Wednesday, February 22, 2017

How Psychiatry Can Change Who You Are

Most people do not know what goes on inside a mental hospital. They simply assume that patients are getting much needed psychiatric treatment there. It might be shocking for someone to learn what really goes on inside one of these places.

As well known and highly influential sociologist Erving Goffman (1961) has explained, in the psychiatric hospital every aspect of a patient’s life is considered a component of their psychiatric treatment. P. 149 For example, if a patient is given food, allowed to quietly read a book, or attend to his own personal hygiene these things are considered privileges that are given to the patient as part of a therapeutic program. A patient who misbehaves will have these things taken away. A patient may be reduced to very poor living conditions. A patient may be reduced to sleeping on a wooden bench, eating very little poor tasting food and having nothing to preoccupy his time. As Goffman (1961) explains in a psychiatric hospital patients are subjected to a system of punishments and rewards p. 163. Through this system nurses and doctors exert total control over the patient.

According to an anonymous interview with a former psychiatric patient (2017), the existence of this system is not explicitly communicated to the patient. In fact, according to the former patient (2017), if a patient articulates anything about this system then it might have adverse consequences. Also, the former patient (2017) goes on to say psychiatric treatment may be used as a punishment for behavior the psychiatric staff deem undesirable. For example, if a psychiatric patient has an intense argument with staff they could be forcibly injected with drugs.

Goffman (1961) explains the inpatient hospital alters the person’s self. This process of punishments and rewards is applied to the mental patient’s sense of self p. 148. Goffman (1961) goes on to explain that in the psychiatric hospital a patient’s level of privileges mirrors his current state of mental health and is considered a direct expression of his self p. 149. Meanwhile, the person’s former identity is discredited. A case record of the patient’s past behavior is constructed. Goffman (1961) explains that in the patient’s case record his past experiences are reframed as symptoms of mental illness P. 156. Also, the patient’s own story for why he is in the psychiatric hospital is discredited verbally by the hospital staff.  As Goffman (1961) states, “If the psychiatric faction is to impress upon him its views about his personal make-up, then they must be able to show in detail how their version of his past and their version of his character hold up much better than his own” P. 154.

In my opinion, this process is basically a form of brainwashing. Through psychiatric treatment, the patient is punished for retaining his former identity and rewarded for assuming a new identity. A patient is transformed from someone that believes he is an ordinary person to someone who believes that he has a mental illness. This alters the very core of his identity.

Frightening Consequences

The social environment of the mental hospital can have frightening consequences. For those that haven’t heard of Catatonic Schizophrenia, it is a psychiatric condition where someone, who has nothing medically wrong with them, becomes completely motionless and mute for a long period of time. People diagnosed with Catatonic Schizophrenia can sometimes remain mute and motionless for years. Goffman (1961) points out that the tendency for patients to become mute in mental hospitals is actually a result of the mental hospital itself. Goffman (1961) explains that becoming completely mute for long periods of time can be a kind of tactic to survive in the psychiatric hospital. As Goffman (1961) states,” For these patients withdrawn muteness was the official stand-a defense presumable against both importuning attendants and fellow patients that was grudgingly accepted as a legitimate mental symptom” P. 257.

A person  diagnosed with Catatonic Schizophrenia
 may remain motionless for years. 
In my opinion, withdrawn muteness may be a direct result of the social environment of the institution. Unlike normal life where self-expression is expected to occur freely without too much inhibition, in the mental hospital the patient’s ability to express himself is much more limited.  As Goffman (1961) explains, for the mental patient, any kind of self-expression against the institution is considered a psychotic symptom p. 307. Because of this, as Goffman (1961) explains, a kind of vicious cycle can occur where the more the patient expresses his dissatisfaction with the institution the more he is likely to suffer punishments in the form of deprivations and psychiatric treatment p.306. This process may continue until the patient has very little means of self-expression at his disposal.

The things the patient can use to distinguish himself as a person become very valuable to him. The patient may cling to hospital issued clothing or bits of trash because the patient sees these objects as representations of who he is. To outsiders this may seem irrational but to the mental patient this is a way to cope with living inside a mental institution.

In my opinion, because of this, withdrawn muteness may be a way for the patient to express his rejection of the institution. Withdrawn muteness may be a means of self-expression that the doctors and staff cannot stop the patient from engaging in. As Goffman (1961) states, “From the patient’s point of view, to decline to exchange a word with the staff or with his fellow patients may be ample evidence of rejecting the institutions view of what and who he is” p. 306. 

A Final Word

In my opinion, through examining the social environment of the psychiatric hospital, it is evident that the psychiatric staff are not really trying to understand the perspectives of the patients they treat. Instead, the psychiatric staff are engaged in a process to coerce patients into conforming to conventional social norms and values. Such a process may cause the patient to behave in an agreeable way but at a cost.  The patient is forced to change. His free will and autonomy as a person are compromised.

I do not deny that individuals at times enter psychological states where they become unreasonable, unreachable or cannot take care of themselves. I write this to point out the often destructive transforming power that the psychiatric hospital can have on the individual and to question if it is always justified when people think and act abnormally.  It seems like an approach to returning a patient to consensus reality that does not coerce the patient but instead recognize him as a thinking, feeling person who is capable of free will could be achieved.

A peer-run crisis respite is one such approach. A peer-run crisis respite is an alternative to the psychiatric hospital. It is a building, typically a house, where individuals can go and stay for two weeks and recover from a mental health crisis. A peer-run respite is not operated by psychiatrists but by individuals that know the path to recovery best, former mental health consumers. There a person who is having a crisis is free to act as they choose and is never coerced. Peer run respites exist in various locations across the country. Perhaps in the future peer-run crisis respites will be widely available to everyone. 


Goffman, Erving. Asylums. 1st ed. Garden City, NY: Anchor Books, 1961. Print.
Former Psychiatric Patient, Anonymous. 2017. in person.

1 comment:

  1. Brilliant article/write up- the fact is almost 80% of first episode psychosis- usually not even a real psychosis-9/10 purely a street drug psychosis- transient and temporary- is "unethically" being judged and treated- as real mental illness- when its not- the reality though is that any mental illness description- explanation- known to humanity- is in every psychotropic their is- from average 1200 to 1400 reported, recorded, and known, "mental illness" side effects.http://psychroachesadverseevent.blogspot.com/2009/03/zyprexa-adverse-reactions.html