reviewed by Mira de Vries
Erving Goffman’s Asylums was first published in the same year as Thomas Szasz’s The Myth of Mental Illness. Dutch historian Gemma Blok claims that these two books, by drawing attention to the terrible conditions in mental institutions, inducted a new era in psychiatry. Whether they actually had that impact is debatable, but neither are about conditions in mental institutions.
Asylums is not specifically about asylums, mental institutions, or psychiatry. It is about what Goffman calls “total institutions.” Why the book is called Asylums remains obscure.
Total institutions are places where people, called inmates by Goffman, live, work, eat, sleep, and carry on all their social activities. Examples of voluntary total institutions are monasteries and ships’ crews. Semi-voluntary total institutions might be boarding schools or sanatoria. Involuntary total institutions are compulsory military service, jails, concentrations camps, and mental institutions. Some total institutions have live-in staff. Others have staff coming in from the outside, serving as a bridge to society at large.
Goffman is interested in the relationships that develop in total institutions: inmates among themselves, inmates and staff, and staff among themselves. He draws on a vast array of anecdotes from various kinds of total institutions. Of course the relationships in involuntary institutions will inevitably reflect the bad conditions and/or injustices of these places, but this is not Goffman’s primary concern. He has no problem comparing, for instance, a mental institution to a monastery, when discussing the alternative forms of communication developed by their inmates.
From the point of view of opposition to psychiatry, the most outstanding feature of Asylums may in fact be that Goffman makes such comparisons. Inmates are inmates to Goffman, psychiatric or not. Although not denying the existence of mental illness, Goffman assigns no role to it in influencing interpersonal relationships. The inmates of mental institutions he describes behave as rationally as inmates of other total institutions, and develop similar relationships and coping strategies, unless they are so brain-damaged that they are more like fixtures.
In the last section of the book, constituting only about 50 pages out of 336 (in the edition I read, which was published posthumously in the UK in 1986) Goffman examines psychiatry as a profession. He points out the social role of the psychiatrist as opposed to the service role of other physicians. Today we would call it eminence based medicine as opposed to evidence based medicine.
If you’re looking for testimony about how bad conditions were in mental institutions, Asylums will disappoint you. If you’re interested in micro-societies – Goffman calls them shadow societies – then you will surely find Asylums as fascinating as I did.