Erving Goffman was way ahead of his time. Goffman’s work on asylum was among the first sociological scrutiny of patients living in psychiatric asylums, from their perspective. He based his groundbreaking work Asylums (1961) on a year of field research at St Elizabeth’s Hospital in Washington, USA.
Goffman described the mental hospital as a “total institution”, a formal organization in which regimentation dominated every aspect of daily life, along with a customary separation of places for work, sleep, and play.
The daily liturgy was carried out in the form of batch living. Activities were scheduled by rules and officials, and the activities were devised as part of a plan to realize the institution’s goals. Life in the total institution was very different from civil life and domestic family households.
Induction to these institutions involved “a series of abasements, humiliations, and profanations of self”. Initiation rites were followed, where the inmates were frisked, their personal belongings confiscated, hair cut, and they were uniformed.
Goffman also observed resistance i.e., the acts through which patients constructed a life for themselves amidst the conformist asylum. He called this an “under life” that went on beneath the radar of the staff. This underlife included “free places”, “stashes”, sexual liaisons, using personal contacts on the outside etc.
These acts were merely antics in an oppressive environment. Goffman countered psychological orthodoxy, where he said that the “sick behaviour” of the patient was not because of any illness, but due to the consequence of social distancing from the patient’s immediate situation.
His analysis of asylums was supported by Stigma (1963).
Stigma dealt with the themes of difference, disadvantage, and otherness, primarily “being disqualified from full social acceptance”. Goffman wrote, “A stigmatized person is first of all like anyone else, trained first of all in others’ views of persons like himself.”
Thus, “normal” and “stigmatized” were not persons, they were perspectives and interactional roles instead.
Ryan Murphy’s Ratched is a psychological thriller series. It follows the life of a nurse, Mildred Ratched (Sarah Paulson), based on the character in Ken Kesey’s One Flew Over the Cuckoo’s Nest, working in a psychiatric asylum in the 1940s.
Similar to what Goffman described, Lucia State Hospital, the asylum in Ratched, is modelled keeping in mind the absolute obedience of patients. Upon entering the establishment, processes are implemented to destroy the patient’s old self and create a new self.
The patients are dispossessed from normal social roles, stripped of their usual identities. The patients go through a “mortification process” of self via physical and social abuse, whereby their personal details and biography are recorded, belongings confiscated, their hair cut and civilian clothing changed for institutional purposes.
These processes are instituted to rid the patients of any form of self-identification. Contacts with outside persons are limited and the patients can’t stop their visitors from seeing them in humiliating and mortifying conditions. Their daily activities are monitored and scheduled by the staff.
Activities and rituals are conducted in batches. There are group tasks, closely supervised social events like dances, etc. However, there are also strict rules that prevent any form of solidarity among patients, discouraging high morale and friendship.
The patients are cut off, rather, alienated from the wider society. Human needs are managed in a bureaucratic and unsentimental way. An under life is also manifested in the show, as patients develop bonds of camaraderie with each other, friendly banter is exchanged along with casual plans to escape the asylum.
These bonds help the patients to hold onto a semblance of their past lives and restore worth. There is a form of social distance between the staff and the patients, as each group tends to be hostile to each other. This reflects a feature of the total institution that Goffman highlighted.
Just as he had claimed, the patients at Lucia have a strong feeling that the time spent there is time wasted or time is taken from one’s life. Goffman described an “inpatient” phase, where the patients realize that they are completely deserted from society.
They begin to acknowledge themselves as “patients” and are made aware of the fact that society will treat them differently once they go back. This is very apparent in the show, as the patients at Lucia also know that when they get out of the institution, life on the outside will never be like it was, before admission.
This brings us to stigma. Goffman addressed how the patients felt about their stigma. His analysis emphasized the bigotry the stigmatized faced as they attempted to navigate through society’s standards of worthiness. The standards for labelling people were widely shared.
The stigma that mentally ill people are savage is epitomized in Ratched. This is one of the many stigmas portrayed in the show. These prejudices haunt the patients at Lucia as they gradually begin to accept that they are completely shunned from society.
Several movies have spread the false stigma that people with mental illnesses are prone to violence, unpredictable behaviour and thus, are incapable of leading a life in society by gaining employment. Some films have even presented people who seek asylum as being “possessed”.
These obstinate stereotypes engender harsh negative attitudes towards people with mental illness. Ratched is not foreign to this, as it illustrates the horrifying consequences of these stereotypes.
Thus, the stigma attached to asylum is ubiquitous. Asylums take the psychological mentality of a patient as its point of departure. Stigma makes no presumption of psychological difference between the normal and the stigmatized.
There is no country, society, or culture where people who have been institutionalized have the same societal value as others. A survey was conducted with respondents from 27 countries, where nearly 50% of persons with mental illnesses reported discrimination in their personal relationships.
Succumbing to these realities, asylum and stigma have become leading themes in psychological movies in the last 50 years.