Phoebe Sengers

Literary and Cultural Theory / Computer Science
Carnegie Mellon University

 

Institutionalization, October 11-18, 1991. What happened?

 

The week was bizarre, inexplicable, intense. The week had a story, the story of a breakdown, a story whose breakdown delineates the workings of the psychiatric machine. This machine, operating on a streaming in/out flow of people, is not only institutional but institutionalizing; its inputs become institutionalized. It works where it breaks down; “The social machine’s limit is not attrition, but rather its misfirings; it can operate only by fits and starts, by grinding and breaking down, in spasms of minor explosions” (Anti-Oedipus 151). The breakdown of its patients is reflected onto the ward; in its case, however, breaking down is productive and creates the institutional moment. Understanding that experience of institutionalization, making it explainable, means reading that story and following its lines of flight. What results is a patchwork narrative, neither coherent nor choosy about its sources. The aim is not purity of form, but an answer to “What happened?” that respects the complexity of the institutional moment and a diversity of viewpoints on that moment. Nevertheless, from this patchwork emerges an effective understanding of social machines in general and the possibilities for agency even at the moment of subjugation; the narrative of this singularity leads to a general strategy for escape from totalization based on the postulates of machinic analysis.

 

What Happened

 

In the middle of September, I started to get depressed. By the middle of October, things had progressed to the point that I could no longer function: I couldn’t read or write and was having trouble walking. I went to see a counselor and told him, ‘I think I need to go to the hospital.’ He took me to Western Psychiatric Institute and Clinic.¹

 

The fastest way into and out of theorizing about insanity is to state that people are labeled insane if they fail to correspond to social norms. Such a statement fails to take into account the experience of many mental patients who have committed themselves or of people who are seeking treatment outside the institutionalized stream. For these people the experience of being “crazy”–schizophrenic, depressed, or anxious, to follow the clinical classification–is routed through feelings of misery and, often, physical symptoms like an inability to concentrate, insomnia, or involuntary movement. This is not to deny that these physical symptoms bear the mark of the social formation (“[I]t is a founding fact–that the organs be hewn into the socius, and that the flows run over its surface” [Anti-Oedipus] 149). It is only to state that insanity and institutionalization are more complicated than a mere labeling on the part of a social organization. Insanity is something experienced both from the individual and from the social point of view.

 

I do not pretend to be able to (re)present the real institutionalization, the real experiences of mental patients. Instead, I want to consider the period of institutionalization as a moment where two flows come into contact with each other: that of the institution, with its labels and categories, ready to take in new input, and that of the individual, who leaves his or her everyday life to become, for a while, a more-or-less functioning member of the social community under the auspices of the ward. Corresponding to these two flows there are two points of view or modes of representation of the conjunctural period to be considered, that of the institution and that of the patient.

 

For the institution, any particular institutionalization is just a moment in its history, though each of these moments is in the strictest sense essential–the institution really only consists of the sum of these institutionalizations. For the individual, ripped from his or her normal existence and deprived of his or her accustomed social context, the commitment is a traumatic event, but one that is not constitutive–in most cases, the institutionalization will last only a moment in the scale of their lives. The meeting of the institution and the patient is a point of conjunction of the paths of two very different social machines. Here, I would like to consider the dis- and conjunctions between the ways in which these two social machines deal with their shared moment. By considering their respective representations of that moment–particularly the gaps between those representations–I hope to gain an understanding of how the processing of both machines comes to constitute the process of treatment in the institution.

 

I had to wait a long time in the emergency room before I was checked in. After a long wait someone took my temperature. After another long wait I talked to a counselor. After yet another long wait I talked to the psychiatrist.

 

While I was waiting someone was brought in from the state penitentiary. They locked him in a little room. He was screaming and kicking the door. The screaming went like this: ‘Society has made me this desperate! I was only arrested because I’m black and living in a white world.’ All the staff in the room, including the receptionist, put on latex gloves. They put a crying woman in a private room so she wouldn’t be bothered by this man. They asked me to move, too, so I wouldn’t be so dangerously close to the room where they had him locked up.

 

As the soon-to-be-patients stand on the threshold of entering the institution, they are immediately confronted with its first moment of breakdown. There is a conflict between two functions of the mental hospital: its function as a site of medical care or rehabilitation and its role as a custodian of certain more dangerous elements of society. As Erving Goffman discusses in “The Medical Model and Mental Hospitalization,” the stresses and gaps between these two models are felt keenly within the institution, which currently prefers to underscore the service model. “Each time the mental hospital functions as a holding station, within a network of such stations, for dealing with public charges, the service model is disaffirmed. All of these facts of patient recruitment are part of what staff must overlook, rationalize, gloss over about their place of service” (30). Nevertheless, the institution continues to be able to operate on both registers (“No one has ever died from contradictions” [Anti-Oedipus 151]).

 

This presents a quandary for the mental patient. S/he is generally all too aware of being incarcerated despite the staff’s assurances that s/he is only there “for your own good.” “[O]ur conversation [had] the character of an authoritarian interrogation, overseen and controlled by a strict set of rules. Of course neither of them was the chief of police. But because there were two of them, there were three. . . .” (Blanchot 18). Though the institution claims to work on the medical metaphor, it differentiates patients according to how well they fit into the service model. In the case of the man in the emergency room, the patients (i.e., I and the other woman) that are more or less “normal” are treated courteously and are even physically separated from the “problem patient.” He is considered dangerous and alien; the staff dons gloves to avoid coming into contact with him. The patient occupies a troubled status; s/he is at the same time the “good patient,” being treated for an illness more or less external to him or her, and the “bad patient,” fundamentally flawed and not allowed to go outside; the latter status is all the more real for being denied.

 

The most seditious example of this is the status of the “voluntary” patient. The involuntary patient, who is committed to the institution by legal forces and against his or her will, is at least somewhat explicitly incarcerated. The voluntary patient is, for all intents and purposes, equally though more surreptitiously incarcerated. This is because one’s status as voluntary is ephemeral. As soon as the patient shows signs of resisting doctor’s orders or of attempting to leave prior to “cure,” s/he can be and often is committed by the hospital, whose financial clout is often such that the patient’s legal representation can only look puny by comparison. Voluntary status, the ghost of the service model, lives on the cusp of existence, to disappear precisely when it is most needed.

 

Then two big white men went into the room and gave the black man a shot. He was still kicking and screaming. Later they went into the room again. I heard the receptionist talking on the phone. She said, “They’ve already given him twice the normal dosage and he’s still not calm.”

 

They brought me papers to sign myself in. I joked with the nurse. “This is so I can still run for president, right?” She didn’t think it was funny.

 

The moment of entrance into the institution is a symbolic one. It is accomplished through “order words” (Plateaus 80)–deeds that occur entirely through an act of signification. In the case of the institution, the order word is the signature. The papers I sign mean that I no longer have a right to speak for myself before the law. Once I have signed the paper, my signature is worthless. This gives the signature on the commitment form an eerie status–a signature, sealing its own inability to seal.

 

The signature, despite or perhaps thanks to its paradoxical status, is central to the institution. It is what binds the patient to the institution; it is what controls the flow of patients in to and out of the institution. The patient arrives, bound by his or her own signature or by that of a doctor. The patient may not leave, even if s/he came voluntarily, without the signature of a proxy²: the psychiatrist, competent, as though by an act of conservation of agency, to speak for two.

 

The signature is itself a proxy for the law. Maurice Blanchot writes,

 

Behind [the doctors’] backs I saw the silhouette of the law. Not the law everyone knows, which is severe and hardly very agreeable; this law was different. Far from falling prey to her menace, I was the one who seemed to terrify her…. She would say to me, ‘Now you are a special case; no one can do anything to you. You can talk, nothing commits you; oaths are no longer binding to you; your acts remain without a consequence.’ (14-15)

 

In this respect, the patient stands beyond the grasp of the arm of the the law. But it would be more appropriate to say the patient is jettisoned by the law. “When she set me above the authorities, it meant, you are not authorized to do anything” (15). The law deprives the mental patient, not only of his or her culpability, but also of his or her ability to speak. “Of course you had what they called an [sic] hearing but they didn’t really want to hear you” (Washington 50). The category of the “insane,” then, is defined by its inability, socially speaking, to speak for itself. It is a category without legal status in the narrowest sense.

 

The breakdown of the institution at the moment of entrance, then, is mirrored by a breakdown of the social machine of the patient. It would be better, perhaps, to speak of a breakout: the patient is no longer seen as a functioning member of society. This is a Catch-22 for the patient trying to affect reform or even just trying to voice his or her experience; how can a group of people defined by an inability to speak find a voice in society? By definition this should be impossible, except perhaps for the gap between “insane” (insane as a social label, from the point of view of the institution) and insane (insane as an experiential label, from the point of view of the labeled individual). In the mental reform movement, as well as in this paper, one often finds such voices stemming from ex-patients: “We, of the Mental Patients’ Liberation Project, are former mental patients” (Liberation Project 521). “Insanity” in the first person is invoked as a category of nostalgia.

 

The Mental Patients’ Liberation Project is a good example of one such reform project. The project aims to get basic civil rights protection for patients in asylums. The problem of establishing civil protection for individuals held to be outside of civil society is approached in their project statement by a loosening of the term “we,” which is used alternately to mean the “former mental patients” of the project and patients currently in asylums. “We have drawn up a Bill of Rights for Mental Patients. . . . Because these rights are not now legally ours we are now going to fight to make them a reality. . . .” (522). By blurring the categories patient/ex-patient the Project also blurs their respective legal statuses, pulling the patient into the realm of the law occupied by the ex-patient. The Project still speaks for the patient, but with some sleight of hand its voice appears to come out of the patient’s mouth.

 

In the same statement, the Liberation Project also plays the role of the law for the mental patient. The Project presents the patient with a Bill of Rights; rights, the Project grants, without true legal status but “which we unquestioningly should have” (522). A major concern of this Bill is the legalization of the mental patient: “You are an American citizen and are entitled to every right established by the Declaration of Independence and guaranteed by the Constitution of the United States of America” (523). The project thus solves its theoretical problem handily–it plays the parts of the constituencies that cannot or do not want to appear on the stage.

 

After I had waited for a total of seven hours they took me upstairs. When we got to the 11th floor (the depression ward) I was met by a disoriented-looking patient, who said, “You’ll like it here. We all help each other get better.” I thought to myself, “Oh no! I’m going to be locked on a floor with all these strange people.”

 

The moment of the signature has passed. As far as the hospital is concerned, the patient has already been classified into the type that will determine how s/he will be processed for the rest of the stay. For the patient, however, the order word is not enough to change his or her entire system of functioning. His or her point in the social hierarchy has changed but this change has not yet manifested itself in the realm of action. The machine is still running, just as it did before. On entry into the social situation of the ward its old system of functioning will choke; the machine will have to reprogram itself.

 

My clothes and all my belongings were searched and they took everything they thought was “dangerous” out of it. That includes my contact lens solution and my tampons. I said, “What could I possibly do with my tampons?” The staff person checking me in couldn’t think of anything. But those were the rules.

 

Although the commitment took place at the moment of the signature, the institutionalization really begins here. This is the moment at which the patient is made to realize the rights and privileges s/he has lost by seeking help within the institution. The incoming patient is stripped, searched, given hospital clothing, and led onto the ward identified only by a hospital bracelet. No one on the ward knows the patient, who is reluctant to circulate with the other patients, people from whom until recently s/he was protected by the comforting arm of the law. Any attempts to identify with the staff, however, will soon be rebuffed; the patient becomes forcibly alienated from the person s/he thought s/he was and must assume a new role.

 

From the point of view of the institution, this is a dangerous moment. A new element has been absorbed but at this point it still retains marks of the outside world. These now out-of-date attributes must be removed as quickly as possible. Erving Goffman points out, “Many of [the admission] procedures depend upon attributes such as weight or fingerprints that the individual possesses merely because he is a member of the largest and most abstract of social categories, that of human being. Action taken on the basis of such attributes necessarily ignores most of his previous bases of self-identification” (“Institutions” 16). The institution must create a deterritorialized space onto which to reterritorialize its input.

 

Once the incoming patient has been sanitized, s/he is more easily adapted to the role the institution has planned for him or her. “Admission procedures might better be called ‘trimming’ or ‘programming’ because in thus being squared away 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.” Institutionalization becomes mechanization; the humanity of the patient is stripped away and replaced by a robotic faciality. The issue is not whether the patient is comfortable in the new role; from the point of view of the institution, the patient can only be dealt with in so far as s/he is mechanized. Stripped of individuality, individual psychotherapy no longer makes sense; in the hospital, the model is group therapy. The model for the psychology of the mental patient is a robot psychology, working mechanically in the roles of the automated patient, Parry³, and his analyst, Eliza⁴.

 

After a while, I had a headache. I went to the nurses’ station and knocked. After a couple of minutes of ignoring me, someone came. I asked for a Tylenol. “Has your doctor approved it?” she asked. “I don’t have a doctor.” “Well, then you can’t have any.” After a couple more equally humiliating trips to the nurses’ station I gave up, even though by then my new doctor had given me permission to take two Tylenol every four hours.

 

Changing arbitrary people into cogs in a machine takes some filing down of resistance. In the institution, the most innocuous requests are taken as an opportunity to regulate the life of the patient more closely. “[T]he inmate’s life is penetrated by constant sanctioning interaction from above, especially during the initial period of stay before the inmate accepts the regulations unthinkingly. . . . The autonomy of the act itself is violated” (“Institutions” 38). The patient is made to feel that any unusual activity–one that is not already structured by the institution–requires too much effort. S/he becomes more passive; the authority of the institution is reinforced.

 

The power of deciding over the patient’s life does not disappear; it is given to the psychiatrist. “Incarcerating institutions operate on the basis of defining almost all the rights and duties the inmates will have. Someone will be in a position to pass fatefully on everything that the inmate succeeds in obtaining and everything he is deprived of, and this person is, officially, the psychiatrist.” (“Medical Model” 35) The psychiatrist has an enormous amount of power over his charges. Blanchot: “[T]hese men are kings” (14). But it is not the individual psychiatrist who has gained agency; s/he too must play within the parameters of the game. “Almost any of the living arrangements through which the patient is strapped into his daily round can be modified at will by the psychiatrist, provided a psychiatric explanation is given” (“Medical Model” 36; emphasis mine).

 

Soon I started meeting the other patients. At first I thought that would be a little scary. But it turned out they were no weirder than the average person you meet on a bus. One of them was even a psychologist himself! When I arrived, there was only one patient on the ward who had lost grips with reality. She talked a lot, very enthusiastically. I’ve met a lot of people like that on the bus, too.

 

There was only one scary person on the ward. She showed up a couple of days after I did. She wore latex gloves all the time, thought she had all sorts of horrible diseases and tried to get everyone to take care of her. We were afraid of her and thought she should have been on a different floor.

 

As far as the institution is concerned, all patients on a ward are the same (except as differentiated by whatever deed-reward system has been put into place). Nevertheless, outside the purview of the institution the patients remain a heterogeneous group. Thus the patients will coalesce into social groups on the basis of educational level, race, neighborhood and so forth. In particular, the patients on the ward repeat (though without institutional support) the same status differentiation of sane/insane as on the outside; those patients perceived to be “more insane” are treated with a similar kind (though not a similar level) of distancing as the “saner” patients themselves receive at the hands of social organization. Thus, the patients think the strange woman should have been on a different floor–just like the rest of society, they want to be separated from her.

 

The paradox is that the strange woman (we dubbed her “Latex Lady”) actually comes to embody the institution. Her preoccupation with disease and desire for care reflect the “medical model of hospitalization” Erving Goffman points towards, while her perpetual donning of latex mirrors the less appetizing aspects of the institution. We considered it in bad taste; it reminded us of our loss of agency, which we were all too willing to gloss over just as the staff did. She brings forth the same kind of stratification within the hospital that the hospital brings forth in society. This stratification is different in that it has no legal backing and this is what brings about the fear in other patients. They realize that under the law they have no protection against her because they belong to the same class of undesirables.

 

I started meeting the staff then, too. That is when you realize what your status is. The patients still treat you like a human. The staff treats you like you’ve lost the right to speak about yourself. Everything you do is treated as a symptom. You’d better not confide in any of them since they report to each other. You run into your psychologist and he says, “I hear you had a hard group therapy session.” In that respect, there is no privacy.

 

The mental hospital treats the “whole patient” (as much of him or her as the hospital can recognize): for the institution there is no room for excess. “All of the patient’s actions, feelings, and thoughts–past, present, and predicted–are officially usable by the therapist in diagnosis and prescription. . . . None of a patient’s business, then, is none of the psychiatrist’s business; nothing ought to be held back from the psychiatrist as irrelevant to his job” (“Medical Model” 34-5). All information about the patient is funneled to his or her psychiatrist. For all intents and purposes s/he becomes the patient’s institutional alter ego. “Throwing open my rooms, they would say, ‘Everything here belongs to us.’ They would fall upon my scraps of thought: ‘This is ours’ ” (Blanchot 14). The psychiatrist takes over the legal role of the patient: s/he alone can make decisions about what kind of medication (including over-the-counter) the patient can take, what kinds of “privileges” the patient can have and whether the patient will be allowed to go home.

 

Now that the psychiatrist has taken over the agency of the patient, everything the patient does is treated as symptomatic. The patient can no longer act, only signify. “Right before their eyes, though they were not at all startled, I became a drop of water,a spot of ink” (Blanchot 14). The patient’s actions only function insofar as they are informational–they only act as ciphers, which it is then the responsibility and right of the doctor to decode. As a cipher, a patient’s words can never be taken seriously as such; rather than being understood to refer to their intended meaning, the words are used to place the patient in the narrative of the doctor’s diagnosis. “When you spoke, they judged your words as a delusion to confirm their concepts” (Robear 19). The institution makes a double movement–it ciphers the patient in order to decipher him or her. The patient’s acts are robbed of meaning so that another system of meaning can be imposed. Though the patient cannot speak, the patient is always already signifying, against his or her will.

 

We already noted that the patient has lost the right to speak. Now we see how his or her language is re-routed, being cited to the patient as the rationale of his or her loss of control–“my story would put itself at their service” (Blanchot 14). The patient’s desires, agency, and subjectivity have been elided; his or her words become the voice of the doctor and, through him, the judge. No longer a person, the staff often also no longer considers the patient to be a worthy addressee. Goffman notes,

 

Often he is considered to be of insufficient ritual status to be given even minor greetings, let alone listened to. Or the inmate may find that a kind of rhetorical use of language occurs: questions such as, “Have you washed yet?” or “Have you got both socks on?” may be accompanied by simultaneous searching by the staff which physically discloses the facts, making these verbal questions superfluous. (“Institutions” 44)

 

By this point, the patient qua human agent has been written out of the institutional picture. The patient has no social choice but to turn to his or her fellows.

 

The main kind of therapy is talking to the other patients. Once you realize your status in the hospital you’d much rather talk to them than the staff anyway. There is no hope of fruitful discussion with the psychologist at all. He or she is just someone you see for five minutes a day and who asks if you’ve been feeling suicidal.

 

We patients talked about a couple of different things. We were all depressed so we spent a lot of time talking about how pathetic we were and about our miserable problems. Another popular topic of conversation was medication. Almost everyone was medicated, so we spent a long time discussing our medication and rumors about what different drugs (or treatments, such as shock therapy) would do to you. Finally we spent a lot of time complaining about being in the hospital and being treated like a mental patient. This was usually done when there was no staff around. One common comment was, “The people on the outside are just as crazy as we are. We just had the sense to get treatment.”

 

The mental institution’s functioning is predicated on the value of treating individuals, not groups or situations. The individual is separated from society, treated, and then like as not returned to the situation in which the original symptoms were brought about. The unspoken implication is that the individual is at fault for any problems that occured. At the same time, modern psychiatry has had a hard time explicitly laying the blame for the genesis of insanity on individuals or just their bodies per se–and blame it is, as the discourse of insanity maintains discreet moral overtones. Both institutional psychiatry and antipsychiatry have used the notion of “schizophrenogenic” and other dysfunctional families to describe a situation in which someone becomes insane because of the madness of his or her world. “Madness, that is to say, is not ‘in’ a person but in a system of relationships in which the labeled ‘patient’ participates” (Cooper 149). Indeed, it seems that if one’s world lacks logical coherence the only sane response is to go mad.

 

All this calls into question the utility of labeling the individual patient as insane in contrast to the rest of society. If the problems are inherent in the structure of society, it might make more sense to treat that structure than to lock up the walking wounded. “[The law] exalted me, but only to raise herself up in her turn. ‘You are famine, discord, murder, destruction.’ ‘Why all that?’ ‘Because I am the angel of discord, murder, and the end.’ ‘Well,’ I said to her, ‘that’s more than enough to get us both locked up’ ” (Blanchot 16).

 

The end result was that many patients felt a strong bond with the other patients but were a lot less enthusiastic about the staff and doctors.

 

After a couple of days in the hospital I was starting to get claustrophobic (in its usual metaphoric sense). None of the windows open–since patients might be tempted to jump out–so the ward never got fresh air. I started to feel like I was living in a fishbowl, constantly observed.

 

Here is where the patient and non-patient are truly differentiated: by the very experience of being in the hospital itself. This is particularly true of people with schizophrenia, whose terms of hospitalization are generally longer than those of anxious or depressed people. Some psychiatrists claim they “[need not] fear that it is [their] diagnosis which separates a schizophrenic person from his family and peers” (Freedman xviii). But in the most material sense it does: it is the justification for the removal of that person from his or her surroundings and their depositing into the institutional machine.

 

In fact, the notion that the institution itself participates in the construction of its patients’ insanity has developed currency in the psychiatric community, who label it “institutional neurosis” (Cooper 129). The effect of the institution is not limited to the changes we have already seen a person must make to adapt to the hospital situation. David Cooper sees the structure of the hospital ward as reproducing the conditions of the schizophrenogenic family, thereby creating, not a curative climate, but one that fosters the development and maintenance of insanity. Documented effects of the asylum on its inmates lead some people to believe that “[w]hat [psychiatry] attempts to cure us of is the cure itself” (Seem xvii) and to speak of “the artificial schizophrenic found in mental institutions” (Anti-Oedipus 5). “One is left with the sorry reflection that the sane ones are perhaps those who fail to gain admission to the mental observation ward. That is to say, they define themselves by a certain absence of experience” (Cooper 129).

 

I wanted out. But that wasn’t so simple.

 

If I checked myself out (since I was a voluntary) I would have to wait three days before they let me go. If they let me go. A number of my fellow voluntary patients were committed by the hospital (or threatened with commitment) when they tried to leave. This was rumored to be because the hospital was afraid of being sued. And even if they did let me go, it would be “AMA,” against medical advice, and I would forfeit my right to come back if I should take a turn for the worse. The only option was to fool the doctors into thinking I was better.

 

The anti-psychiatric community is well aware that many patients manipulate the doctors into letting them out prior to any basic change in them that can be correlated with cure. “I am quite sure that a good number of ‘cures’ of psychotics consist in the fact that the patient has decided, for one reason or other, once more to play at being sane” (Laing 148). But consider what a patient needs to be able to do in order to “play at being sane.” Among other things, the patient must have enough control of him or herself to be able to play a role, s/he must be able to monitor him or herself well enough to understand what his or her social role is expected to be, and s/he must be suspicious of the doctors and/or the psychiatric institution. In short, s/he must be able to function in his or her role to the satisfaction of the institution. Fooling the doctors is therefore equivalent to being healthy for the institution. The nature of the institution means there can be no question of whether the patient is “really” better, or only pretending; the two states are identical.

 

This is due to the paradoxical fact that the institution’s control over the patient is limited by the very mechanisms it uses to gain control over him or her. The institution can only control the patient insofar as s/he is mechanized. There are aspects to the patient that the institution cannot even see, let alone do anything about. For instance, some (perhaps most) patients get very good at playing the part of the patient. These patients may use their acting abilities to shorten their length of stay or to get a hospital bed as an alternative to sleeping in prison or on the street (I myself took advantage of their ignorance to read what might be considered subversive literature–Anti-Oedipus and The Birth of the Clinic–without any problems). One Flew Over the Cuckoo’s Nest is usually cited as an example of the power of the institution over its charges: McMurphy, by defying Nurse Crachett, places himself in the way of smooth running and is crushed by the institutional machine. But in the same novel Chief Bromden has staked out a territory of agency: he pretends to be deaf, stays away from the moving parts and hence finds space to maneuver.

 

The certainty of the existence of such territories is a consequence of the gap between the institution’s mechanized view of the patient as symbol and the patient’s view of him or herself. The patient as agent always exists in a space beyond the totalizing view of the institution and is hence after a certain point invisible to it. “The whole of me passed in full view before them, and when at last nothing was present but my perfect nothingness and there was nothing more to see, they ceased to see me too. Very irritated, they stood up and cried out, ‘All right, where are you? Where are you hiding? Hiding is forbidden, it is an offense,’ etc.” (Blanchot 14). On the one hand, this gap between agent and role means there can be no question of a “real” or “objective” cure; on the other, it provides some play in the system where the denied agency of the patient can work.

 

I actually was feeling somewhat better. The pressure of constant observation was returning me to a normal level of repression and I got some tips from some of the more seasoned patients on what the doctors looked for. After three more days I was allowed to go home.

 

Now when I think back to my time in the hospital the main impression I have is one of being trapped. I also got pretty good at ping-pong. A few weeks after I got out of the hospital, I received a final reminder–the bill, $11,000.

 

Money is a theme running discreetly under the surface of the institutional situation. Many of the deprivations of freedom the patients suffer (not being able to go for a walk, for example) can be traced to worries on the hospital’s part of being sued. The fact that the patient is paying to be in the hospital runs in strange counterpart to this loss of agency. After all, the patient is being held accountable for the bill, even though s/he has no control over the length of the stay (witness recent allegations of hospitals unnecessarily committing people for their insurance money). This brings a new twist to Henry Miller’s comment: “The analyst has endless time and patience; every minute you detain him means money in his pocket” (Henry Miller; cited in Seem xv); in this case, it is every minute he detains you.

 

In the end, then, the legal status of the patient is restored to him or her in the form of the bill. The hospital says, in effect, “You are now a legally responsible person–we entrust you with the ability to pay us.” But the patient is not merely returned to his or her former existence. As we have noted, the hospital stay leaves marks, both intended and unintended, on the functioning of the now ex-patient and “mental health survivor” (Beeman 11), while the hospital churns on, processing new patients.

 

In my case, I was left in a state of confusion, insistently wondering what had happened. My experience had been intense, mysterious, inexplicable; the process of finding some order and meaning in it is reflected in the paragraphs above, which were mostly written while slowly returning to sanity in the months after the institutionalization. As months turned to years it became apparent that it was not the week of institutionalization that had marked me most strongly; rather, it was the analysis that had made it comprehensible that continued to live on in me. Over time, it became distilled into a general technique of analysis which I found tremendously useful in all situations where institutions attempt to totalize and circumscribe individua ls. I had learned to escape, not merely from the psychiatric institution, but from all totalizing institutions. This machinic analysis, with its roots in experience, reached the plane of the theoretical with its politics still intact, allowing those politics to be applied to superficially radically different situations.

 

Postulates of Machinic Analysis

 

While the analysis of this institutionalization has consisted of a patchwork of diverse voices, it is not amethodical. In fact, its methodology is unexpectedly strengthened in that the affinity of the explanation with the narrative of my experience removes that methodology from the realm of the purely theoretical. The analysis makes the story explainable, while the story makes the analysis understandable. The analysis is rhizomatic, its roots in a schizoanalysis inexorably leading, like Avital Ronell’s schizophrenic, to the metaphor of the machine: “I am unable to give an account of what I really do, everything is mechanical in me and is done unconsciously. I am nothing but a machine” (118).

 

Instead of describing society in terms of grand individual subjects and the utilitarian institutions and systems with which they come into contact, machinic analysis describes it in terms of machines: systems of rules, procedures, habits, that operate, that take input and produce output, that couple with other machines: social, technical, economic. Machines are processes in society that cut across individuals and across institutions; they allow one to theorize history and political action without depending on a coherent subject as the subject of history.

 

Machinic analysis is not only an explanation of a single event–it tells what happened–but a strategy which, though derived from a singularity, generalizes into (1) a mechanics of escape from subjugation and (2) a form of analysis with purchase that goes beyond the scene of psychiatric institutionalization to all situations where institutions are mechanically constructing subjects. In all these cases, a machinic analysis can trace out lines of flight for the subjugated individual and suggest strategies for delineating the limits at which mechanizing institutions can no longer appropriate their input. This generalized analysis, distilled from this particular example, works because it is based on the following postulates:

 

Machines are asubjective

 

(1). What I mean here is that a machinic analysis does not posit psychological states or experiences on the part of the individuals involved. The psychiatric institution is a social machine which channels an in/out flow of bodies, labels and categorizes them, and attempts to route them into a method of functioning which will allow it to manipulate them in terms with which it is familiar. The patient, too, has certain accustomed methods of functioning, which break down when they come into contact with the institutional machine and have to be recalibrated for processing. Such recalibration will always be incomplete, since it is only done with an eye to the limited modes whereby the institution understands the patient; additional modes of functioning which the institution cannot account for are not excluded. This analysis allows one to talk about what concretely happens in spaces where institutions and individuals meet without trying to pin down the subjectivity involved. It is assumed that these social formations can only be discussed within the limited framework they afford.

 

(2) Machines focus on process, not on structure. While structuralism focuses on cultural manifestations as structure, schizoanalysis is interested in these manifestations as process. The psychiatric institution is not a static structure of meanings in which a subject is inserted; it is a method of operation which necessarily involves not only meanings and principles but also concrete actions and effects. This is not the age-old distinction between synchrony and diachrony revisited. Rather, it leads directly to a politics of engagement. Structures are to be interpreted; processes, on the other hand, are to be tinkered with–one can be engaged in a mechanics and in experimentation. Mechanics means that one deals with the social formation in question as a process and sees it as changeable through tinkering. Experimentation refers to the fact that this style of analysis is not complete when the intellectual work is done; institutions must be dealt with as concrete formations. An analysis that has no effects in practice must be jettisoned.

 

(3) Machines do not operate in isolation. Machines, as process, have input and output. They work with and in the context of other machines. The psychiatric machine works in conjunction with a legal machine, which both provides the psychiatric machine with some of its input and conditions much of its workings. Technologists sometimes forget that technical machines work in the context of social machines, through which they come into being and without which they cannot be evaluated. Analysis via machinery demands always going beyond the limited context in which the machine views itself to ask what things it hooks up with, what it works with, how other processes allow it to come into being. This means politics, purchase, and, paradoxically, the enablement of an immanent critique through a reunderstanding of the limits of the system and of the outside forces invisibly at work on it.

 

(4) Machines are engaged in a process of incomplete de- and encoding. This is because machines do not operate alone, but work upon other objects and machines. When an input comes in, it must be deterritorialized, i.e. have the markings of previous machinery removed, and reterritorialized, i.e. reunderstood in the context of the current process. In the case of the psychiatric institution, this means the process of taking in a new patient and recoding it to be manipulated by the institutional machinery. This encoding process ignores the subjectivity of the oncoming object; instead, a faciality is constructed for the input, which will have an effect on but does not constitute the range of expression, action, and experience for that individual. Machines necessarily leave out something of the objects they process.

 

(5) Machines do not need to be coherent. This type of analysis does not expect either patient or institution to be rational and coherent; in fact, the opposite is expected, because of each machine’s limited point of view. And there is no need for social machines to be coherent. “The death of a social machine has never been heralded by a disharmony or a dysfunction; on the contrary, social machines make a habit of feeding on the contradictions they give rise to, on the crises they provoke, on the anxieties they engender, and on the infernal operations they regenerate” (Deleuze 151). Just as Freud analyzed human consciousness by noting how it breaks down, analysis of machines is an analysis of the ways in which they misfire, and how those misfirings allow the machines to function.

 

(6) As noted above, in the case of the psychiatric institution, there is a disjunction between its legal and service functions. It functions simultaneously as an alternative prison for those who cannot be contained by the law alone and as a locus of rehabilitation for the ill. Both of these functions overcode the hospital stay, though the institution itself prefers to stress its medical aspects. While the institution can ignore its legal function–though simultaneously fulfilling it–the patients cannot; their position outside the law is keenly felt in such aspects as not being able to discharge oneself, not being able to go for walks, and being locked in a ward with patients who are perceived as insane(r). The legal function, while ostensibly not at work, plays an important role in keeping the patients in their place: continuously faced by these restrictions, they are all the more likely to be worn down into the mould the institution has prepared for them. Thus, the contradiction between the hospital’s self-presentation as a service machine and status as semi-penitentiary is not debilitating to the institution but functional.

 

Based on these principles, machinic analysis engages the following argument:
 

(1) Machines are asubjective, so they can be thought of as pure process.

 

(2) Because they are processes, they operate on input and generate output.

 

(3) Because they operate on input and output, they must work in the context of other machines.

 

(4) Because machines operate on circuits occupied by other machines, each machine encodes and decodes its input and output not in absolute terms but with respect to its own limited methods of functioning.

 

(5) Because machines encode and decode in a non-transcendental fashion, there is always space left for the individual being operated on and limits outside of which the system’s totalizations no longer hold.

 

In the case of the psychiatric institution, the stated function of hospitalization is to take in those who are labeled “insane” and return them to some level of normality. We see that the institutional machine does not function at this ideal level in its performance of its task. Through a machinic analysis we discover that the institutional nature of the ward, with its emphasis on a mass-produced patient, demands a total abandonment of agency on the part of the patient, who is reduced to a cipher. At the same time, by insisting on seeing the patient only in the most reductive ways, it leaves an unmonitored gap between the ideal and the actual patient, a space where the real patient can maneuver. The psychiatric institution not only does not accomplish its stated function of total enclosure and cure, it cannot accomplish it. The institutional moment works both through and despite the point where the institution breaks down: the point at which its visions of totalization obscure the limits of its own system of encoding.

 

Notes

 

1. This is my story in my words. I wrote them with this paper in mind, but before I wrote the paper.

 

2.If a patient voluntary commits him or herself, s/he can sign him or herself out, but must wait three days before s/he can leave. In the meantime, s/he can be, and often is, committed by the hospital against his or her will.

 

3.Parry is a program that simulates a paranoid schizophrenic. See Kenneth Mark Colby, Artificial Paranoia: A Computer Simulation of Paranoid Processes (New York: Pergamon Press, 1975).

 

4.Eliza is a computer program intended as a study in natural language communication. It plays the part of a Rogerian psychoanalyst. It is described in J. Weizenbaum, “ELIZA–A Computer Program for the Study of Natural Language Communication Between Man and Machine,” Communications of the Association for Computing Machinery 1 (1965) 36-45. To the shock of its programmer it was received with enthusiasm by the psychiatric community and was recommended for eventual therapeutic use in K.M. Colby, J.B. Watt, and J.P. Gilbert, “A Computer Method of Psychotherapy: Preliminary Communication,” The Journal of Nervous and Mental Disease 2 (1966) 148-152.

 

Works Cited

 

• Beeman, Richard P. “Court Appearance.” In the Realms of the Unreal: “Insane” Writings. Ed. John G. H. Oakes. New York: Four Walls Eight Windows, 1991. 10-11.
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• Ronell, Avital. The Telephone Book: Technology–Schizophrenia–Electric Speech. Lincoln: University of Nebraska Press, 1989.
• Seem, Mark. “Introduction.” Anti-Oedipus: Capitalism and Schizophrenia. By Gilles Deleuze and Felix Guattari. Trans. Robert Hurley, Mark Seem, and Helen R. Lane. New York: Viking Press, 1977. xv–xxiv.
• Washington, Karoselle. “The Killing Floors.” In the Realms of the Unreal: “Insane” Writings. Ed. John G. H. Oakes. New York: Four Walls Eight Windows, 1991. 48-52.
• Weizenbaum, J. “ELIZA–A Computer Program for the Study of Natural Language Communication Between Man and Machine.” Communications of the Association for Computing Machinery 1 (1965): 36-45.