Closing the State Mental Hospitals

by Thomas J. Scheff (September 2012)

This is the story of my studies of mental hospitals. My first was Stockton State Hospital, in northern California. My involvement began when I was still a graduate student in sociology at UC Berkeley. The Department of Mental Hygiene in Sacramento made available several six-month fellowships to study mental hospitals. I was chosen to be one of Fellows, and, in turn, I chose to study Stockton State, beginning August 1, 1958. This study was the basis for my Ph.D dissertation. As it turned out, the study raised questions for me that I was able to examine more fully in the research I did on the Wisconsin mental hospital system, to be described in a later essay.

Stockton State

I later found out that there was a physician nominally in charge of each ward, and a social worker. However, I seldom saw either on the ward, nor a nurse either. I learned that the doctors and social workers had offices in the administrative building, and visited their ward only under unusual circumstances. If most of the patients are not treated by doctors and social workers, what was going on?

I made an appointment to talk with my advisor, the sociologist Erving Goffman, at his office on the Berkeley campus. When I got there I told him my dilemma. As I began to describe some of the sights I had seen, some abusive, he interrupted me:

When I tried to resume the conversation, he sent me on my way. For my 150 mile round trip, I was awarded only ten minutes. However, he was right about Lemert. After reading his chapter, I had a way of understanding what I had seen. The chapter was a brief description of the sociology of labeling: the social and psychological effects on a patient of being officially diagnosed as a deviant. Since deviants lose many of their rights as persons, I could better understand the way they were dealt with by the techs.

I came to believe that the back wards of the hospital (all but the two admission wards) were warehouses for people rejected by their society, basically the poor and the old. At the time there was also another kind of resident who were young, poor, and spoke no English. At one point during my stay, I noticed that sheets, blankets and pillowcases were changed frequently on all the wards. I was curious, since laundry for a thousand beds could be very expensive.

Crisis

One change that might have resulted from the incident was that the hospital had insisted that all units have a weekly group meeting between the day staff and all patients. It had a good name, Therapeutic Community, but it had no effect whatever on E-5. The patients had been intimidated by the rough treatment of the outspoken patient described above. The staff simply used the meetings as one more way of keeping order and obedience on the ward.

I thought it might help if I talked to Jean Harwood about what to do. When I told her, she looked into it, then reported the incident, not just to the hospital administration, but also to the Dept. of Mental Hygiene. I believe that this time there were significant repercussions. I am not sure, however, since this event occurred near the end of my stay at the hospital.

The other attendant said:

Staff members often complained that the dress of some of the physicians make it impossible to distinguish them from the patients. This declaration was usually met by a smile or laughter from other staff members present, as if it were malicious to admit such a mistake for someone with so high a status as a doctor. The humor in this situation was based on the unstated assumption of the lowly, undesirable status of the patient. The fact that staff members laughed at jokes like these was an inadvertent affirmation of these underlying assumptions.

On E-5 such beliefs were firmly held by most of the staff. Since practically all of the staff shared these beliefs, they were consensually validated. On A-1, however, these beliefs were much more of an individual matter, so that the staff member was much less certain of their validity.

(Said with rolling of eyeballs and gestures indicating a serious offense.)

The student nurse felt, and the other staff strongly concurred, that such behavior was inappropriate for a person with the status of a patient. Although patients occasionally were promiscuous, there was no factual basis for most of the stories that circulated though the staff.

Staff meetings were created by the administration so that the entire ward staff could participate in making ward policy. In the front wards, most of the policy discussions were firmly in the hands of the physicians and other professionals. Ward problems and case materials were usually discussed within the framework of psychiatric and psychological principles. In these circumstances, participation of the nursing staff in policy making was limited.

When the patient Rose Ryan continued to smoke illegally, and all methods of control had been exhausted, her case was discussed once again in the staff meeting. When the discussion had reached an impasse, an attendant said:

The doctor answered briefly. One of the other attendants then cited the case of another incorrigible patient in some detail, getting appreciative smiles and nodding of heads in agreement with her telling of the story. Stringing together anecdotes about patients was a typical sequence of discussion when a difficult problem came up. Some fifteen to twenty-five percent of the staff discussion on ward E-5 took the form of citing roughly comparable cases.

One major theme of the stories that were told has been mentioned: ridicule. The absurd behavior of a patient can be retold in such a way as to result in laughter, which dispels tension, and, at the same time, tends to discredit the patient in the story, and by association, all patients. In the case above, in which the staff was discussing Rose Ryan, the last story in the sequence of anecdotes broke up the meeting in a burst of laughter: an attendant, by a series of associations, got around to a story of an allegedly promiscuous patient, who was discovered in dubious circumstances with a man on the grounds. The man in this case was a male attendant. According to the attendant telling the story:

The meeting thus ended on a high note, with everyone apparently feeling that something had been accomplished.

A third theme was disgust. A problem with the continence or uncleanliness of a patient, which had repulsed all efforts at control, often led to a series of stories about patient behavior which aroused progressively more revulsion. Often, two themes combined. Thus the patient who had slit the throat of her three children in the bathtub was the subject of an anecdote which stressed both disgust and fear. There are other themes in addition, but ridicule, fear, and disgust were the most prominent.

The cumulative result of the constant stream of rationalizations, the labels, ridicule, fictions, and anecdotes, was that an image of the patient was created and maintained in the ward, an image that was congruent with traditional practices. The administration sought to break up this image in its training of the attendants, and in its formal presentations. But the image offered by the administration was vague in outline, and heard infrequently on the back wards.

Goodbye

 What's Love Got to Do with It?: The Emotional World of Popular Songs (Boulder: Paradigm Publishers) 2011

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