Abstract
In this article I summarize the main points in the first two essays in Erving Goffman’s Asylums, published in 1961, which is based on his field work at St. Elizabeths Hospital in Washington, D.C. in 1955–56. The first essay presents his concept of total institutions. The second focuses on the mortification of the self that one experiences during the pre-patient and patient phases. Although these essays reflect observations that were made some 60 years ago, his analysis of what happens to the mental patient in the hospital environment is still relevant, especially for seminary students whose CPE field work takes place in the mental hospital setting. This article also provides the basis for a follow-up article on William F. Lynch’s (1965) Images of Hope, which he wrote during his residence at St. Elizabeths Hospital in the early 1960s.
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Notes
It is, of course, worth observing that the deinstitutionalization of the mentally ill was an important political issue at this time and that if he were released at this time, he would probably have nowhere to go. This issue is addressed in the video Asylum: A History of the Mental Institution in America (Mondale and Patton 2006) which focuses on St. Elizabeths Hospital. It debates whether deinstitutionalization has been an overall failure, leaving more patients homeless than are mainstreamed into society, and asks whether the time has come to reintroduce the asylum as a place of therapy and benign confinement.
Goffman moved to the University of Pennsylvania in 1968. He was born in Canada in 1922 and died in Philadelphia in 1982. He received his B.A. from the University of Toronto (1945) and his M.A. (1949) and Ph.D. (1953) from the University of Chicago. Other books by Goffman include The Presentation of Self in Everyday Life (1959), Behavior in Public Places (1963a), Stigma: Notes on the Management of Spoiled Identity (1963b), Interaction Ritual (1967), Relations in Public (1971), and Frame Analysis (1974).
Goffman uses the male pronoun “he” which was standard practice at the time the book was written. There were, of course, female as well as male patients at St. Elizabeths Hospital.
Asylums may be viewed as a sequel to The Presentation of Self in Everyday Life (Goffman 1959), a book that focuses on the manner in which we enter the presence of others and present ourselves to them and on the ways in which they perceive us (i.e., the impression that we make on others, the evidence that they use to form their impression of us, and so forth). Employing the theater metaphor, Goffman discusses such issues as performance (which involves the issue of whether we believe in the part we are playing and the roles of dramatization, idealization, mystification, and realism in our performance, say, in the work that we do); participation on a team; formal and informal conduct; the playing of discrepant roles; communication that is out of character; and impression management.
A conversation I had with a female patient when I was at St. Elizabeths supports Goffman’s point about the restrictions placed on social mobility between the two groups while also suggesting that there were violations in this regard. I knew that she had been a patient at St. Elizabeths for 10 years or so. So when she told me that she was the mother of an eight- and a five-year-old, I suspected that she was delusional, and said as much to her: “Since you’ve been here 10 years, how is it possible that you are the mother of two young children?” She responded, “You haven’t been here very long, have you?” Then she told me about what goes on between patients and attendants at night in the tunnels, whose official use is to transport patients and various supplies between buildings.
In my article on John Hinckley (Capps 2013), I discuss his efforts to gain the privilege of leaving the hospital for brief periods of time and the role that his attempted assassination of President Reagan has played in this regard.
Webster’s New World College Dictionary defines mortification as “a mortifying or being mortified, specifically (a) the control of physical desires and passions by self-denial, fasting, etc. (b) shame, humiliation, etc.; loss of self-respect” (Agnes 2001, p. 939). Goffman clearly intends the second meaning of the word. The relevant definition of mortify is “to cause to feel shame, humiliation, chagrin, etc.; injure the pride or self-respect of” (p. 939). A third definition is “to destroy the vitality or vigor of” (p. 939). This definition may also be intended by Goffman.
Goffman continues his discussion of the characteristics of total institutions by focusing on the staff world and institutional ceremonies. As these are somewhat outside the emphasis of this article on the experience of the mental patient, I will not discuss these aspects of his essay here.
Goffman notes that subcultures in American society differ in regard to what they consider grounds for the view that someone is losing his or her mind and that this is reflected in differential rates of self-referral. He suggests that “the capacity to take this disintegrative view of oneself without psychiatric prompting seems to be one of the questionable cultural privileges of the upper classes” (p. 132).
Goffman cites several illustrations. For example, one case history noted: “At first she denied having had premarital experience, but when asked about Jim she said she had forgotten about it because it had been unpleasant.” He also cites unsuccessful efforts to elicit symptomatic thoughts or behavior. Another case history noted, “Even with considerable pressure she was unwilling to engage in any projection of paranoid mechanisms,” and “No psychotic content could be elicited at this time” (p. 157). See also footnote 6 and my questioning the veracity of what the patient was telling me.
A major reason for these doubts was that the denomination to which I belonged was in the process of liturgical reform which included the expectation that clergy would sing their responses in the liturgy. I was convinced that I was incapable of singing solo in front of an audience (see Capps 2010).
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Capps, D. The Mortification of the Self: Erving Goffman’s Analysis of the Mental Hospital. Pastoral Psychol 65, 103–126 (2016). https://doi.org/10.1007/s11089-015-0665-1
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DOI: https://doi.org/10.1007/s11089-015-0665-1