Abstract
This paper offers an analysis of forms of social interaction between direct care staff and patient members of a state institution for the “Mentally Retarded” (MR) and dually-diagnosed (MR with a mental disorder diagnosis) located in the northeastern United States. This work’s significance is that it updates and extends Erving Goffman’s (1961) classic study of the underlife of total institutions. It does so by delineating a sub-type of secondary adjustment to total institutions, termed ancillary adjustment. Ancillary adjustment is defined as performances of patient role that undercut the institution’s official prescription for patient identity toward normalizing direct staff member identity. It is shown how ancillary adjustment arose as an unintended consequence of the institutional reforms of the 1970s, or how, under a professionally reformed and bureaucratized “New School”, direct care staff members experienced themselves as disempowered and discredited as “normal” professionals and defensively and repeatedly cued hyper-stigmatized comedic spectacles through types of staff-patient interaction termed staff prompting and patient burlesque. This paper is based on a three-year fieldwork study entitled Defending the Self in an Institution for the Mentally Retarded that utilized Glaser and Strauss’ (1967) and Strauss and Corbin’s (1990) grounded theory methods for qualitative research.
Highlights
“(Harry), a graying Mentally Retarded man in his fifties, was prompted again to perform a kind of sideshow when staff discussed his dramaturgical ‘talent’ in his presence
This paper is about forms of interaction observed at a state institution located in the northeastern United States: staff prompting and patient burlesque, or direct care staff cueing patients to perform as hyper-stigmatized comedic spectacles
While the aim of this paper is to demonstrate how some direct care staff benefited from the construction of mentally ill and low level patients as hyper-stigmatized, it may be noted that the reticence of high level patients who observed staff prompting and patient burlesque is suggestive of their own profit from displays of radical Otherness
Summary
“(Harry), a graying Mentally Retarded man in his fifties, was prompted again to perform a kind of sideshow when staff discussed his dramaturgical ‘talent’ in his presence. This paper is about forms of interaction observed at a state institution located in the northeastern United States: staff prompting and patient burlesque, or direct care staff cueing patients to perform as hyper-stigmatized comedic spectacles.. This paper is about forms of interaction observed at a state institution located in the northeastern United States: staff prompting and patient burlesque, or direct care staff cueing patients to perform as hyper-stigmatized comedic spectacles.1 In these carefully guarded theatrical displays adult male patients were repeatedly prompted by male, working class, direct care staff members to perform beyond their already stigmatized status as institutionalized, Mentally Retarded, and/or mentally ill persons. Patient burlesque played upon a number of symbolic displays of debasement: patient ignorance, begging, self-denigration, sexual exposure, gibberish speech, and alterations of the normative mode of communication It involved “comedic” scenes of patients asserting their discredited selves, violating the social space of others, and performing various animated spectacles and sideshows. It is argued that staff prompters engaged in these interactions as a method of defending their stigmatized selves through the dramatization of high contrast deviant others in a reformed and professionalized total institution dedicated to normalizing patients
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