"The Moral Career of the Mental Patient"
(Goffman, 1961)
The full text of the Goffman (1961) article is on 2-hour reserve at the UWMC library (in the book Asylums, pages 128-169). Please read (or at least skim) this article prior to Friday, January 31, in preparation for an in-class discussion on this topic. Please also review the questions and exercises below to assist you with digesting the article.
1. Thinking about Goffman's use (p. 127) of the word "career" (which is much wider than our usual use of the term), what has your life's "career" been like? Try the exercise below, remembering Goffman's distinction between private vs. public aspects of any person's career.
In their book Finding Your Perfect Work: The New Career Guide to Making a Living, Making a Life (1996), Paul and Sarah Edwards suggest a "life line" exercise to review your own life's "career". On a sheet of paper, draw a vertical line down the middle of the page. At the bottom of the line, draw a dot and label it "Birth". At the top of the line, draw a second dot and label it "Today". Label the left-hand column "Negative Events" and the right-hand column "Positive Events". The height (11" if you're using a standard sheet of paper) of the page represents the years of your life to date.
Reviewing your life, list key events that shaped you and made you the person you are today, or key decision points, turning points, or (in the words of another career counselor) "life gates". List positive events to the right, negative events to the left, in chronological order from Birth (bottom of page) to Today (top of page). You won't be asked to turn this in or to reveal details about your life, so you might as well be honest... though, if you are worried about your neighbor sneaking a look at your paper, you can always write in code.
Then ask yourself: what is your life all about? What patterns, trends, or themes do you see? Is there a thread running through your life? If you had to sum up your life choices in one word, what word would you choose?
2. Much of Goffman's writings have to do with the concept of "total institutions", organizations that attempt to control all aspect of a person's environment and choices: prisons and mental hospitals are two obvious examples. (Can you think of some others?) What are some of the differences you can imagine between total institutions and other, more typical social institutions: for instance, as related to the question of privacy or the right of selective self-disclosure? What impact do these differences likely have on the career of mental patients?
3. Goffman argues (p. 130) that while mental institutions are designed to help people become healthier, in many cases they actually promote "sicker" behavior (at least in the short run). Can you think of some reasons why this might be so? What, if anything, could inpatient facilities do about this problem? Why do you think such steps are usually not taken?
4. "The prepatient's career may be seen in terms of an extrusory model: he [in 1961, no one worried about gender-inclusive language -- this is Goffman's problem, not mine] starts out with relationships and rights, and ends up... with hardly any of either... [leading to a near universal] experience of abandonment, disloyalty, and embitterment." (p. 133) Since these are obviously counter-therapeutic states, what if anything could institutions do to avoid the problem?
5. Why do mentally ill persons who are hospitalized end up so different from those who are "absorbed" into society in other, less extrusory ways? "In the degree that the mentally ill outside hospitals numerically approach or surpass those inside hospitals, one could say that mental patients distinctively suffer, not from mental illness, but from contingencies." (p. 135) What does Goffman mean by "contingencies"? Can you give some examples? What approaches might society take, other than involuntary commitment, to those who appear to be of imminent danger to self or others?
6. Goffman makes much of the fact that part of the coming to terms with involuntary commitment -- both for the patient and for family members -- involves a sort of reconstructive rewriting or "historical revisionism" of the patient's past. Indeed, without this, neither the patient nor family members can make sense of what has happened to the patient (p. 145). Does this require a distorted or distorting view of the patient's life? To some extent is this true of all of us, since Goffman suggests that "an important aspect of every career is the view the person constructs when he looks back over his progress" or her/his life? See the examples on pp. 152-153. What social purposes do these "reconstructions" serve for the patient?
7. Look in the article for instances of the "psychiatrization" of behavior: times when what we might otherwise call "normal" behavior is viewed exclusively through the lens of a psychiatric label or diagnosis. What does this suggest about the power of labels? About their two-sided nature?
8. Is it true in your view, as Goffman suggests, that any human life, if mined selectively for "psychiatric evidence", could justify inpatient treatment? "The events recorded in the case history are, then, just the sort that a layman would consider scandalous, defamatory, and discreting... although it might seem also to be true that anyone's life course could yield up enough denigrating facts to provide grounds for the record's justification of commitment" (pp. 158-159). Why or why not?