The observation that care homes, prisons and military encampments are very similar, might sound strange. But that is precisely the claim made by Erving Goffman (1922-1982) in the early nineteen sixties, referring to them as total institutions. Goffman published several books that earned him a place in sociology. For social work, his most important work is from 1961: Asylums: essays on the social situation of mental patients and other inmates. It quickly became popular, and was translated in several languages. The key message is coined by the concept of total institutions. Several seemingly very different organizations have in common that they influence the lives of citizens comprehensively. Normally, we sleep, work, shop, and organize our leisure time in separate locations. Within total institutions, this is not the case: the life of inhabitants takes place 24 hours a day and 7 days a week within the same confined space. Examples include care homes, prisons, psychiatric hospitals, military encampments and convents. Often, but not always, there are physical barriers between these total institutions and the outside world, for instance with high walls or barbed wire. Each total institution has a clear distinction between inhabitants and staff. For the latter, the total institution is not total: they usually go home after working hours.
Goffman was particularly interested in describing how inhabitants experienced these total institutions. He went undercover for a year in one of the total institutions, posing as the assistant of the sports director. As far as possible, he avoided contact with staff, and only the people at the top of the organization know about his actual role as a researcher. The study became recognised as a fine example of qualitative research.
Based on what he observed during this year, Goffman describes how the total institution moulds (new) inhabitants and disciplines them to follow the rhythm and rules of the house. He labels this as mortification, whereby the civilian identity and connections to the outside world are slowly stripped away and redefined by the total institution. Anyone who has spent time in hospital will recognise the experience: waking up, eating, washing … everything happens according to the rhythm set by hospital staff, leaving little or no room for individual preferences.
Goffman`s analysis gained popularity not only through his publications, but also through the movie One flew over the cuckoo’s nest, based on the novel by Ken Kesey. Jack Nicholson plays the role of psychiatric patient Randle McMurphy. After being admitted to a psychiatric hospital he rebels against the culture of total institutions and tries to engage his fellow patients in his revolt. Nurse Ratched is probably one of the most villain characters in film history. The aversion felt by the viewer against her epitomises the popular aversion felt since the sixties against total institutions in the social realm (although perhaps surprisingly, not against total institutions in the field of justice).
Goffman’s work and the role played by Jack Nicholson, together with other developments like Italian anti-psychiatry, resulted in a huge wave of deinstitutionalisation. Large scale care institutions and long term care were replaced by care in (and where possible by) the community and shorter term care. However, there was and remains also a critique of deinstitutionalisation, arguing that people are released without proper support, resulting in higher levels of crime and homelessness.
This text was written by Jan Steyaert
Date of first publication: 02-2011
Date of latest revision: 04-2013
