Therapeutic Clinics

Abstract

Of all the types of institution discussed in this volume, perhaps the most explicitly and self-consciously reinventive are those which have a therapeutic ethos. Psychiatric treatment was of course the goal of the asylum, Goffman’s archetypal TI, but whereas this structural form has declined, there has been a growing recognition of the wider, societal pervasiveness of mental and emotional distress (Bendelow 2009). This chapter focuses on a particular set of institutional sites that offer peer-mediated help, with or without the backing of mainstream psychiatry. Therapeutic communities, self-help groups and other semi-voluntary organisations function to provide social and emotional support for those who self-define as troubled souls (Gubrium & Holstein 1995) and who seek to find meaning in their madness. In these institutions, recovery is framed as a journey of self-discovery, to be experienced both as a personal triumph of identity work and as a public, socially negotiated career trajectory. The patient is redefined as a client, who makes an active choice to subject themselves to scrutiny from peers as well as professionals. Their conduct is evaluated and judged not only in itself, as psychiatrically symptomatic, but also as an index of their social and moral status relative to other members in the group. This has implications for the inmate’s self-identity as something that is both discursively constituted and interactively managed.