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Justina Luongo

Escaping the Asylum:

Erving Goffman and the Transition Away from Insane Asylums

A place of both pain and dark curiosity, the source of terror for many generations of pop

culture, and an outdated form of psychiatric care, the asylum was once the center of immense

controversy. Previously a common treatment for those with mental illness, asylums now have no

place in modern medicine. The deinstitutionalization movement of the 1950s and 60s aimed to

eradicate asylums and institute community-based care and largely helped to expose human rights

issues within the asylum system. Social psychologist Erving Goffman played a pivotal role in the

movement with his critically renowned book Asylums, detailing the psychological hardships

faced by institutionalized patients. Goffmans account of patient experience and asylum

bureaucracy gives further support to the deinstitutionalization movement and influenced the shift

away from asylum treatment.

Asylums became a common institution around the United States during the 19th century

with the intention to serve as a place to house and cure the mentally ill. Yet, curability, and even

treatability for the most part, remained out of reach for patients (Wilkins 189). Psychiatry had

only recently emerged as a science and knowledge about mental disorders was limited, creating a

dangerous situation for patients who served as test subjects for new treatments. One of the most

controversial psychiatric treatments was the lobotomy, which was practiced mainly during the

1930s and the 1940s. Psychiatrists reserved this procedure to permanently tranquilize

troublesome patients. During a lobotomy, the surgeon inserts a sharp metal rod through the

patients tear duct and into the brain. The rod disconnects neural circuits within the frontal lobe

and permanently damages the brain. Lobotomized patients experience perpetual lethargy and
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apathy, becoming hollow versions of their previous selves. The highly unethical surgery amassed

decades of controversy about the rights of mentally ill patients (Turkington and Harris 201-202).

Another form of experimental treatment used on patients was the psychoactive drug

chlorpromazine. Marketed in the United States as Thorazine, this drug creates effects similar to

that of the lobotomy, but without the need to perform surgery. Thorazine and psychoactive drug

use began to dominate patient treatment regimens within asylums. However, during the 1950s,

the side effects of these drugs gained recognition among the psychiatric community. Along with

the debilitating, lethargic effects akin to those of lobotomy, Thorazine causes tardive dyskinesia,

which is characterized by involuntary mouth movements such a jaw clamping and rapid tongue

movement (Waxman 1393-1394). Like with lobotomy, many patients suffered from this

experimental treatment before their pain was acknowledged enough to halt treatment.

In addition to procedural experimentation, asylum occupants encountered unsettling

living conditions, justifying the use of the phrase the worst home is better than the best

hospital. Overcrowding and understaffing became recurrent issues, and the physical institutions

themselves decayed over time with little resources to repair them (Piat 202) (Scull 545). The job

of the asylum attendant was considered an occupation of last resort, leading to patient abuse

by uncaring and undedicated attendants throughout the country (Monk 83). Not only that, but

due to faulty methods of diagnosis, many institutionalized people did not even have a form of

mental illness. Many asylums operated on the belief that One could go mad from a blow to the

head, from the inhalation of poisonous vapors, from indigestion, from masturbation, from

hereditary disposition, or from another disease excessive study, religious enthusiasm, anxieties

over work, and even 'blowing Fife all night,' 'reading vile books,' and 'extatic [sic] admiration of

works of art.'" (Bennett Theaters of Madness: Insane Asylums and Nineteenth-Century American
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Culture) So by way of mistaken diagnosis, some mentally healthy people became forcibly

institutionalized, obvious neglecting these individuals human rights.

From the human rights controversies generated from unethical and experimental

treatments, miserable living conditions, and forced institutionalization, the deinstitutionalization

movement was born. Instead of isolating mentally ill people from the community in asylums,

where these abuses had taken place for over a century, deinstitutionalization aimed to shut down

mental hospitals in favor of treatment administered within a patients community. In this system,

patients could stay at home or closer to their home and still have a place in society while being

treated. The movement began in the 1950s and these human rights issues served as a solid basis

for its campaign (Piat 201-202). Over time, however, the fight for deinstitutionalization evolved,

in large part due to social psychologist Erving Goffman. Goffman originally became famous for

his 1959 book The Presentation of Self in Everyday Life about how individuals manage and

express their societal roles. The Presentation of Self won him the American Sociological

Associations MacIver Award in 1961 along with a citation reading, to the author of a

publication which contributed in an astounding degree to the progress of sociology during the

two preceding years... (Oromaner 288). Goffman began research for his second book titled

Asylums with high credibility within the sociological community (Burns 141). For this book,

Goffman went undercover as a physical education instructor at St. Elizabeths Hospital in

Washington D.C. (the nations largest asylum at the time) to conduct an investigation on patient

life within mental institutions, and in 1961, he published his findings (Suibhne Perspectives on

Erving Goffmans Asylums fifty years on) (Fine and Martin 92). His work shed light on a

whole new, especially heinous type of asylum abuse which became a cornerstone argument for
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the deinstitutionalization movement from then on: psychological abuse stemming from the innate

bureaucracy of insane asylums.

One of the most important topics in Asylums is the concept of total institutions. Total

institutions arise through the bureaucratic control of the human needs of a group of people

and Goffman defines five different types: the monastery, the orphanage, the army barrack, the

prison, and the asylum. In his work, he draws many parallels between the institution of the prison

and that of the asylum. In both situations, individuals are treated as blocks to be managed

through surveillance and a strict hierarchy of command, and social mobility is grossly

restricted. Every aspect of patient life is completely out of the control of the patient and

enforced by a singular authority. Patients are deprived of property and a say in how they live

their own lives. Through this restrictive system, patients lose their morality and their sense of

identity, a process Goffman calls mortification of self (Halliwell 212) (Goodman Erving

Goffman and the total institution). His word choice in particular creates a sense of oppression

from an unstoppable source and evokes empathy for those who have to endure it (Burns 143).

Goffman also dramatizes these responses by remaining intentionally vague about his eye-witness

experiences while at St. Elizabeths. The ambiguity emphasizes the omniscient nature with which

he attempts to portray the asylum system. Both his word choice and ambiguity create fear within

the reader and he uses this tactic to frighten people into despising asylums.

In concordance with the dehumanizing effects of total institutions, Goffman makes sure

to emphasize the irony of a mental care facility causing extensive mental harm, as well as, to

discredit them.

From the patients point of view, to decline to exchange a word with the staff or with his

fellow patients may be ample evidence of rejecting the institutions view of what and who
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he is; yet high management may construe this alienative expression as just the sort of

symptomatology the institution was established to deal with and as the best kind of

evidence that the patient properly belongs where he now finds himself When a patient,

whose clothes are taken from him each night, fills his pockets with bits of string and

rolled up paper, and when he fights to keep these possessions in spite of the consequent

inconvenience to those who must regularly go through his pockets, he is usually seen as

engaging in symptomatic behavior befitting a very sick patient, not as someone who is

attempting to stand apart from the place around him. (Fine and Martin 105)

Goffman skillfully details the presence of self-fulfilling prophecies in attendant-patient relations,

and again uses a vague description of events to dramatize his point. In this way, patient abuse

stems directly from a lack of knowledge about human nature and the human mind, which strikes

the reader as quite ironic, since psychiatrists aim to master the processes of the mind. He

describes a patient so oppressed by the system that he collects literal scraps of his identity,

symbolized by the bits of string and paper, in direct defiance of the authority trying to take them

away from him. In this situation, Goffmans theory becomes actuality and this form of patient

oppression takes on a more lifelike shape in the mind of the reader. Whether this particular

incident actually occurred remains a mystery, but Goffmans symbolic imagery are nonetheless

effective in bringing his theory to life. Goffman adds to the irony of the situation by criticizing

the authority of attendants to impose any sort of will onto patients. Women long since unable to

perform such routine medical tasks as taking bloods are called nurses and wear nursing uniforms;

men trained as general practitioners are called psychiatrists. (Fine and Martin 108) Attendants

who cannot perform even the simplest tasks of their professions have no qualifications to care for

other human beings in need. The only authority they enjoy originates from their recognized role
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as an authority figure by their patients, who are extremely vulnerable due to their mental health.

Through this argument, Goffman questions the existence of asylums by and large. Asylums

operated throughout the previous century using their perceived ability to care for the mentally ill

as justification for their presence. Goffman contends that the appearance of mental hospital care

is, like a uniform, just a shroud for the systems shortcomings of treatment and capability as a

whole.

Goffmans use of strong language and bitter irony earned him even more notoriety within

the sociological community and contributed greatly to the basis of the deinstitutionalization

movement (Burns 141). Soon after the publication of Asylums in 1961, the deinstitutionalization

campaign began to influence change on a national level. On February 5, 1963, President

Kennedy gave a Special Message on Mental Illness and Mental Retardation to Congress, which

marked the first time in American history that a President has given an address dedicated

specifically to mental illness and mental retardation. Kennedy called for changes in concordance

with the goals of deinstitutionalization. Services to both the mentally ill and to the mentally

retarded must be community based and provide a range of services to meet community needs.

(Kennedy Special Message to the Congress on Mental Illness and Mental Retardation)

Kennedys language clearly shows parallels between the mission of community-based care called

for by the movement. After Kennedys speech, in October of that same year, the Community

Mental Health Act was signed into law by Congress, giving funds to create new outpatient

services throughout the country (Feldman and Goldstein 247-248). Large state-run hospitals

slowly turned into smaller, more widely spread patient care facilities, and out-patient services

grew quickly during the 1960s. In 1955, 77% of mental patients were institutionalized, but, in
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1975, that number fell to just 8% (Halliwell 202-204). The Kennedy administration created a

notable turning point in the transition away from patient care within asylums.

Although the deinstitutionalization movement achieved its goal and successfully helped

end asylum abuse, it also created new problems that Unites States still deals with today. After

getting rid of asylums, many mentally ill people had nowhere else to turn. They fell through the

cracks of the transitioning system, and were seemingly left behind and forgotten about. In the

1970s, the homeless population began to grow, along with the proportion of that population

suffering from mental illness (U.S. Cong. House. Comm. on Energy and Commerce). More

recently, in 2009, the Substance Abuse and Mental Health Services Administration found that

26% of the homeless population in the United States suffered from severe mental illness

(Pearson and Linz Linking Homelessness with Mental Illness). Homelessness remains a large

social issue on its own throughout the country, but it is not the only result of the changing mental

health care system. Many mentally ill, lacking the care and guidance that they need, even find

themselves incarcerated within the United States prison system. In 1992, the National Alliance

for the Mentally Ill found that 7.2% of inmates had a serious mental illness, and in 2005, the

United States Bureau of Justice Statistics found that over half of prison and jail inmates had

some form of mental health problem (Krieg An interdisciplinary look at the

deinstitutionalization of the mentally ill) (James and Glaze 1). What started out with good

intentions failed in its ability follow through and correctly apply its ideology to benefit the

mentally ill. It seems that the external hardships faced by those with mental illness did not truly

go away after the eradication of the asylum, they simply took on a new form.

Ever since the construction of asylums in the United State during the 19th century,

mentally ill patients suffered from misinformation, scientific experimentation, misdiagnosis,

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dreadful living conditions, and patient abuse. The deinstitutionalization movement aimed to

eradicate these maladies inside the treatment system and aided by the insights of Erving

Goffman, finally made strides toward its goal. Goffman carefully and cleverly chose his words to

portray the asylum as a place of totalitarian oppression, depriving patients of morality and

identity. He went on to affirm the irony of such institutions, which cause more harm than good.

As successful as Goffmans arguments and the deinstitutionalization movement were at

contributing to the end of the asylum system, the new policies that replaced the previous ones

still fail to give the mentally ill the care that they need to live happy lives. Nonetheless, history

proved that mental illness care can change, and it can change again, hopefully this time for the

better.
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Works Cited

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Culture, vol. 4, Liverpool University Press, Liverpool, 2010.

Burns, Tom. Erving Goffman. London: Routledge, 1992. eBook Collection (EBSCOhost). Thurs.

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California. Commission in Lunacy. Insanity And Insane Asylums. Sacramento [Calif.]: T. A.

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Feldman, Saul, and Harold H. Goldstein. "Community Mental Health Centres in the United

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Halliwell, Martin, and Project Muse. Therapeutic Revolutions: Medicine, Psychiatry, and

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Krieg, Randall G. "An Interdisciplinary Look at the Deinstitutionalization of the Mentally Ill."

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