave when his father ides or his wife gives birth to a baby. Similarly, a wife can assume that her husband will publicly stand by her side to form a visible social unit, yet each weekday she must give up to the world of work; and may exert the occasional right to spend an evening alone in a bar, play card with the boys, or engage in some other bargain of liberty. (p173-174)
In actual practice the individual often abjures all of these extremes. He holds himself off from fully embracing all the self-implications of his affiliation, allowing some of this disaffection to be seen, even while fulfilling his major obligations. (175)
It is this theme of expressed distance, and some patterns of behavior upon which it bears, that I want to explore here. I propose to discuss mainly one type of social entity, “instrumental formal organizations,” relying largely on case-history material from a mental hospital as one instance of one class of these. (175)
An “instrumental formal organization” may be defined as a system of purposely coordinated activities designed to produce some over-all explicit ends. The intended product may be material artifacts, services, decisions, or information, and may be distributed among the participants in a great variety of ways. I will be mainly concerned with those formal organizations that are lodged within the confines of a single building or complex of adjacent buildings, referring to such a walled-in unit, for convenience, as a social establishment, institution, or organization. (176)
Every organization, then, involves a discipline of activity, but our interest here is that at some level every organization also involves a discipline of being - an obligation to be of a given character and to dwell in a given world. And my object here is to examine a special kind of absenteeism, a defaulting not from prescribed activity but from prescribed being. (188)
Primary and Secondary Adjustment (188)
A concept can now be introduced. When an individual co-operatively contributes required activity to an organization and under required conditions - in our society with the support of institutionalized standards of welfare, with the drive supplied through incentives and joint values, and with the promptings of designated penalties - he is transformed into a co-operator; he becomes the “normal,” “programmed,” or built-in member. He gives and gets in an appropriate spirit what has been systematically planned for, whether this entails much or little of himself. In short, he finds that he is officially asked to be no more and no less than he is prepared to be, and is obliged to dwell in a world that is in fact congenial to him. I shall speak in these circumstances of the individual having a primary adjustment to the organization and overlook the fact that it would be just as reasonable to speak of the organization having a primary adjustment to him. (188-189)
I have constructed this clumsy term in order to get to a second one, namely, secondary adjustments, defining these as any habitual arrangement by which a member of an organization employs unauthorized means, or obtains unauthorized ends, or both, thus getting around the organization’s assumptions as to what he should do and get hence what he should be. Secondary adjustments represent ways in which the individual stands apart from the role and the self that were taken for granted for him by the institution. (189)
Finally, as we shall see later, the official doctrine according to which an institution is run may be so little honored in practice, and a semi-official perspective may be so firmly and fully established, that we must analyze secondary adjustments relative to this authorized-but-not-quite-official system. (193)
An interest in the actual place in which secondary adjustments are practiced and in the drawing from which practitioners come shifts the focus of attention from the individual and his act to collective matters. In terms of a formal organization as a social establishment, the corresponding shift would be from an individual’s secondary adjustment to the full set of such adjustments that all the members of the organization severally and collectively sustain. These practices together comprise what can be called the underlife of the institution, being to a social establishment what an underworld is to a city. (199)
Reverting once again to the social establishment, an important characteristic of primary adjustments is their contribution to institutional stability: the participant who adapts to the organization in this way is likely to keep on participating as long as the organization wants him to, and, if he leaves before this, to leave in a way that smooths the transition for his replacement. This aspect of primary adjustments leads us to distinguish two kinds of secondary adjustments: first, disruptive ones, where the realistic intentions of the participants are to abandon the organization or radically alter its structure, in either case leading to a rupture in the smooth operation of the organization; second, contained ones, which share with primary adjustments the characteristic of fitting into existing institutional structures without introducing pressure for radical change, and which can, in fact, have the obvious function of deflecting efforts that might otherwise be disruptive. The settled and established parts of an organization’s underlife tend, therefore, to be composed primarily of contained, not disruptive, adjustments. (200)
Disruptive secondary adjustments have been studied in the dramatic processes of unionization and infiltration of governments. Because disruptive secondary adjustments are by definition temporary things, as in the planning for a mutiny, the term “adjustment” may not be quite suitable. (200)
Part Two: Hospital Underlife (207)
The first thing to note is the prevalence of make-do’s. In every social establishment participants use available artifacts in a manner and for an end not officially intended, thereby modifying the conditions of life programmed for these individuals. A physical reworking of the artifact may be involved, or merely an illegitimate context of use, in either case providing homely illustrations of the Robinson Crusoe theme. Obviously examples come from prisons, where, for example, a knife may be hammered from a spoon, drawing ink extracted from the pages of Life magazine, exercise books used to write betting slips, and cigarettes lit by a number of means - sparking an electric-light outlet, a homemade tinderbox, or a match split into quarters. While this transformation process underlies many complex practices, it can be most clearly seen where the practitioner is not involved with others (except in learning and teaching the technique), he alone consuming what he just produced. (208)
In
total institutions make-do’s tend to be focused in
particular areas. One area is that of
personal grooming - the fabrication of devices to facilitate presenting oneself
to others in a seemly guise. For
example, nuns are said to have placed a black apron behind a window pane to
create a mirror - a mirror being a means of self-examination, correction, and
approval ordinarily denied the sisterhood.
In
There were several strategic points in the hospital social system where association with outsiders was possible. Some of the adolescent female children of the resident doctors participated as sociable equals in the small circle of paroled male patients and student nurses who dominated the hospital tennis court. During and after games this group would lounge on the nearby grass, engage in horseplay, and in general maintain a non-hospital tone. Similarly, on evenings when outside charitable organizations ran a dance, bringing some young females with them, one or two male patients affiliated themselves with these women, apparently obtaining from them a non-hospital response. So, too, on the admission ward where student nurses were spending their period of psychiatric training, some young male patients regularly played cards and other games with them, during which a dating, not a nursing, ethos was maintained. And during the “higher” therapies such as psychodrama or group therapy, visiting professionals would often sit in to observe the latest methods; these persons, too, provided patients with a source of interaction with normals. Finally, patients on the all-star hospital baseball team, when playing against teams from the environing community, were able to enjoy the special camaraderie that develops between opposing teams in a game and that separates both teams off from the spectators. (218-219)
It may be suggested that the more unpalatable the environment in which the individual must live, the more easily will places qualify as free ones. Thus, in some of the worst wards, housing up to sixty patients, many “regressed,” the problem of reduced personnel on the evening (4:00 to 12:00 P.M.) shift was met by herding all the patients into the day room and blocking the entrance so that every patient on the ward could be placed under the surveillance of one pair of eyes. This time corresponded with the departure of medical staff; with dusk (in winter), which was very apparent because the wards were ill-lit; and, often, with the shutting of windows. At this time a pall fell on what was already a pall, and there was an intensification of negative affect, tension, and strife. A few patients, often ones willing to sweep down the floor, prepare the beds, and herd other patients to sleep, were allowed to stay outside of this pen and wander freely in the then-emptied hallways between the dormitory and the maintenance offices. At such times any place not in the day room took on a quiet tone, with a relatively unhostile staff definition of the situation prevailing. What was off-limits for the bulk of the patients became, through the same ruling, a free place for a select few. (238)
I have mentioned two kinds of places over which the patient has unusual control: free places and group territories. He shares the first with any patient and the second with a selected few. There remains private claim on space, where the individual develops some comforts, control, and tacit rights that he shares with no other patients except his own invitation. I shall speak here of personal territory. A continuum is involved, with a veritable home or nest at one extreme, and at the other a mere location or refuge site in which the individual feels as protected and satisfied as is possible in the setting. (243-244)
In
mental hospitals and similar institutions the basic kind of personal territory
is, perhaps, the private sleeping room, officially available to around five or ten
per cent of the ward population. In
I would like to repeat that there were some good reasons for these bulky carryings-on. Many of the amenities of life, such as soap, toilet paper, or cards, which are ordinarily available in many depots of comfort in civil society, are not thus available to patients, so that the day’s needs had to be partly provided for at the beginning of the day. (253)
In considering undercover transportation systems we found that the consumer of what is transported without authorization can also be the person who transports it. But in many cases the recipient of the unauthorized delivery makes regular use of the effort of another. By regular fitting another’s efforts into his own designs, the individual can greatly increase the range and scope of his secondary adjustments, including those which do not primarily rely on transportation systems. Since this use of another constitutes an important aspect of the underlife of the inmate, an attempt must be made to examine its forms and the elements of social organization that underlie them. (263)
One way in which an individual may incorporate another’s efforts into his own plans is on unrationalized force or what might be called private coercion: here the helper helps not because his present condition will improve but because failure to comply will be costly enough to make him perceive compliance as involuntary; and here the person demanding help provides no pretext for the legitimacy of his demand. Without considering here the admixture of this coercion in otherwise “voluntary” co- operation, I want to suggest that in total institutions private coercion unadorned can be important in the underlife of inmates; open expropriation, blackmail, strong-arm techniques, forced sexual submission - these are methods that can be employed without rationalization as a means of bringing the activities of another into one’s own line of action. When such coercion becomes routine, how long it can remain naked and how soon it is regularized by a show of reciprocation or moral justification are other, and interesting, questions. (263-264)
In
every social establishment bonds of solidarity develop among sets of
members. In domestic and convivial
establishments some of these bonds may be specifically prescribed as part of
the primary adjustment of the participants.
In other cases, as in the mildly involving free time cliques found in
some commercial offices, primary adjustment will entail an option as to whether
or not one becomes involved in these structures. In many cases, however, bondedness
functions as part of the underlife of the
establishment, and in two ways. First,
the mere emotional support and sense of a personal tie provided thereby may not
be something established in the official design of the organization. Perhaps the clearest form of this is the
so-called office affair or, in hospital terms, “bug-house romance,” for such
involvements, as previously suggested, can absorb a great deal of the
participants’ time, filling out much of the world in which they live. Second, and more important here, these substructures
can provide the basis for both economic and social exchanges, of the kind that
result in the unauthorized transfer of goods and services. To consider the role of social exchanges in
As expected, then, some of the secondary adjustments practiced in the hospital were designed to produce goods that could in turn be given to others - in short, ritual supplies. The patient dining halls and cafeterias served as one source of ritual supplies, for when portable fruit was available - oranges, apples, or bananas - patients would take it back to the ward uneaten, not only for personal supplies and as a means of effecting economic exchange but also something to give to friends. So, also, at bridge in the recreation building, a man might accept a tailor-made cigarette and return the compliment with an orange, a fair exchange but performed in the spirit of persons in no way concerned with such picayune fairness. (280)
Without something to belong to, we have no stable self, and yet total commitment and attachment to any social unit implies a kind of selflessness. Our sense of being a person can come from being drawn into a wider social unit; our sense of selfhood can arise through the little ways in which we resist the pull. Our status is backed by the solid buildings of the world, while our sense of personal identity often resides in the cracks. (320)
The Medical Model and Mental Hospitalization: Some notes on the tinkering of the vicissitudes of the tinkering trades. (321)
In each society there are favored ways in which two individuals can approach and have dealings with each other, for example, as kindred to kindred, or high caste to low. Each of these frameworks for contact can be at once a source of identity, a guide for ideal conduct, and a basis of both solidarity and divisiveness. Each framework involves a set of interdependent assumptions that fit together to form a kind of model. In every case we find that characteristic pressures present persons from fully realizing the ideal and that the resulting deviations have characteristic reverberations. The student of society can therefore use for his purposes the same models that members of society use for theirs. (321)
In our Western society, an important way in which two individuals may deal with each other is as server and served. By exploring the assumptions and ideals behind this occupational relationship, I think we can understand some of the problems of mental hospitalization. (321)
Specialized occupational tasks can be divided into two categories, one where the practitioner “meets the public” through his work, a second where he does not, performing it only for the established members of his work organization. I assume that the problem of facing the public and of controlling it sufficiently central to merit treating together all who experience it. This means that a hardware-store clerk and a factory tool-bin man are to be separated for purposes of study, in spite of similarities in what they do. (324)
Among tasks requiring the performer to meet the public, two kinds may be distinguished, one where the public consists of a sequence of individuals, and another where it consists of a sequence of audiences, a comedian the second. (324)
A personal-service occupation may be defined, ideally, as one whose practitioner performs a specialized personal service for a set of individuals where the service requires him to engage in direct personal communication with each of them and where he is not otherwise bound to the persons he serves. (324)
In this paper I want to consider personal-service occupations as here defined, but I shall include some practitioners who do not entirely fit my definition, since the ideal on which it is based draws people who are not in a position to conform to it. Deviations from an ideal imposed by self or others create problems of identity that the student must understand in terms of the ideal - and understand differently decoding on the relation of the deviation to the ideal: a high-pressure car salesman and an insurance-company doctor both provide something less than a personal service, but for a different framework of reasons. (325)
The type of social relationship I will consider in this paper is one where some persons (clients) place themselves in the hands of other persons (servers). Ideally, the client brings to this relationship respect for the server’s technical competence and trust that he will use it ethically; he also brings gratitude and a fee. On the other side, the server brings: an esoteric and empirically effective competence, and a willingness to place it at the client’s disposal; professional discretion; a voluntary circumspection, leading him to exhibit a disciplined unconcern with why the client should want the service in the first place; and, finally, an unservile civility. This, then, is the tinkering service. (326)
Now a foreign agent lodged in a physical system may be permanently dealt with by the internal corrective capacities of the system itself, by natural repair or natural compensation, and cease to constitute a problem for the object’s possessor. But with many disruptive agents a different phase follows, namely, an increased malfunctioning over time. The little evil spreads out until the whole system is placed in jeopardy. Thus the tire, once punctured, gets lower and lower, until the tube and rim are ruined and the car can no longer be driven. (p330-331)
There is a threshold point where the possessor himself finally sees that his possession has suffered damage or injury. If the possessor cannot make his own repairs and if he defines his problem as one that a server can help with, he becomes a client in search of a server, or in search of referral to a server through a set of intermediaries. (331)
We now turn to the medical version of the tinkering-services model. Our giving our bodies up to the medical server, and his rational-empiricist treatment of them, is surly one of the high points of the service complex. Interestingly enough, the gradual establishment of the body as a serviceable possession - a kind of physiochemical machine - is often cited as a triumph of the secular scientific spirit, when in fact this triumph seems in part to have been both cause and effect of the rising regard for all types of expert servicing. (340)
The signs that medical men currently employ, especially signs involving refined laboratory work, are increasingly sophisticated, yet medical men still claim to rely on the patient for reporting symptoms; the client is still a participant to be respected in the service relationship. But, as with other competencies, there are special points of strain in fitting the treatment of the body into the service framework. I would like to mention some of these, with the understanding that the same problems also arise to some degree in other kinds of servicing. (340)
The very willingness of clients to put their bodies’ fate in the hands of their physicians carries its own problem for medical men: they may find that sympathy with the patient subjects them to emotional stress when they are uncertain of what is wrong or what can be done for the patient, or when they are certain that little can be done and must impart this information to the person (or his guardian) whose fate will be sealed by it. But here, perhaps, we have a problem not for medical servicing as such but for the individuals who perform it. (341)
In citing some senses in which mental hospitalization does not fit the medical-service model, I have not mentioned the difficulties in applying the model to outpatient private psychiatric practice, although these of course exist (such as: the length of time required for treatment, with consequent strain on the concept of the fee; the low probability of effective treatment; and the very great difficulty of knowing to what to attribute change in the patient’s condition). (383)
Further, in focusing on the difficulties of the application to the mental hospital of the medical-service model, I do not mean to imply that the application of the model has not sometimes proved useful to those institutionalized as patients. The presence to medical personnel in asylums has no doubt served to stay somewhat the hand of the attendant. There seems little doubt that doctors are willing to work in these insalubrious, isolating environments because the medical perspective provides a way of looking at people that cuts across standard social perspectives and therefore provides a way of being somewhat blind to ordinary tastes and distastes. The availability of the medical version of one’s situation has no doubt provided some patients with a claim on middle class consideration within the hospital; the moratorium, on medical grounds, from family living has no doubt been of great help to some patients; the general medical notion of the “curability” of “mental disorder” consequent on the administration of “treatment” has no doubt made reintegration into the free community easier for some patients and for those to whom they return; and the idea that one has been undergoing treatment for a lifelong wasting of one’s previous years can provide some patients with a way of making some kind of acceptable sense out of the time spent in exile in the hospital. (383-384)
In a medical hospital, one’s own physical incapacities are taken as a sign that treatment, however unpleasant or confining, is needed for one’s own good and should be accepted. In a psychiatric hospital, failure to be an easily manageable patient - failure, for example, to work or to be polite to staff - tends to be taken as evidence that one is not “ready” for liberty and that one has a need to submit to further treatment. The point is not that the hospital is a hateful place for patients but that for the patient to express hatred of it is to give evidence that his place in it is justified and that he is not yet ready to leave it. A systematic confusion between obedience to others and one’s own personal adjustment is sponsored. (385)
Mental patients can find themselves in a special bind. To get out of the hospital, or to ease their life within it, they must show acceptance of the place accorded them, and the place accorded them is to support the occupational role of those who appear to force this bargain. This self-alienating moral servitude, which perhaps helps to account for some inmates becoming mentally confused, is achieved by invoking the great tradition of the expert servicing relation, especially its medical variety. Mental patients can find themselves crushed by the weight of a service ideal that eases life for the rest of us. (386)