The Organisation of Mental Health Work
The rise of the asylum and its legacy
Incarceration in asylums is seen as linked to the wider scale containment of social deviancy.
Goffman (1961) proposed four types of total institutions:
- Those that care for the ‘incapable’ and ‘harmless’ (e.g., nursing homes)
- Those for people perceived to be an unwanted threat to the community (e.g., sanitariums)
- Those which cater for dangerous people where the welfare of the inmate is not paramount (e.g., prisons)
- Those designed for people who voluntarily retreat from the world (e.g., monasteries)
The old style of asylums would fall into category #2 above.
The crisis of the asylum
On entry to an asylum, a person undergoes a process called the mortification of self. This is where the person is deprived of their previous identity through regimentation. This is also known as a degradation ceremony.
According to Martin (1985), there are six types of isolation which are commonly associated with institutions:
- Geographical isolation: most institutions are situated outside of main town centres.
- Immediate isolation: wards are further isolated from each other.
- Personal isolation: untrained (or under-trained) and isolated staff were left to cope with unbearable conditions.
- Consultant isolation: worst wards were rarely visited by the responsible consultant.
- Intellectual isolation: lack of professional stimulus, staff development and training.
- Privacy: patients regularly visited by relatives were not usually the focus of complaints.
These points, while hardly focusing on the isolation that individual patients must surely experience, go towards explaining why abuse within institutions became a common occurrence, and this resulted in a crisis which then served as a key factor in the deinstitutionalisation movement.
Response to the crisis
The ‘pharmacological revolution’ played a key role.
Changes in the organisation of medicine: there was a shift to acute problems and primary care.
Community care and re-institutionalisation
- Acute units retain a biomedical emphasis which maintains a spurious illusion (a problem is brought in, fixed, and sent out ‘mended’)
- Acute units charged with coercive control role.
This is part of a series of summaries that I am doing in order to revise Sociology of Mental Health. It won’t be shared on social media, but anyone is welcome to read these posts if they would be of interest.
If you would like to read more, most of this information came from this book.