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The permeable institution: An ethnographic study of three acute psychiatric wards in London

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  • Quirk, Alan
  • Lelliott, Paul
  • Seale, Clive

Abstract

In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

Suggested Citation

  • Quirk, Alan & Lelliott, Paul & Seale, Clive, 2006. "The permeable institution: An ethnographic study of three acute psychiatric wards in London," Social Science & Medicine, Elsevier, vol. 63(8), pages 2105-2117, October.
  • Handle: RePEc:eee:socmed:v:63:y:2006:i:8:p:2105-2117
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    References listed on IDEAS

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    1. Quirk, Alan & Lelliott, Paul & Seale, Clive, 2004. "Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward," Social Science & Medicine, Elsevier, vol. 59(12), pages 2573-2583, December.
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    Cited by:

    1. Jacqueline McIntosh & Bruno Marques & Gabrielle Jenkin, 2022. "The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind," IJERPH, MDPI, vol. 19(18), pages 1-21, September.
    2. Reilley, Jacob & Pflueger, Dane & Huber, Christian, 2024. "A typology of evaluative health platforms: Commercial interests and their implications for patient voice," Social Science & Medicine, Elsevier, vol. 350(C).
    3. Wood, Victoria J. & Curtis, Sarah E. & Gesler, Wil & Spencer, Ian H. & Close, Helen J. & Mason, James & Reilly, Joe G., 2013. "Creating ‘therapeutic landscapes’ for mental health carers in inpatient settings: A dynamic perspective on permeability and inclusivity," Social Science & Medicine, Elsevier, vol. 91(C), pages 122-129.
    4. Reavey, P. & Brown, S.D. & Kanyeredzi, A. & McGrath, L. & Tucker, I., 2019. "Agents and spectres: Life-space on a medium secure forensic psychiatric unit," Social Science & Medicine, Elsevier, vol. 220(C), pages 273-282.
    5. McGrath, Laura & Reavey, Paula, 2015. "Seeking fluid possibility and solid ground: Space and movement in mental health service users' experiences of ‘crisis’," Social Science & Medicine, Elsevier, vol. 128(C), pages 115-125.
    6. Golden, Annis G., 2014. "Permeability of public and private spaces in reproductive healthcare seeking: Barriers to uptake of services among low income African American women in a smaller urban setting," Social Science & Medicine, Elsevier, vol. 108(C), pages 137-146.

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