Erving Goffman: What Makes One A Mental Patient?
Psychological disorders, says the charitable. Craziness, says the uncharitable. An ‘alienative coalition’, says the sociologist Erving Goffman. Before you dismiss this as conspiracy talk, let’s look more closely at what he meant. ‘Coalition’ means an alliance of different parties, and ‘alienative’ refers to isolating someone. Goffman argues that a mental patient is first a prepatient, and the key condition for the transition is not the severity of condition, but the reactions of other parties. In other words, stigma. Here’s how the process looks like:
1. It starts with an effective complaint.
This is likely preceded by many ineffective complaints, either pacified or not acted upon. We complain a lot but usually don’t lodge them. The decision to lodge a complaint is influenced by particular life circumstances.
2. The mediators encourage the transition.
Mediators include the “police, clergy, general medical practitioners, office psychiatrists, personnel in public clinics, lawyers, social service workers, school teachers…” who refer the prepatient through to the mental hospital. These tend to be specialists who are “more psychiatrically oriented than the lay public, and will see the need for treatment at times when the public does not”. It’s good for you, they say!
3. The prepatient feels betrayed.
The prepatient is persuaded by the mediators who “conceive of mental hospitals as short-term medical establishments… not as places of coerced exile”. The prepatients then realize that mental hospitals are really places of coerced exile. Shit! I wouldn’t have agreed so easily if I knew this shit!
4. The next-of-kin cements the transition.
The next-of-kin is by now helpless, and has to listen to the advice of the experts they meet. The mediators, “with their great psychiatric sophistication and their belief in the medical character of mental hospitals”, will assure them that “hospitalization is a possible solution and a good one, that it involves no betrayal”. This provides them with a valid defence against allegations of betrayal from the prepatient.
5. The prepatient is convinced; transition to mental patient is complete.
If the whole world thinks I’m mad, perhaps I’m really mad! Oh no!
Goffman: Stigma Makes You Mentally Ill
Perhaps the patient is really mad, you might say. But Goffman says that the “perception of losing one’s mind is based on culturally derived and socially engrained stereotypes” and that many of the most convincing symptoms “signify merely a temporary emotional upset in a stressful situation, however terrifying to the person at the time”.
This is controversial, since we are used to treating disorders as facts. You need not accept his position, but it helps to see how our stigma of the patients can be even more dangerous than the patients themselves. In some cases, hospitalization may indeed be necessary. But in other cases, it may do more harm than good. After all, can you imagine the shock of being labelled as unhinged by everyone, including your own kins, and perpetually treated as such?
How might you recover from such a condemnation?
Erving Goffman – The Moral Career of the Mental Patient (1959)