The Moral Career of the Mental Patient

The paper written by Mr. Goffman described the many different aspects of a person being committed to a mental hospital. The career of the mental patient falls popularly and naturalistically into three main phases: the period before entering the hospital, called the prepatient phase; the period inside the hospital, called the inpatient phase; and the period after the patient’s release, called the ex-patient phase (Goffman, 130). This paper will only cover the first two phases of the total internment.

The first phase, or prepatient phase, has several different ways of being enacted. A relatively small group of patients come to the mental hospital willingly, because they think that it is the best option for them, or because of wholehearted agreement of the patient’s family (Goffman, 131). These people have found themselves acting in a way that makes them think that they are losing their minds or losing control of themselves (Goffman, 131). For this type of person, coming to the hospital may bring relief, if only for a short time until the patient realizes what he or she has really gotten himself into. Another type of prepatient does not come their own free will, but is escorted to the hospital by force, usually by the police. This is what we mostly see on TV, when someone pleads “not guilty by reason of insanity” and wins their case. Still, some come to these hospitals thinking they are going to somewhere else, purposely mislead by their family to get them to come along and get the help that they need. These people are almost always teenagers (Goffman, 131).

Now, how did the prepatient discover his or her problem? Most of the time there is a “complainant,” a person that is wronged or the person that has taken action against the prepatient which eventually leads to his internment. This may not be the person that makes the first move, but it is that person’s move who counts, so to speak (Goffman, 132). Here is the beginning of the prepatient’s career, regardless of if he or she realizes it or not.

Who does the prepatient see as the person who can help him or her the most? This person is called the “next-of-relation”. This could be the next of kin, a brother, or another person that was emotionally close to the prepatient. This person is valuable to the prepatient because he or she would be the first one to his or her side if there was trouble, they could always be counted on (Goffman, 132).

The third and last group involved with the prepatient are the mediators. The mediators take the form of agencies or agents to which the prepatient is referred and “processed” on his or her way to the hospital (Goffman, 132). They help to ease the move from the comfy home life to the not-so-comfy but relieving atmosphere of the mental hospital.

During all of this, many thoughts and emotions are going through the prepatient’s head. He or she feels bitter, deserted, as if he or she is being dumped on the hospital because the real world cannot deal with the prepatient anymore, it does not want to or does not have the energy to. The prepatient sees that the world he or she is leaving is incredibly rich with freedoms and privileges, and everyone helping him or her to the hospital is merely adding a “pious gloss to a clear case of traitorous desertion.” (Goffman, 139). Goffman is suggesting that the prepatient enters this phase with freedoms and liberties, and leaves this phase being stripped of almost everything, including his humanity (Goffman, 140). All in all, the prepatient phase, according to Goffman, is not a pleasant experience.

Next there is the inpatient phase. This is the phase where the patient is actually inside of the hospital and is inserted into the environment, much like new prisoners at a jail. During this phase, it is not uncommon for the patient to not socialize at all, usually because the patient does not want others labeling him or her by what they have turned into (Instead of calling him Bob, he’s known as the manic-depressive guy in Cell 18) (Goffman, 146). If he or she does talk, a nickname is used to keep the person’s real identity a secret from the other patients.

Once the patient begins to settle down, the main outlines of his fate are similar to those of prisons, work camps, monasteries, concentration camps, and so on (Goffman, 147). The patient spends his whole life on the grounds, breezing through his regimented day with several of his fellow inpatients. The patient learns that everything about him is restricted, including meals, movement, and communal living (Goffman, 148). While undergoing these humbling moral experiences, the patient learns to cope with, and eventually depend on, the services of the staff, or “wards” (Goffman, 148). During all of this, the patient is constantly reminded, through interactions with the other patients or the staff, or by his surroundings, that he has degenerated into a typical mental patient, having failed in society and cannot act like a whole person at all (Goffman, 152). These humiliations are all part of the experience inside the hospital, and an important part of his moral career as a mental patient. This is but one strand of the patient’s overall life, but it is one of the most important. Eventually when the patient is “cured” of whatever ails him or her, they are released from the hospital, but the paper did not cover this part of the moral career.

In conclusion, I have discussed the first two parts of patient internment discussed by Goffman, the prepatient phase and the inpatient phase, and have gone into depth defining these two terms. Being admitted to a mental hospital, whether of your own free will or by police escort, is, more times than not, a life changing experience and an all too important part of the moral career of any would-be mental patient.

BIBLIOGRAPHY

Goffman E. 1961A Asylums. Essays on the Social Situation of Mental patients and Other Inmates Harmondsworth: Penguin, 1968. First published New York: Doubleday Anchor, 1961