A half-century ago Erving Goffman (1961) suggested in his book, Asylums: Essays on Social Situations of Mental Patients and Other Inmates that people were turned from human beings into mental patients, in places he called ‘Total Institutions,’ where the roles, goals, and identities of people are stripped from them as they are re-assigned the role of ‘diseased.’ (de)VOICED shows evidence that this still happens today.

In order to accomplish this mortification process, people quickly learn from fear of retaliation such as loss of privileges or extended stays in psychiatric places with greater levels of confinement, and/or forced drugging, electroshock, restraint, seclusion or other aversive actions which Goffman called forms of physical “contaminative exposure” to curtail their voices and accept their new assignment as ‘diseased.’

People, due to the social experience of being turned into an object, by psychiatric assignors they come in contact with, are conditioned to question their own voices, silence themselves, and comply with the psychiatric assignors, and that this less than human status allows for a certain kind of social contaminative exposure. Goffman discussed these phenomena of what occurs in mental institutions based on observations of people who were involuntarily committed at St. Elizabeth’s Hospital, a psychiatric facility in Washington, D.C., in the late 1950s. (de)VOICED shows evidence for the phenomena which Goffman described, which are deeply discussed in this dissertation, occurring to people who were both voluntarily and involuntarily involved with state-sponsored organized psychiatry through a public service delivery system.
William Cross, Jr. (1971) put forth an article entitled: “The Negro to Black Conversion: Toward a Black Liberation Psychology,” which described a developmental process where one fights one’s way out of a place of oppression and moves toward liberation. The turning point from oppression to liberation, for Cross (1971, 1991), was an “encounter” which for many, he described, was inspired by either witnessing something heinous such as Martin Luther King Jr. being assassinated or meeting someone further turned on in the Black Power Movement.

(de)VOICED shows parallels to this process of going from assigned mental patient toward a person again. We show turning points or encounters to also include experiencing something heinous, such as electroshock, restraint, seclusion, forced drugging, aversive behavioral actions.

We also show a turning point to be simply getting off the psychiatric drugs, which is not to suggest the process of getting off psychiatric drugs is simple.
Throughout this dissertation, I showed evidence for why I equate what Goffman (1961) described as “mortification of self” to oppression and name its consequences as a psychological state of psychological mortification. I equate what Cross (1971, 1991) described as an encounter and the following movements toward liberation to the experience of breaking free from identifying and thinking of oneself as a mental patient, consumer, recipient, and/or peer back into human status.
In his otherwise benign, ‘just the facts’ sociological analysis of Total Institutions, Goffman (1961) described a large piece of his work:

The career of the mental patient falls popularly and naturalistically into three main phases: the period prior to entering the hospital, which I shall call the prepatient phase; the period in the hospital, the inpatient phase; the period after discharge from the hospital, should this occur, namely, the ex-patient phase (p. 131).

Goffman specified that he only dealt with the first two phases, and footnotes the ex-patient phase in this way:

This simple picture is complicated by the somewhat special experience of roughly a third of ex-patients—namely, readmission to the hospital, this being the recidivist or ‘repatient’ phase. (p. 131)

Goffman did acknowledge that there were some people who have had these experiences of being discharged, who he identified as ex-patients, who work to change the psychiatric systems they were involved with. He wrote that some in the ex-patient phase develop “briefly at least, a devotion to the social cause of better treatment for mental patients” (p. 169).
The people involved in (de)VOICED in the roles of Advisors, Study Coordinators, Environmental Workographers, and Evaluators are evidence of Goffman’s (1961) claim of how some experience the ex-patient phase—“a devotion to the social cause of better treatment for mental patients” (p. 169). I argue that those of us who are working toward the protection and promotion of human rights are not in ‘a phase’—but all of us are painfully aware that we are at extra risk for the fate of the one-third of people who do get out of institutions—to become “repatients” (Goffman, 1961, p. 131)—ourselves.

For many of us, once we have broken out of the mental patient role, we begin working in a movement toward human rights. As reported by participants in (de)VOICED, the grassroots movement of people who identified as ex-patients and survivors of psychiatric assault which bloomed in the 1970s was, ‘bought out’ in 1985 and became a state-controlled operation. In 1985 federal and state governments began to pay for and therefore ultimately control a fraudulent version, within the system’s traditional power structure, of what it is the people in the Human Rights Movement had previously offered: rights, self-help, mutual support, and advocacy, which often currently is called various things, beginning with the word, ‘peer.’

(de)VOICED showed the way the total administration of total institutions has exhibited control over these ‘peer’ positions, often preventing the people working in these positions from meeting their original intentions and goals. This control often deeply compromises the values of the person who is in the role of ‘peer.’ This power of the State—or its partners via managed care companies—was even described as “seductive” by one person who participated in the research process.

These controls, as reported by Environmental Workographers, have come both in the form of threats of retaliation and direct retaliation to people working in these ‘peer’ positions, for speaking out against—or refusing to comply with—the message of the medical model of psychiatry.
(de)VOICED showed that when people have spoken out about the mortification process we experienced to the State—concerning our experiences of the public service delivery systems of psychiatry, (without referencing Goffman—but the true process he outlined—the experience of being dehumanized) we have often used words to highlight the experiences we endured such as malpractice, abuse, neglect, torture, involuntary servitude, slavery, and even murder.

(de)VOICED showed that this was true for people who participated in its processes, that it was historically true over many generations, and that it is still true today. The State, through the arms of its total institutions (Goffman, 1961), attempts to silence and control those speaking out about the places, policy makers, practitioners, practices, products, and procedures, and the profit they generate, especially if the people who are speaking out are funded through state tax dollars.
Some situations we were (re)told through (de)VOICED about when people voiced dissent included: loss of employment with the State and/or State-funding and, in the most egregious situations, re-institutionalization and forced drugging.
The field of Environmental Psychology gave us methods to uncover and understand these realities. This dissertation focused on how the use of these methods can aid in ending human rights violations within SSOPI.


Cross, W. E., Jr. (1971). The Negro to black conversion experience: Toward a psychology of black liberation. Black World, 20, 13-27.

Cross, W.E., Jr. (1991). Shades of black. Philadelphia, PA: Temple University.

Goffman, E. (1961). Asylums: Essays on the social situations of mental patients and other inmates. New York: Doubleday.

2 thoughts on “Theory”

  1. Thank you Lauren for this very important and groundbreaking work, making visible the oppression and suffering of those deVoiced.


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