Introduction

This chapter will argue that the development of mental health policy was hugely influenced by conceptions of space and place. By the middle of the 20th century the asylum had become, in the public and sociological imagination, a Gothic institution of seclusion and abuse. This is not to suggest that there was no basis for this view. The chapter will explore the development of this representation of the asylum. The final representations of the asylum contrast dramatically with the original ones that saw the new institutions as modern and progressive. Deinstitutionalisation was to present the community in binary opposition to the asylum. Community based services would, almost by reason of their location, lead to the creation of a new form of inclusive mental health provision. This is based on an idealised notion of community. As the pressures on mental health services grew, a range of social policies that were introduced that meant that urban communities, in particular, became exclusionary rather than inclusionary.

Total institutions

Goffman is one of the most influential sociologists of the 20th century. Goffman's work on stigma and the sociology of everyday life – the social practices that we engage in to structure and make sense of day to day social interactions – have left a rich legacy. It is interesting to note that the treatment and management of mental illness was a key area of analysis in his work. This area was representative of other stigma generating processes (Cummins, 2017a). Asylums (2017) is Goffman's most important work in this field. It is an ethnographic account of life at the St Elizabeth's Hospital in Washington DC. Goffman carried out his research when there were over 7,000 patients at St Elizabeth’s. The study is a landmark in ethnographic research. It also had a key role in the moves to tackle the abusive nature of the regime he described. Goffman's portrait of the asylum was one dominated by essentially anti-therapeutic, dehumanising practices. Goffman's work was part of the drive for reform but also had a key role in shaping the image of the asylum regime.