Making It Crazy

Making It Crazy: An Ethnography of Psychiatric Clients in an American Community

Sue E. Estroff
Foreword by H. Richard Lamb
Copyright Date: 1981
Pages: 338
https://www.jstor.org/stable/10.1525/j.ctt1pnd3j
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  • Book Info
    Making It Crazy
    Book Description:

    Estroff describes a group of chronic psychiatric clients as they attempt life outside a mental hospital.

    eISBN: 978-0-520-90775-1
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. FOREWORD
    (pp. ix-xii)
    H. Richard Lamb

    In an era of rhetoric about deinstitutionalization, it is refreshing to have solid clinical data from a perceptive observer who does not have a vested interest in this matter, that is, one who is neither mental health professional, nor patient, nor union official, nor legislator. Amid the heated discussions about the advantages and benefits or the problems and scandals of the mentally ill living in the community, the kind of objective information provided by this book is essential.

    What is the everyday world of the psychiatric patient really like? If we try to understand it within the context of our...

  4. PREFACE
    (pp. xiii-xxii)
    S. E. E
  5. PART I INTRODUCTION AND ORIENTATION
    • 1 A PERSONAL VIEW OF CLIENTS AND STAFF
      (pp. 3-9)

      Instead of arranging for passage, visas, fearsome injections, getting out my hiking boots, and packing my trunks, I got in my car, drove for ten minutes to the downtown area of a city where I had lived for five years, and thus began fieldwork. Despite the geographic proximity and lack of exotic contingencies, I am convinced that the experiences of the two years that followed constituted as long, arduous, exciting, and frightening a journey into differentness and newness as that of any novice anthropologist on her first vision quest. My purpose was to encounter and to learn from a group...

    • 2 DEVELOPMENT OF THE TOPIC AND PERSPECTIVE
      (pp. 10-19)

      Living among us are nearly one and a half million persons (Minkoff 1978:13) who are described as chronically and severely mentally ill. For some, community life represents a new challenge after months or even years of continuous or periodic hospitalization. For a growing number of others, the community represents the primary locale of treatment and daily life; these are the new corps of community mental health system veterans who have had frequent but usually brief exposure to inpatient psychiatric treatment. The experiences of literally hundreds of thousands of psychiatric patients in the United States have been dramatically altered during the...

    • 3 FIELDWORK–TACTICAL AND METHODOLOGICAL ASPECTS
      (pp. 20-40)

      Before proceeding to more substantive ethnographic material, it is appropriate to outline the actual procedures and principles used to collect and work with the data. How does the anthropologist go about learning to make it crazy?

      Traditional approaches to fieldwork include participant observation, structured depth interviews, some use of questionnaires, a gathering of life histories, and a vast array of ad hoc procedures (Edgerton and Langness 1974; Wax 1971; Pelto 1970). This project included all of the above in some manner, but at the experiential and phenomenological levels of learning, obvious obstacles were encountered. The anthropological fieldworker customarily attempts to...

  6. PART II ETHNOGRAPHIC MATERIAL
    • 4 CLIENTS AND PACT–A DESCRIPTION
      (pp. 42-67)

      The following pages discuss our primary subjects and the most important components of their environment during the research: the PACT program and staff, other clients, and the community setting. A demographic profile of clients is provided, including pertinent aspects of their psychiatric histories and clinical designations. Staff composition is outlined, and the PACT treatment modality and philosophy is discussed. Important features of the setting are described and the clients are characterized according to their conceptions and use of time, space, and information.

      Forty-three persons comprised the group of clients studied for this project. All were admitted to treatment in the...

    • 5 MEDICATIONS
      (pp. 68-117)

      In exploring the subject of psychoactive medication, termed “meds” by clients and staff, a brief orientation to the medications most often prescribed for the group is offered, as well as an overview of the benefits and drawbacks of their use from a research and clinical psychiatric perspective. The focus is not only on clients’ feelings about taking meds but upon attendant side effects and their significance in the clients’ world. A commentary on my experience with meds is also included.

      To the outsider, medications represent one of the most striking and distinct aspects of the psychiatric world, especially among clients....

    • 6 SUBSISTENCE STRATEGIES–EMPLOYMENT, UNEMPLOYMENT, AND PROFESSIONAL DISABILITY
      (pp. 118-173)

      This chapter explores the subsistence strategies of the clients-how they obtain the basic necessities of life, such as food, shelter, clothing, and money. An overview of the employment experiences of long-term psychiatric patients living in the community is given, figures for our subjects are reported, and the employment program and orientation at PACT and among clients is described. Reciprocal exploitation and exchange within the client group is outlined, including such extracurricular subsistence activities as panhandling and the selling of drugs and sexual favors.

      The employment experiences of clients comprise but a portion of the picture. Because most of the group...

    • 7 NORMALS, CRAZIES, INSIDERS, AND OUTSIDERS
      (pp. 174-194)

      I have presented some of the ethnographic facts, paradoxes, and dynamics of the clients’ world. These ethnographic details underscore the unique operations, frustrations, and dilemmas of this particular brand of psychiatric patienthood in a community setting. One lesson becomes clear. Clients are not the only persons caught in the web of contradiction and the Catch-22 dynamics of their own and others’ making. So are we all. With few exceptions, whichever way we may turn and however we may act in attempts to be helpful, it seems that our psychiatric belief and treatment systems and our interactions as community members can...

  7. PART III INTERPRETATIONS AND CONCLUSIONS
    • PROLOGUE
      (pp. 197-198)

      Everything outside was coated with inches of lovely and awesome ice in the early spring of 1976. Nothing mechanical was working well; artificial heat and light that had been yesterday’s taken-forgranted conveniences were today’s irritatingly absent necessities. My main concerns were the welfare of my tropical fish and how difficult it had become to have hot coffee when I wanted it.

      Downtown, Sam was thinking in different terms. He had a paying job for the first time in a long while. And he had moved out of the YMCA into an apartment that was the envied meeting place of his...

    • 8 REVIEWS OF RELEVANT LITERATURE
      (pp. 199-212)

      Perhaps nowhere does the complicated nature of our subject become more evident than in surveying relevant research and writing. Academic and clinical personnel from diverse disciplines have joined forces to describe, assess, plan, and implement community-based treatment for psychiatric patients. For reasons of emphasis, the focus of this review is on two areas: (1) community treatment of long-term psychiatric patients, and (2) psychiatric anthropology and ethnography of deviant or marginal persons.

      Because extensive bibliographic (Bloom 1968; Driver 1972; Pearsall 1963) and analytic (Bachrach 1976, 1978; Test and Stein 1978a and c; Paul 1969; Talbott 1978; F abrega 1972b; Lieban 1973)...

    • 9 THE SOCIAL CONSTRUCTION OF A CRAZY REALITY
      (pp. 213-239)

      In the preceding chapters, I have described aspects of the clients’ world, including their uses of and experiences with time, space, resources, and information. Their subsistence strategies and their experiences with and attitudes toward medications have been explained. I have suggested throughout that clients, staff, and the community at large participate in the construction and perpetuation of a paradoxical, nonsensically contradictory (crazy) world within which clients receive and express somewhat contradictory indications about who they are and how they are expected to behave, think, and feel. Threading through my discussion has been a tone of nearly whimsical, often distressing, ambivalence...

    • 10 THE SOCIOCULTURAL CONTEXT OF ILLNESS AND CRAZINESS
      (pp. 240-248)

      The ambivalent, paradoxical view held by clients and others regarding the crazy self and the chronic sick role in American culture has been articulated in the past, perhaps first by Parsons (1972). In Parsons’ perceptive scheme, the balance of rewards between the legitimized dependency arid lowered expectations of being ill, and the motivations and obligations to return to healthy, effective task and role performance is tipped in favor of the latter. The ill person is motivated to become well, to perform his tasks, to participate in society in accordance with his role, thereby demonstrating his commitment to the values of...

    • 11 REFLECTIONS, CONCLUSIONS, AND QUESTIONS FOR FURTHER RESEARCH
      (pp. 249-257)

      It seems a long time since I plunged into this project, filled with enthusiasm and curiosity, envisioning revelations of untold mysteries. The enthusiasm and wonder remain, but the years have deepened, saddened, cleared, and clouded the visions all at once. I understand less than I had hoped, but more than I did at first. Perhaps the reader shares these sentiments. It has been my intention to convey my continuing formulations of a complex and confounding subject.

      In the preceding chapters, I have described what I wanted to learn and how I thought I could learn it. An analytic, inductive approach...

  8. EPILOGUE
    (pp. 258-276)

    Nearly a decade has passed since I began the research on which this book is based, and almost five years have gone by since the manuscript went to press. I now write from a different locale, affiliated with a different institution, and with new people to thank for teaching me. I also write with reflection formed by experiences that have been more varied and profound than I could have anticipated when writing previously. Essentially, in the interim, the research never stopped. I have, however, changed level of focus, role, and vantage point several times, while the always incomplete process of...

  9. Appendix COMMUNITY ADAPTATION SCHEDULE
    (pp. 277-306)
  10. REFERENCES
    (pp. 307-334)
  11. INDEXES
  12. Back Matter
    (pp. 346-346)