1.2 Explaining what we find out
How do we make sense of what we saw? The video tells the story of the hospital in dramatic tones: we hear about a riot, escapes, punishment and drug treatment regimes. But we also hear about football matches, dances and friendships. Even so, they are only part of the story of 60 years and many hundreds of people's lives. We saw several volumes of detailed records. What can be learnt from so much information? How can Howard Mitchell begin to organise all these facts and accounts?
One way of beginning is by drawing out some common themes from all the available evidence – the written and recorded data. Perhaps fortunately for us, we've only got the video to draw on, so let's start with that.
Social scientist Erving Goffman wrote, an important paper in 1961, ‘On the characteristics of the total instituion’. His model of the ‘total institution’ may be usefully related to Lennox Castle Hospital. In the paper he outlines four characteristics of institutional life:
Batch living – where people are treated as a homogeneous group without the opportunity for personal choice. Activity is undertaken en masse. Rules and regulations dominate and residents are watched over by staff.
Binary management – where the two worlds of residents and staff are seen to be totally separate and staff wield power over residents by maintaining distance between them.
The inmate role – where people who come to live in institutions are stripped of their former roles, made to break with the past, lose their personal identity and become an inmate.
The institutional perspective – over time the inmate may come to accept the loss of self and the power of the institution, taking on roles which reinforce its existence.
'Goffman also suggests that ‘total institutions’ are ‘symbolised by the barrier to social intercourse with the outside world and to departure that is often built right into the physical plant, such as locked doors, high walls, barbed wire, cliffs, water, forests or moors’ (‘On the characteristics of the total institution).
Activity 2 Lennox Castle: a ‘total institution’?
Taking each of Goffman's four characteristics note down some examples from what you saw in the video against each. How helpful is Goffman's model do you think? Does it fit completely onto the picture of Lennox Castle?
At this point you may feel you need to watch the video again, particularly if you only watched it through once for Activity 1.
I don't know what you decided to enter under the four headings but here are a few examples which I felt fitted Goffman's model very well:
Batch living. From what James, Margaret and Colin told us there was regimentation and a feeling that lives were lived out in very public conditions. Margaret mentioned the way clothes were handed out and Colin can still recite menus from nearly 60 years before. The detailed records of so much of people's lives suggest a public accountability concerned to establish that formal rules about behaviour and treatment were to be maintained whatever the cost to human dignity and individuality. Management of behaviour through drugs might also be viewed in this way.
Binary management. Although we heard how staff lived on the hospital grounds and were subject to rigid supervision of their social lives there was plenty of evidence of the kind of separation which enabled staff to use physical and other powers over patients. Records were a form of control which were not open to patients to amend or contest and personal lives were subject to close scrutiny and observation. There were other separations within the hospital. The nursing staff had less power and access to information in comparison with the medical staff. Not so much a binary system perhaps, rather a hierarchy of divisions with the patients very much at the bottom.
The inmate role. People like James and Margaret were very young when they first came into hospital. They learned how to grow up as inmates and seemed to have become skilled at living as patients at Lennox Castle. The inmate role was created from a range of what would have seemed extraordinary practices if anyone had attempted to impose them on people outside the hospital. Disability resulted in what sound like conditions more appropriate for prisons or military barracks. Reality seems to have been stood on its head: cruelties are defined as right and appropriate and defenceless people are defined as dangerous and immoral. Contacts with the outside world were strictly limited and regimented as the ‘Regulations regarding the visiting of patients’ (see next screen) make clear.
The institutional perspective. This was perhaps less obvious from the video. Margaret Scally has moved out of the hospital and is obviously pleased to be able to distance herself physically and emotionally from the place. She also suggests that she never completely accepted the regime. Though she never ran away she says she wanted to. James Lappin comes over as someone who is more accepting and unquestioning of rules which meant that he and his girlfriend were never free to meet on their own.
Goffman's definition of a total institution might have been based on Lennox Castle. The hospital's layout, its grounds and its distance from most people's homes in Glasgow and further afield helped to contain everyone who lived and worked there. Everything seemed to be catered for. We heard about ‘escapes’ so presumably there was a feeling of barriers with the outside world that people tried to break through, and there were the less visible barriers maintained between the hospital and nearby Lennoxtown which at one stage prevented local people from working there. But this physical separation was only a backdrop for the kind of life which develops in an institution like Lennox Castle. Goffman argues that separation from the world outside enforced by bizarre rules, secrecy, punishments and loss of individual identity, isolated inmates and staff from accepted standards of rationality and ethics in the world ‘outside’, leading to what Howard Mitchell describes as an ‘impenetrable and cruel’ community.
Elsewhere Goffman also mentions solidarity among inmates and the development of communal activities. We didn't hear too much about these from the video. Perhaps the riot might be an example of communal resistance, and presumably the football and other sporting activities generated their own group experience. Although a total institution like Lennox Castle might seem like one community from the outside there were clearly times and occasions when, from the inside, it felt as if it contained several different communities.
Goffman has been criticised for drawing conclusions about institutions from a study of only one hospital and for devising a model which focuses on similarities while not allowing for variations within and between hospitals (Jones and Fowles, 1984, pp. 9–26). But as a sociological model the ‘total institution’ is only a tool to help us organise and identify key features in any context or set of relationships.
Over the years, practices at Lennox Castle Hospital changed. Mixed villas became a feature of life in the 1980s, a far cry from the strict segregation of Colin Sproul and James Lappin's early years at the hospital. Facilities later included a cafe and shopping area. Sports continued to play a big part in hospital life for both patients and staff. The hospital film shows and dances continued as television was introduced to the villas. Other changes came with the ending of domestic work for patients, to be replaced by education and training, preparation for life outside the hospital. Some element of privacy and individualisation was introduced as cubicles broke up the long rows of hospital beds in the villas and people were allowed to wear their own clothes.
Despite these changes the hospital remains isolated physically and with a distinctive layout determining a way of life and set of care practices which might be seen as normal to the people who live and work there, but far from normal as far as life outside is concerned. Goffman made his observations while he was ‘assistant to the athletic director’ at one hospital (Jones and Fowles, 1984, p. 23). He had no nursing or administrative experience of hospital life so perhaps he remained very much an outsider while he made his observations. Howard Mitchell tried to combine having been a nurse at Lennox Castle with being a researcher. How did this background contribute to his investigations?