Goffman 3 - The Inpatient Phase Flashcards
What is the last step in he pre-patient’s career? How is this avoided upon first admission?
The last step is the realization that he has been deserted by society and turned out of relationships by those closest to him.
He may avoid this by avoiding talking to anyone, including the next of relation during visiting hours. Goffman believes that this is to cling to remnants of relatedness and to protect these remnants from dealing with the people they have become. I believe that this is also an an attempt to maintain some inkling of control.
What is known as “settling down” by attendants?
When the patient first begins to make themselves available to the staff and other patients in the hospital.
The new patient finds himself stripped of the right to free movement and is subjected to communal living and the diffuse authority of the staff.
Describe the relationship between ward level and identity or self.
The hospital consists of graded living arrangements, each with different living situations and privileges.
The patient is told that the ward he is assigned to, the restrictions and deprivations he is subjected to, have been decided based on his conditions. They will be changes or improves when he is able to manage a new privilege. A such, the assignment is not a privilege or a punishment, but an expression of his level of functioning or status as a person.
Moving up in ranks requires that he admit things he is embarrassed about or has otherwise been trying to conceal, and to admit that he is sick and that the situation he is in is his own fault.
How does the medicalization or pathologizing of the patient’s behaviour affect his view of self?
When the hospital presents the patient’s pre-patient phase as a personal failing, and that his attitude to life is objectively incorrect. This is presented through mandated group therapy or psychotherapy.
How does the patient first cope with feelings of personal failing and social alienation, or perceived loss of personhood?
The patient develops what Goffman calls “sad tales,” where they assert that they are not sick and that the trouble they got into was somebody else’s fault. This preserves the idea that the hospital is unjust in forcing the status of mental patient onto him.
Goffman argues that a social role of the patient community is constructed on the basis of reciprocally sustained self-supporting tales.
Why is it in the hospital and staff’s interest to discredit a mental patient’s view of self and self-sustaining stories?
How will they do this?
Most of the difficulties caused by the patient will be closely tied to his version of what has been happening to him. To ensure his cooperation, this version of the self must be discredited.
This is done by focusing on the perceived troublesome parts of the patient and his family’s past, without mention or focus on issues where he coped well or behaved with fortitude. This is done to keep note of “symptomatic behaviours” but it paints a biased picture.
In doing so, and in the way interaction within the hospital are described, staff act as an absolute authority on both the reality of encounters and the “acceptability” of the patient’s behaviour and conduct.
How does Goffman describe the way hospital staff write about patients?
He describes them as scandalous, defamatory, and discrediting. Claims that hospital staff fail to deal with material with moral neutrality. This occurs in both staff-patient interactions and in staff-staff interactions.
How would knowledge about patient records effect the behaviour of the patient?
Knowing that all of his behaviour is recorded an available to whomever should seek in in the hospital, the patient is not relieved by the cultural pressure to conceal them and by feel threatened that they’re available.
“he can learn practice the amoral arts of shamelessness”
How do staff meeting continue to impose the “patient” role and persona onto an individual?
What about coffee-room talk?
Individual staff members are unable to form their own opinions of patients because the collective opinion is aired out regularly.
The patient is faced with more collusion against him.
Even informal break room talk carries the implication that the patient is not a complete person.
How does pressure to “get well” effect the patient’s view of self?
Pressure to get well constantly reminds the patient to view himself as either a success or a failure.
How does a fluctuating sense of self due to fluctuations in the ward system affect the patient’s moral career?
A kind of civic apathy develops as the patient learns not to attach to a stable sense of self, and thus not to society. He also learns in this phase that he can survive on the borders of social acceptability.
This closed society might be done as a response to feeling rejected by or alienated by the outside world and the people in it.
This is especially true for patients on lower wards who have little reputation or rights to lose and therefore take certain liberties.
How does the ward system affect the risks the patient is willing to take?
A patient on a lower ward has less to lose and is therefore more likely to take risks.
Considering that risk taking calculus is a major part of the self-conception, movement through the ward system might help to disenchant the patient.
Which three factors might contribute to moral loosening in the patient?
- unstable sense of projected self, inability to control one’s reputation.
- Risk taking calculus become looser in lower wards
- Being released requires that he cooperate with and obey the next of relation until he is off of hospital records. This might require lying if the patient is still embittered or untrusting of the next of relation and further separates the person from the worlds that others take seriously.
