| Two organizations for the care of the mentally ill, the total institution and the therapeutic community are contrasted. The former has been considered a symbol of suppression and authoritarianism, the latter as representative of a humanizing, liberalizing trend in psychiatry. In order to examine the assertion that the therapeutic community shuns all forms of organization associated with the total institution, themes abstracted from Goffman's work Asylums (1961) were contrasted with those abstracted from the literature on the therapeutic community. These themes were then reviewed and assessed in light of research data collected during a seven-week period of participant observation in one therapeutic community.;A central conclusion of this work is that under important differences in the stated ideologies of the total institution and therapeutic community, there are profound similarities generated by societal demands and constraints on the psychiatric profession. Of importance is the finding that in the therapeutic community the forms of control are different from those in the total institution. The focus in the former is control of motivations as well as behavior, to which end, patients are instructed they are important contributors.;In both settings it was clear that staff viewed themselves as distinct from the patient body and ultimately more responsible for care and control of patients. The distinction between the therapeutic community and the total institution appeared most marked in the role-requirements for patients in the therapeutic community. Patients there were expected to act as therapists to each other and share intimate information with staff and fellow patients. It was suggested that such a practice has significant implications for the heightening of aspects of the "mortification process" described by Goffman in the total institution. |
