What gets called mental disorder or illness, mild or severe, shows itself as a misplaced fear of others. Personal relationships break down, followed by an inability to form and maintain new ones. The sufferer becomes progressively more emotionally and cognitively isolated. Madness results from our failure to constantly update and modify our mental map of the world. If we do not ‘test’ our predictions, beliefs, dreams, thoughts, internal dialogue, fantasies, hypotheses, plans, ideas about how the world is, and what the people within it think and feel, our map becomes rapidly out of date. If we act with an out of date model of the world - we will look mad to others, and they will treat us as mad. If others don’t share a large part of our model of reality we are emotionally and cognitively isolated. We need an accurate map; by sharing we come to have a more complete understanding than we could ever achieve alone. The ability to doubt and live with uncertainty, and hence know that we must constantly test our vision of the world - is sanity. To control and fix our view is the first step on the road to disaster and the way an unchanging outlook is maintained is by isolating oneself from any evidence that might contradict it. An unmodified and out of date model of the world is one where our thoughts and feelings are anchored in the past, hence our predictions of the future may be hopelessly wrong.

Sunday, 21 February 2010

John Clare - from the Northampton Asylum

They, have never thought to lay a pathway from the hospital entrance to where the pavement ends on the edge of our town. If you do not have a car, and generally we don’t, and given the irregular bus service - then you must for a short distance walk along the main road. The hospital has changed its purpose over the years, today if you are a patient there it usually means you are coming to the end of a prison sentence, but receiving treatment because you have a mental disorder. If you are driving along the road and are frightened by a menacing male figure; well, remember he looks ragged because he has so little to his name, is walking because he has no money, is scared by the amount of traffic (that is you) and shocked by the outside world which he hasn’t felt, unaccompanied and for himself, for - how long?

When I have business at the hospital I always walk. Those who seek to ‘involve’ me always offer a lift, I refuse saying it’s just up the road. In fact it is a half hour walk at a leisurely pace - and it has to be that way. Those workers who organise us, talk of ‘journeys’ to a recovery, or care ‘pathways’ - I prefer something more grounded in the reality of the material world and with a real history. On that journey I inevitably think of the times in my ‘career’ as a mental patient when I have just had to be outside, have used walking as an attempt to clear my mind. I often think of the poet John Clare’s fifty mile walk home, over the best part of two days and a night, having escaped from his first confinement, and who, were he alive today, might well have had the same diagnosis as myself (Bipolar Affective Disorder) - and of course have found a large part of his pathway occupied by the A1! The real journey to the hospital has only one ‘staging post’ and that is the wooden bus shelter, which survives - just. There I pause, to make that adjustment you must make when passing from your own world to that of workers and clients interacting with each other. I roll a cigarette, look for any additions to the graffiti (a kind of testimony) and think about the problem every client has - the inability to explain oneself to others.

John Clare (1793-1864) was a small farmer who briefly found fame in the 19th century, becoming known as ‘the peasant poet’ but was then socially excluded when he began to experience mental health problems. He spent the last 20 years of his life confined in the Northampton County Asylum but was able from time to time to continue writing poems, one of which was ‘I Am’;

‘I am! Yet what I am who cares, or knows?
My friends forsake me like a memory lost.
I am the self-consumer of my woes;
They rise and vanish, an obvious host,
Shadows of life, whose very soul is lost.
And yet I am - I live - though I am toss’d

Into the nothingness of scorn and noise,
Into the living sea of waking dream,
Where there is neither sense of life, nor joys,
But the huge shipwreck of my own esteem
And all that’s dear. Even those I loved the best
Are strange - nay, they are stranger than the rest.

I long for scenes where man has never trod -
For scenes where woman never smiled or wept -
There to abide with my Creator, God,
And sleep as I in childhood sweetly slept,
Full of high thoughts, unborn. So let me lie, -
The grass below; above, the vaulted sky.’

Detail from photo of the  Northampton Asylum grounds as they are today via St. Andrews Healthcare

Forty years after his death however, he did achieve a kind of inclusion, validation and immortality through the efforts of a legendary teacher Arthur Quiller-Couch who included the poem in the first edition of the Oxford Book of English Verse. Quiller-Couch (known to all as Q) taught at Cambridge University and in the early 1930’s was personal tutor to one Alistair Cooke who then went on, through his radio broadcasts (Letter From America 1946-2003) to give several generations in the UK their first taste of America. He pioneered ‘writing for talking’ in which the broadcaster speaks personally and directly to what he imagines is just one person!

In the late 1930’s a young women from Philadelphia made her way to New York in the hope of becoming a playwright. It would be thirty years before she found success, but she educated herself at various public libraries and discovered there Q’s writing on modern language and literature. Indeed one of her books is entitled Q’s legacy, alas not as widely read as her second book which simply contained her correspondence with a secondhand book dealer in London’s Charing Cross Road. Helene Hanff wrote short, direct and extremely powerful letters to Frank Doel, which would not look out of place today on any social networking site.

From 1975 until his death a couple of years ago, John Mortimer created in fiction a great comic hero. Horace Rumpole, defending barrister, who rejects status and money, in order to uphold the rights of ordinary citizens. He’s ridiculed by the people around him, but always comes out fighting using humour as a weapon. Famously he often quotes from his bedtime reading - Q’s anthology. He has a soft leather bound copy, printed on India paper with gold leaf around the edges, alas my copy has only a cardboard cover - but it’s still just the right size to slip into a pocket when out and about searching for some grass to lie on beneath that vaulted sky.

(And of course, all the above is what is meant by the vertical transmission of memes!)

Bate, J (2003) John Clare: A Biography Picador: London
Quiller-Couch, A. T ed. (1906) The Oxford Book Of English Verse 1250-1900 Clarendon Press: Oxford

Sunday, 14 February 2010

Minimum Qualifications (for helpers and supporters)

If I feel I need help.

If I can ask for help.

If I can lift the phone.

If I can open my door to you, or get through your door, or meet you in a public place.


Can I feel safe with you?

Can I talk to you?

Are there words to describe my feelings and thoughts?

Can you see how I feel?

Can I trust you (does what you say, match the way you act)?

Can you show some understanding?

Can you do something today, that will allow me to act tomorrow (hope)?

Are we both in the present moment?

Thursday, 4 February 2010

Introducing Ecotherapy (...the Brandeau connection)

Ecopsychology starts from the premise that the more natural an environment we are able to live in, the better our physical and mental health ought to be. It has an inescapable logic to it - the problem of course is that almost all of the environment that is habitable, is now man-made! There has been very little academic research on the idea of an ecotherapy, rather those who believe in it have simply got on with it in an intuitive and practically way. I’d like to introduce what will be one of the ongoing themes of the blog with an autobiographical extract describing my experience of it. Those providing it didn’t call it 'therapy' and neither did I. But it occurred during what turned out to be the happiest period of my adult life - that is until very recently.

…What followed was six months of unemployment. I managed to get four interviews; one of which was for a clerical post at one of the local mental hospitals, none led to a job offer. I wrote at the time: ‘It took me several days before I could bring myself to sign-on the dole, it seemed to me to be a gesture of defeat. I felt guilty and ashamed at being out of work; perhaps the legacy of a middle class upbringing… I felt all I had to do was keep filling in application forms and a job would turn-up… The handful of interviews I did have all seemed to go well, l felt they liked me, then came the letter of rejection… After a time you find yourself writing less and less applications and you lower your expectations of employment; you take positive steps to avoid further rejection and alienation from employed society… After several months I could see in the faces of friends that they did not believe I could not get a job’. After Christmas 1982 I packed-up my flat, accepted the offer from the university of my choice for the following October, and left for Paris to stay with my sister. After a few weeks sleeping on her floor, I wrote out an advertising card to place on the notice board of the British Council, it began; ‘I’ll do anything!’ Amazingly I got a response - it turned out to be the greatest stroke of luck I’d ever had.

The deal didn’t sound great, but it paid of in spades - literally. The man at the end of the phone offered me work at a small Chateau vineyard/farm in South-west France. It was bed and board only, but if I stayed more than a month there was some pocket money thrown-in. I accepted after his wife sent me a description of the small community they were running. The farm had nine hectares of vines, some grassland and woods; enough for thirty or so sheep, a kitchen garden, two pigs, half a dozen ducks, about eight chickens and four geese - plus two cats and a collie sheep dog. The human occupants were the couple who owned it and anyone prepared to work for bed and board - but they had a lot of ‘connections’. Students came from Denmark, Holland and the UK, but most of all from Southern California where the couple had previously lived, and worked at various universities. The only other habitation that could be observed from the farm was a neighbour’s barn, the nearest telephone was a fifteen minute walk away, there was no television or radio (just a music centre in the main kitchen/living room) no flushing lavatories, a cold shower, and one hot bath per week. There was a wood fire and wood fuelled range in the main room. There was one Renault Four van, one decrepit 2CV which drifted across the road when cornering, two vineyard tractors (one pre-war), which given the steep slopes would be regularly ‘tipped’ by over confident drivers. The sheep dog only recognised three calls but had the right instincts and was loved by all. In the spring and summer we got up at six, worked till breakfast at seven, worked till twelve or one, took a leisurely lunch, siesta’d till four, then worked till nine, had dinner and went to bed. Sunday was a day-off. Cooking was Mediterranean and sometimes Mexican - meat a luxury, vegetables the staples. But of course there was as much wine as you wanted.

Their philosophy was to be as ‘self-sufficient’ as possible, and wherever practicable to use traditional methods of farming and viticulture. And it worked. The owners had been young enough in the late 1960’s to recognise some of the virtues of the ‘counterculture’ but had tempered it with economic realism. They had a historical perspective on peasant culture, its strengths and weaknesses. However, some of the ‘natives’ in the surrounding countryside were convinced it was a ‘free-love’ colony! On my first visit I stayed four months. It was my first experience of living in a remote rural area - of being outside all day, of doing manual labour, of communal living. The number of workers varied from two or three, to seven or eight. I’ve never felt so hungry or eaten better. My brain was fed by people better educated than myself. I came to feel physically fit and free of mental distress. I was to return another four times during university vacations.

Some farm jobs are highly skilled and interesting to learn, but once learnt become monotonous to do because of their repetitive nature. Others require flexibility and a high level of concentration. Some jobs require little skill and are just drudgery. Spring pruning of vines using traditional methods is a skilled job. First you have to bend horizontal and tie the two remaining branches of last year’s growth to the wire frame using twigs of willow, carried in bundle around your waste. Two knots are required for each branch and the surplus willow cut with a knife. If the job is done on time, you won’t come back to the same vine for maybe another six weeks. Then the new growth from the tied branches can be pruned, a judgement must be made about which two new branches will grow the strongest so as to become next year’s horizontals - but they also have to be the most likely to bare grapes. They are then woven vertically between the higher wires of the frame. Then the rest of the new growth has to be either removed or woven vertically depending on the likelihood of them bearing grapes. (Sometimes, if the schedule is lost, you have to do some pruning before tying). Then you move on to the next vine. There may be forty or fifty vines in a row, a row may be as narrow as six feet. Nine hectares is a lot of vines for half a dozen people to complete in the six weeks or so before they become overgrown. You’ve just got to be quick, you need a certain rhythm and choreography. (Traditional methods did of course vary according to the variety of vine, the type of wire frame etc. - even within the Bordeaux region where I was).

Happiness in work is more strongly associated with the use of a person’s skills than with the material reward received. In psychology there is a concept known as ‘flow’; it comes to those who can lose themselves in their work, it comes to children playing games, it comes (if you’re lucky) when making love. It is the sense of happiness that comes from the loss of self-consciousness. To be happy in your work, you need a job which uses all your skills and then asks for just a little bit more.

Some jobs however are communal and require a lot of team work, like the killing and butchering of an animal. During my Business Studies course we visited an abattoir. (The slaughterhouses of Chicago were the inspiration for Henry Ford’s moving assembly line - though they of course disassembled). We watched each part of the process broken down into the detailed division of labour, each man is given a few simple tasks that he could repeat at speed. Pigs were corralled six at a time, then electrodes applied simultaneously to the temples of the first animal. The stunned animal was then hoisted by a leg and it’s throat cut, the blood draining away as it moved slowly along the gantry to where it would be immersed in the machine containing boiling water and which would scrap of the hair. The remaining pigs became increasingly more agitated and vocal as their turn approached. The circumstances surrounding the killing of an animal on a small farm are very different. (A description of the killing of a pig in a traditional way on a French peasant’s farm is given by John Berger in Pig Earth). It is those who have bred, feed and nurtured the animal who will kill it, butcher it and eventually eat it. They have valued the animal and in turn know it will sustain them. The killing of a pig or sheep my involve everyone for a whole day - killing, slaughtering, butchering, and preserving. As much of the animal as possible will be used, such as the blood and brains. I remember the killing of a pregnant ewe who had broken a leg. People worked together quietly, smoothly; without the noise and violence of the factory. Those involved gave reverence and respect both to the animal and themselves. The carcass and unborn lamb were buried on the farm.

Meat is for feasting and flavouring. There is a festival or feast day somewhere in the world, for every day of the year. Obviously the fourth and fourteenth of July were an excuse for a party - but so was Swiss Dependence Day! We’d have a fire outside, partially melt a whole Swiss cheese and grill sausages, practice yodelling and drink Swiss beer. At some point during my first visit I acquired my nickname ‘Danger’ or ‘Nick Danger’; as in some fearless comic strip hero - it was meant to be ironic since I never volunteered for any of the dodgier jobs, like repairing the tiles on the roof of the barn, or taking a tractor on the steepest slopes. Alas the name stuck since my then girlfriend found it hilarious and used it all the time!

One evening I got into conversation with a guy (whose name and background I have totally forgotten) about left-handedness and how I’d always suffered academically as a result - like not being able to spell! He suggested we do an exercise their and then. He got me to read aloud a paragraph from a magazine. I was a bit slow and haltering. He then told me to read it backwards, this time I was faster and more rhythmic - amazing! He then got me to march-on-the-spot, telling me to swing my left arm with the right leg and vice versa. After a second or two he stopped me, pointing out that I’d done the opposite, raising the left arm with the left leg and vice versa. Once I’d done it the ‘right’ way for about thirty times he stopped me and swiftly ran the knuckle of one finger up the full length of my spine. He then gave me a different paragraph to read aloud - this time it was much easier, faster and more fluent. It forced me to think about brain and body, hand/eye co-ordination, and the psychological distress that might follow from the lack of it; of being left handed in a right-handed world, and of course asymmetry itself.

When I had done my Business Studies course the subject that interested me most was Industrial Relations. But there was no first degree course in the subject, so it had to be done as a specialisation within another subject, I chose Sociology. But I’d never studied any Sociology before! During evenings on the farm I sat by the fire and read an introduction to the subject. It seemed to be about every imaginable relationships between people; from simple conversations to the political and economic structures of whole nations. It also ranged from management and worker relations in factories and offices (supposedly my subject) to developing societies (the Third World and peasant societies of the past) seemingly connected to the kind of community I found myself in. Finally there were the studies of institutions like prisons, the military and mental hospitals - what was I letting myself in for?

When I came to leave the farm and stepped of the train in Paris I experienced what has been described as ‘culture shock’! The noise, the speed at which people moved and things happened, the artificial light. What an alien world, surely it was the environment that drove people crazy…

Chateau Brandeau is now owned and run as an organic vineyard by the son and daughter-in-law of the couple who owned it in my time - see links.

Tuesday, 2 February 2010

It's Groundhog Day - again!

Groundhog Day (1993) director Harold Ramis, based on a story by Danny Rubin, staring Bill Murray and Andie MacDowell. Murray plays Phil Connors an egocentric Pittsburgh TV weatherman who, during a hated assignment covering the annual Groundhog Day event in Punxsutawney on the 2nd February, finds himself repeating the same day over and over again…

Over the last ten years or so I’ve got into the habit of re-watching this movie on the 2nd February, it reminds me of what my life has felt like in times past, and could become again, if I get too preoccupied with myself.

It’s one of those movies which leads audiences to endlessly speculate on it’s meaning. Perhaps the dominant view is that it’s about an individual over concerned with ‘self’, leading to unpleasant situations that continually repeat, until he can transcend them and let go - putting other people rather than himself at the centre of his universe. A tale of self-improvement that looks outward, rather than being focused on one’s own need to be ‘in control’. It’s also a hilarious comedy!

Ryan Gilbey writing in The Observer 1.2.04:

‘While Groundhog Day is undeniably charming, it shares a certain stubbornness of purpose with its star. From the moment Rubin typed the first line of his first draft, he resolved to withhold all explanations about how Connors came to be stuck in a time-loop. Co-written and directed by Harry Ramis, the finished film exploits the witty device of a narrative that achieves momentum without moving forward. Rubin refused to surrender the enigma at the movie's core; the absence of narrative exposition remains the most audacious element of Groundhog Day, not to mention one of the most daring ellipses in Hollywood cinema.’

…As well as making its impact on cinema and language, Groundhog Day has exerted a strong influence on religious thinking. Rubin and Ramis continue to receive letters congratulating them on a positive representation of Buddhism. Presumably they file such correspondence alongside similar messages in which the film is claimed by Jesuit priests, rabbis, and followers of the Chinese spiritual movement Falun Dafa, aka Falun Gong. All the letters are characterised by a singleminded belief that the movie endorses the author's faith. 'At first, I would get mail saying, "You must be a Christian, because the movie so beautifully expresses Christian belief,"'Ramis said recently. 'Then rabbis started calling, saying they were preaching the film as their next sermon.'

Roger Ebert writing in the Chicago Sun 30.1.05:

‘Tomorrow and tomorrow and tomorrow, in his case, doesn't creep in at its petty pace from day to day, but gets stuck like a broken record. After the third or fourth day, the enormity of his predicament is forced upon him. He is free to change what he says and does from one Feb. 2 to the next, but it will always be Feb. 2 for everyone else in the world, and he will always start from the same place. They will repeat themselves unless he changes the script, but tomorrow they will have forgotten their new lines and be back to the first draft of Feb. 2.

...One night in a bowling alley, sitting at the bar, he says almost to himself: “What would you do if you were stuck in one place, and everything that you did was the same, and nothing mattered?” The sad sack next to him at the bar overhears him and answers: “That about sums it up for me.” Slowly, inexpertly, Phil begins to learn from his trial runs through Feb. 2'.

Monday, 1 February 2010

Goffman and Becker; stigma and labelling

I'm sometimes asked by people from the world of mental health about the work of Erving Goffman. Regrettably I’ve never been asked about Howard Becker. Yet together they are the source of many of the taken-for-granted ideas in mental health practice today.

The attention paid over the last fifty years to stigma, discrimination, and the social consequences of a psychiatric label (not to mention the existence of a ‘time to change’ campaign) would have been unlikely had these two men not met as graduate students in 1947 and shared an education in the Department of Sociology at the University of Chicago. Goffman died in 1982, but his reputation has continued to grow. Howard Becker is still very much with us.

Like Goffman I hang around cafes and street corners a lot. The social situation of the café and the performances given within that space by the providers and clients of a service formed the heart of his approach. He was, first and last, interested in the contrast between what he could observe of a social interaction and the ‘definition of a situation’ given by the individual participant - in the space between the two lay the performance (Goffman 1971:13-27). The degree to which you allow your world view to be questioned by those around you is the degree to which you are grounded. The more interpretivist your approach however, the more idiosyncratic your form of presentation is likely to be and therefore potentially less understandable. It’s been said you either love or hate Goffman’s writing. He wrote long discursive essays offering novel conceptualisations on every other page, hugely rewarding to read - but it does require effort. Some say his work has proved impossible to ‘operationalise’ - well, all you really need to do is read him in a café, lift your head every few minutes, and watch!

He’s famous for his ‘dramatological’ approach to the analysis of everyday interactions across a whole variety of modern settings. However it’s worth recalling where, for him, it all began. Whilst a postgraduate he managed to escape to Edinburgh in 1949 for a year or so, and hence to Shetland Isle to undertake fieldwork amongst what was then the last complete crofting community - well almost! Their window on the outside world, and the outside world’s window on them, was through the Isle’s only hotel. Goffman became a semi-permanent guest, finding himself watching the occasional tourists every evening, having spent the day amongst the islanders. It was there that the ‘front of house’ performance (one side of the swing door) of the crofting family who ran the hotel began to fascinate. Behind the door they remained crofters, keeping to their peasant (subsistence agricultural) lifestyle, including a diet of root vegetables as staples, with meat restricted to ‘feasting and flavouring’. Coming through the door they were transformed in dress, speech and manners; carrying generous servings of meat, a variety of vegetables and desserts - accommodating the expectations of their wealthy middle class, often English, guests. See the footnotes in The Presentation Of Self In Everyday Life published first in 1959 (Goffman 1971).

In 1955 Goffman worked for about eighteen months in a psychiatric hospital, the 7000 bed St. Elizabeth’s Hospital in Washington DC.


His job was what might be called today a ‘personal trainer‘, or someone offering physical therapy. His real purpose however was to research the nature of ‘total’ institutions, where people live, work and play in the same - often confined - location. However only a handful of the managers knew his real reason for being there. It was this experience which led to the four long essays which were first published together under the title Asylums in 1961 (Goffman 1968a). Many of the social processes he identified were what we routinely call today ‘institutionalisation’. He believed in the importance of keeping detailed field notes and of immersing yourself in the situation, but in the way he wrote you wouldn’t necessarily know in what capacity he had been present! Howard Becker recently took another look at one of those essays (Becker 2007: 223-237) entitled ‘On the Characteristics of Total Institutions’ (reproduced in Goffman 1968a:14-115) which is about the structure and organisation of mental health care. ‘No reader of Goffman’s essay on total institutions can be unaware of the considerable disparity between the social reality he talks about and the way he talks about it.’ (Becker 2007:228)

‘ “trimming” and “programming” to describe how “the new arrival allows himself to be shaped and coded into an object that can be fed into the administrative machinery of the establishment, to be worked on smoothly by routine operations” (p.229)

…“secondary adjustments,” to refer to “practices that do not directly challenge staff but allow inmates to obtain forbidden satisfactions or to obtain permitted ones by forbidden means”

…a variety of “personal adjustments,” such as “situational withdrawal”, which (he notes) psychiatrists might call “regression” ’ (p.230)

‘Goffman used his linguistic inventiveness to name things in ways that evaded conventional moral judgements and therefore made scientific work possible. (p.236)

When I look again at Asylums I can’t help but see an equivalence between those huge institutions and our equally large, confining and impersonal rule-governed bureaucratic mental health organisations. Mental health law is as strong as ever. Illness maybe thought of as episodic for most clients, but there is still the social phenomenon of a ‘revolving door’; and being shoved from ‘pillar to post’ becomes a reality when your behaviour is thought undesirable, persistent or enduring. One can see diagnosis itself as part of the identity ‘stripping’ process, the restrictions of the Mental Health Act as leading to a denial of ‘personal space’; if you are sent under section ‘out of area’, away from your community, surrounded by strangers, under the authority of staff whose language you don’t comprehend - isn’t that ‘asylum’?

Also in 1961 the book Encounters first appeared containing two essays on social interaction in general. In one he writes about ‘role distance’ (Goffman 1961:85-152), the extent to which an individual is able to distance themselves from the rules and expectations of a social situation. The problem is often seen in ‘tongue in cheek’ like behaviour - but when applied to those who are confined, physically or psychologically, it can be seen as the degree to which an individual can escape a role prescribed by others and establish an independent identity. The problem arises when someone has come to have some attachment to there situation at the same as being disaffected or resistant to it. ‘A full twist must be made in the iron law of etiquette: the act through which one can afford to try to fit into the situation is an act that can be styled to show that one is somewhat out of place. One enters the situation to the degree that one can demonstrate that one does not belong.’ (p109) Yet it can’t be called role distance if a person has completely refused a role;

‘…for the special facts about self that can be conveyed by holding a role off a little are precisely the ones that cannot be conveyed by throwing the role over.’ (p.108)

‘Should the subordinate exercise role distance, this is likely to be seen as a sign of his refusal to keep his place (thereby moving towards greater intimacy with the superordinate, which the latter is likely to disapprove), or as rejection of authority, or as evidence of low morale. On the other hand, the manifestation of role distance on the part of the superordinate is likely to express a willingness to relax the status quo, and this the subordinate is likely to approve because of its potential profitability for him.’ (Goffman 1961:129)

Then in 1963 came Stigma. First Goffman seeks to turn our reasoning around from individuals with attributes which are stigmatising, to seeing situations - constructed relationships in which stigma is made and reproduced. This led to his famous assertion: ‘The central feature of the stigmatised individuals situation in life can now be stated. It is a question of what is often, if vaguely, called “acceptance”.’ (Goffman 1968b)

Also in 1963 Howard Becker’s Outsiders: Studies In The Sociology Of Deviance was first published. The word ‘deviant’, before it became corrupted, simply meant any individuals or groups who acted in ways other than the currently accepted norms of society. Becker’s study included prostitutes, drug addicts, criminals, jazz musicians, gypsies, hobos and winos - to name but a few!

Through the studies reported in the book Becker became the principal developer of labelling theory, but he was quite clear that his studies were about society’s response to perceived difference, rather than what might actually constitute ‘otherness’ itself (Becker 1991). Society labels the individual or group, they are then treated differently as a consequence of the label. ‘When I was working on the theory of deviance, I wanted to argue that when others labeled someone as a deviant, that identification often became the most important thing about the person so labeled…’ (Becker 1985:142). Becker is also a jazz musician, and was aware of the drug culture from a young age, he studied and wrote about in the post-war period but the political climate of 1950’s America was such that it didn’t get published for many years - he received his PhD in 1951 for a study of schoolteachers.

When I worked as a volunteer in a mental health centre in 1989, the clients knew my background of mental health problems, when it became clear I had secured a place on a psychiatric nursing course one client (during a conversation where I wasn’t present) apparently reacted in amazement - exclaiming ‘they’ would not allow it. He concluded I must have covered-up my background and lied at the interview!

The view I take now on the stigma and labelling of mental health problems was formed at that time when I was briefly a student nurse, and informed by both Goffman and Becker. However I expressed it someway differently. For to be completely stigmatised, you must be prepared to accept the label. It is also possible to not only define yourself by a stigma, but also come to depend upon it for your own identity. It can grant a special status with certain rewards. To be labelled may exclude you from one community, but allow incorporation into another. There seemed to be, and I see no reason to change what I wrote back then now, four general types of relationship.

1/ I see myself as OK and so does society; this is a relationship of normals, of acceptance and incorporation in like-minded communities.

2/ I see myself as not OK and so does society; this is also a relationship of acceptance and incorporation, someone who accepts the ‘sick role’ and is in long term care.

3/ I see myself as OK but society does not; this is a relationship of rejection and exclusion (on both sides). Someone who does not consider themselves ‘ill’ in anyway whilst those around them do.

4/ I see myself as not OK but society sees me as OK; this is also a relationship of rejection and exclusion; anyone who is ‘screaming’ but not heard.

At various times, before and since, I have embraced all of these roles.

In the last twenty-five years Howard Becker has turned his attention to how academics think, write and undertake research on social behaviour. He has produced three widely acclaimed books, Writing for Social Scientists (Becker 1986), Tricks of the Trade (Becker 1998) and Telling About Society (Becker 2007) - which sadly the world of mental health and health research in generally seem unaware of.

Since the subject of much of my writing is fear, I’ll end with a couple of quotes from Becker on the events that led him to write about social researchers. In the late 1970’s he offered a series of writing seminars for graduate students, with the explicit intention of bringing greater clarity to sociological writing, but what he uncovered was an alarming array of writing ‘habits’ - amongst his students, and the other more senior faculty members who seemed to gravitate to his seminars (Becker 1986:1-25).

‘From one point of view, my fellow participants were describing neurotic symptoms. Viewed sociologically, however, those symptoms were magical rituals. According to Malinowski, people perform such rituals to influence the result of some process over which they think they have no rational means of control.’ (p.3)

‘They feared, to summarize the long discussion that followed, two things. They were afraid that they would never organise their thoughts, that writing would be a big, confusing chaos that would drive them mad. They spoke feelingly about a second fear, that what they wrote would be “wrong” and that (unspecified) people would laugh at them’ (p.4)


Becker, H. S (1986) Writing for Social Scientists University of Chicago: Chicago
Becker, H. S (1991) Outsiders: Studies In The Sociology Of Deviance The Free Press: New York
Becker, H. S (1998) Tricks of the Trade University of Chicago: Chicago
Becker, H. S (2007) Telling About Society University of Chicago: Chicago
Goffman, E (1961) Encounters; two studies in the sociology of interaction Bobbs-Merrill: New York
Goffman, E (1968a) Asylums: Essays on the Social Situation of Metal Patients and Other Inmates Pelican: London
Goffman, E (1968b) Stigma: Notes on the Management of Spoiled Identity Pelican: London
Goffman, E (1971) The Presentation Of Self In Everyday Life Pelican: London
Goffman taught me how to think, Becker how to write - though I suspect that if either were reading this they’d shout: ‘They’re the same thing dummy!