Social control in the therapeutic community: re‐examination of a critical case

Abstract

Abstract Sharp's study ‘Social Control in the Therapeutic Community’ is used as a critical case for the hypothesis that all treatment institutions routinely maintain manipulative control of their clientele. Sharp's argument is that social control is an inevitable consequence of the ubiquitous, nihilating, individualising, and selective properties of staff interpretative work. This view is contested by the presentation of data collected in a second community similar to that studied by Sharp. It is shown that staff interpretative work may also be connected with the provocation (rather than the nihilation) of dissent with the deliberate toleration (rather than the control) of disruption: interpretative work has an occasional, not a universal, social control function. Further, staff are shown to ‘orchestrate’ events within the community whilst encouraging patient autonomy: orchestration and social control are both potential and competitive attributes of a pre‐existing power relationship. It is finally suggested that the autonomous participation of patients in their own treatment, orchestrated by superordinate therapists, may also accurately describe some area of the medical enterprise other than therapeutic communities.