Asylums, the token economy, and the metrics of mental life

Abstract

The history of asylums in this country reveals that these institutions were designed to provide a milieu in which disturbed citizens could escape from the economic opportunities in society-at-large that were assumed to cause insanity. The atmosphere of the asylum was believed to be curative by virtue of its replication of pre-revolutionary stability in status relationships without the encouragement of men's political and commercial ambitions. Numerous forces then contributed to making the asylum a repository of large numbers of chronic patients dealt with primarily in a custodial fashion and comprising the endpoint of careers in downward social mobility. The growth in token economies has been one of the recent attempts to cope with this affront to our personal and professional sensibilities. Chaos, and presumably mental illness itself, would be reduced by introducing into the asylum just that set of conditions which had earlier been held to be pathogenic, namely, a replication of the outside market economy. The source of the disease now became the doctor. While a certain kind of order is probably produced by token economies, questions are raised as to what is being learned by the patients. It would seem that participants in this economy are taught that certain behaviors earn a just reward and that greater predictability is possible through application to mental life of a metric prevalent in commerce. It is suggested that the greater orderliness achieved exacts a serious price, namely that the patient acquires a set which does not match human relationships outside the hospital. Token economies will, to a degree, work because most mental patients do not suffer from economic irrationality. By concentrating on this metric, token economists fail to make changes that will transfer to the demands of nonhospital life.