Psychiatry: A Social Institution in Process

Abstract

T HIS paper will report upon uses of social institutional analysis in study of psychiatry. It will aim at indicating how well suited social process analysis is to understanding of professional development. The background of this paper is a study of extra-mural psychiatry done for Russell Sage Foundation several years ago. This study aimed at a sociological analysis of developing profession. And it sought to indicate where, in changing tasks and contexts of psychiatry's work, social science knowledge might profitably be mediated to it or collaborative research established. Extra-mural psychiatry is name generally given to those aspects of psychiatry which are practiced outside of state hospitals in which American psychiatry was born. The first order of business for study was to determine how and why psychiatry had emerged from its exclusively state hospital concerns to confront community in many new roles and with many new functions. It was also necessary to study matrices in which it was now operating. The contingent problems of such expansion were of primary sociological interest. The problem of ordering seeming chaos of this rapidly changing and widely sprawling field presented itself. Criteria for determining relevant data and delimiting scope of inquiry were urgently needed. Material on social institutions seemed best fitted to meet this need. The relevant framework was established by borrowing from a variety of widely separated sources. The eclectic scheme which resulted formed a model which seemed well suited for study of problems peculiar to changing aspects of psychiatry. These problems were indicated in first brief contacts with field. An immediate impression was formed that a condition of great flux prevailed. Changes appeared to be many and rapid and seemed to be proceeding at different rates in different aspects of psychiatry. Problems of reorganizing profession figured large in literature. The effects of rapid changes made during World War II were being assayed. New associations were active. Controversies with ancillary professions flared along margins of psychiatry. Considerable concern with position of psychiatry within medical profession was shown. There appeared to be in present position of extra-mural psychiatry a laboratory of processes involved in establishment and maintenance of a profession. This was problem complex at which study, in terms of social institutional analysis, was directed. The main terms of analysis of eclectic framework are briefly noted as follows. For Cooley, a social institution was a mature, specialized, and comparatively rigid part of social structure.' In these terms study of institutions is study of formally established aspects of group behavior. Malinowski added other dimensions to concept. He viewed social institutions as problemsolving organs of human society. Culture is an instrumental reality which has come into existence to satisfy needs of man. And institutions, organized systems of human activities are the real component units of cultures which have a considerable degree of permanence, universality and independence.2 He added that there is not a simple correlation of need and function. One need does not receive one satisfaction in one institution. But institutions show a pronounced amalgamation of functions..... Still further sophistication was contributed by Radcliffe-Brown. He emphasized human internal organization of social institutions and their integration with environing society. For him function of an institution was the part it plays in total system of social integration of which it is a part. And by social integration he meant