1.10.4.6 Sociology of residential institutions

The total institution

• Total institution is Goffman's term, from Asylums (1961), for an enclosed residential setting where a batch of people live their whole daily round in one place, under one authority and a fixed schedule.

• Goffman based it on fieldwork in a psychiatric hospital and grouped the asylum with prisons, monasteries and barracks, all cut off from wider society.

• His central claim is that the institution actively reshapes the resident's identity and behaviour through its routines, producing the conduct and self-image of the long-stay patient rather than containing an unchanged self.

Control separates it from a therapeutic community: in a total institution staff control daily life, whereas in a therapeutic community residents share that control.

Entry and mortification of the self

• Mortification of the self is the process by which a total institution strips residents of their former identity on and after entry; mortification is the process, the total institution is the setting.

• Its means include searching and listing belongings, taking away own clothing, cropping hair, a number for a name, impersonal address, a staff-set timetable and asking permission for small acts.

• The betrayal funnel operates in the pre-patient phase: trusted relatives and professionals give a reassuring but unrealistic account of hospital, easing the person in, so that once admitted they feel deceived.

• Looping treats objection as pathology, so anger at restriction becomes a reason for further restriction.

• Secondary adjustments, such as trading, hoarding and working around the rules, form an institutional underlife through which residents keep a sense of agency.

Institutional neurosis and institutionalisation

• Institutional neurosis was described in 1959 by Barton, a medical superintendent, as a syndrome of apathy, submissiveness and loss of individuality caused by prolonged residence in an impoverished mental hospital.

• Other features are poor self-care, loss of practical skills, a stooped posture with mannerisms, and no sense of a personal future.

• Wing and Brown (1970) measured institutionalism in schizophrenia across three hospitals but did not coin the term; negative features improved when ward conditions improved.

• Institutionalisation is the lasting deskilling after years of hospital life in which others make every decision: domestic and social skills fade, initiative is lost and the person depends on staff direction.

Labelling

• Labelling theory (Becker and Scheff) holds that a public label becomes a master status, and restricted opportunities then produce secondary deviance.

• Residual rule-breaking is Scheff's term for acts such as talking to oneself or staring, which breach unwritten norms with no specific name, so society groups them together as mental illness.

• Overgeneralisation is a cognitive distortion, sometimes called a lumping tendency and common in inexperienced staff, in which a sweeping rule about a whole diagnostic group is drawn from a single encounter.

• Depersonalisation treats people as diagnoses or bed numbers, encouraging a passivity that is then mistaken for incapacity.

Reform and the therapeutic community

• Moral treatment is the name for William Tuke's Quaker reform of asylum care at the York Retreat (1796), in the late eighteenth century.

• Main, Jones and Rapoport later developed the therapeutic community, built on shared responsibility, democratisation, permissiveness within limits and reality confrontation through honest peer feedback.

Deinstitutionalisation

• Leaving hospital restores autonomy, social roles and reversible disability when housing, activity, clinical continuity and social support are in place.

• Without them, people face isolation, reinstitutionalisation in hostels and care homes, or transinstitutionalisation into homelessness and the criminal justice system.

• Prisonisation is Clemmer's term for adopting inmate culture and losing the capacity for autonomy outside.