HLTHAGE 2G03 Lecture Notes - Lecture 9: Erving Goffman, Deinstitutionalisation, Simple Explanation

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Lecture 9: Institutions
Recall:
- 19th century growth of institutions and institution pop. (4 big ones in Ontario)
- These institutions were important because they became the new way for mentally ill
to be treated, some spent days, months, or entire lives, sometimes return visits
- Where we get terms like “the nut house”
- Huge number of people in a comparative state
- Belief in isolation of hospitals, rigid scheduling, curative power of institutions
oSame logic was applied in prisons at that time
oPeople were dislocated from their reason (unreasonable in some way and
could not think straight)
- Other goals (no restraints, programming) failed due to lack of funding, personnel
- 1960, half a million US citizens living in psyche facilities
Erving Goffman
- Mid-1950s ethnography of psych institutions, coined “Total Institution” in Asylums
o“Closed circuits” disconnected from society
oTight schedules, little autonomy, privacy, at whims of authority
oMortification of the self- individuals’ past lives scrubbed clean, only
institutional identity
oCan only end in conversion
Criticism of Institutionalization
- Costly, JFK: “The average amount expended on their care is only $4 a day- too little
to do much good for the individual, but too much if measured in terms of efficient
use of our mental health dollars”
- Ineffective: too many long term stays, too many failures after getting out
oRosenhan’s ON Being Sane in Insane Places
Grabs a bunch of students tells them to go to local psyche hospital, tell
them you keep hearing the word thug (all of them institutionalized)-
diagnosed with schizophrenia, and bi-polar
- Inhumane: boredom within institutions, anger written off as pathology, rigid
division between staff and patients, use of straight jacket
Deinstitutionalization
- Fuelled by both growing criticism and psychopharms
- US JFK;s community Mental Health Act in 1963. Combined w/ laws making forced
confinement more difficult, patient population rapidly drops
- 1960s-1980s Canada’s inpatient population dropped 78% form 70000 to 20000
beds
- Funds saved from closing hospitals earmarked for care in the community, yet
community care ahs frown slowly, patient pop. Rapidly released form hospital
- One of the most well intended yet poorly executed social programmes ever
undertaken
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Homelessness and Shelters
- Deinstitutionalization made psyhc. pop more visible. Traditional explanation:
without supports, more people on the streets
- Critics: not simply closing of institutions, rather destruction of welfare state led to
boom in homeless pop.
oWelfare state: a system whereby the government undertakes to protect the
health and well-being of its citizens, especially those in financial or social
need, by means of grants, pensions, and other benefitspublic education is a
welfare state policy, we all pay taxes, and it enables people to send their kids
off to school
Why has the welfare state been under attack: neoliberalism:
neoliberalists believe that society doesn’t actually exist, we do not
exist as a collective, we live as individuals trying to improve their own
condition no binding of meaningful sense
Not about the closing of institution, it’s the removal of all the other
supports that existed for suffering individuals
Poverty and homelessness itself driving mental illness, rather than
reverse. Schizophrenia a simple explanation for more complex
problem of homelessness… implies that were only need to fund more
treatment
Not necessarily that homeless people are mentally ill, or that mental
illness results in homelessness, more complex
oCalls for reinstitutionalization reflect the tendency to individualize mental
illness as a personal problem, rather than a social one
For cynics, revolves around effects of clean up streets, and we know
better
And where is the appropriate place for a sick person? The hospital
Criminalization of Mental Illness
- Might we instead talk about trans institutionalization?
- Before 1970s almost no reports about large numbers of individual w/ mental health
problem in prison system, now one of the great problems of our time
- IN US, 15-25% pop has a severe mental illness while 50% have some kind of
psychiatric diagnosis
oIn Canada, almost 15% of prison pop diagnosed w/ schizophrenia or bipolar
disorder despite representing only a fraction of total pop
In essence criminalizing mental illness
Connection to substance abuse
•Huge numbers this is their pathway to prison (trans institutionailzaization) - growth
fueled by our current take on narcotics – zero tolerance –policy of war on drugs automatic
sentencing
tendency to punish drug related crimes – so lots of people who have problems with
addiction could end up in the prison pop
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