Mental Illness and Society

Erving Goffman's Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (1961) inaugurated the modern sociology of mental illness and remains among the most influential books in medical sociology. Based on a year of fieldwork at St. Elizabeths Hospital in Washington, DC, the book analyzed the total institution — Goffman's term for places where 'a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life.' Prisons, military boot camps, monasteries, and mental hospitals all qualify, and Goffman argued that they share systematic features that shape the selves of their inhabitants.

Total institutions, on Goffman's account, accomplish a mortification of the self: on entry, inmates are stripped of the external supports (clothing, possessions, names, routines, relationships) through which identity is sustained in ordinary life. A uniform replaces personal clothing; a number replaces the name; staff control bodily functions, sleep, and social contact. What follows is a moral career in which inmates gradually come to reconstruct themselves within the institution's categories, developing secondary adjustments — small acts of resistance, underground economies, symbolic self-reassertions — that allow them to maintain a workable sense of self within near-total constraint.

Goffman's particular contribution to the sociology of mental illness was to show that much of what psychiatry treated as symptoms of disease was in fact a predictable social response to confinement and mortification. A patient's paranoid distrust of staff was an accurate reading of staff power; a patient's emotional flatness was a rational strategy for enduring institutional routine; a patient's acts of 'acting out' were assertions of self against a system determined to erase it. Goffman did not deny that mental illness existed or that some patients were profoundly disturbed. But he insisted that the institution itself shaped behavior, identity, and prognosis in ways that psychiatry often failed to see.

Asylums appeared alongside two other major works: Thomas Szasz's polemical The Myth of Mental Illness (1961) and Michel Foucault's Madness and Civilization (French edition 1961, English 1965). All three, despite major differences, challenged the dominant mid-twentieth-century psychiatric paradigm and launched the sociological analysis of mental illness as a socially shaped category rather than a purely biomedical fact. The books were widely read beyond sociology — by activists, policymakers, and patients — and contributed directly to the political climate that made deinstitutionalization possible.