THE MORAL CAREER OF THE MENTAL PATIENT
Santa Gertrudis, por Miguel Cabrera, 1763
精神病患者のモラル・キャリア
THE MORAL CAREER OF THE MENTAL PATIENT
Santa Gertrudis, por Miguel Cabrera, 1763
池田光穂
このページでは、Erving Goffman, THE MORAL CAREER OF THE MENTAL PATIENT, In ［Asylums : essays on the social situation of mental patients and other inmates / by Erving Goffman, New York : Doubleday , [1990], c1961. - (Anchor books)］を 検討する。（→ゴフマン（ゴッフマン）文献リスト）
"The main concern will
be with the moral aspects of career-that is, the regular sequence of
changes that career entails in the person's self and in. his framework
of imagery for judging himself and others)" - pp.127-128
この論文は、冒頭の序文（タイトルがついていな
い）、つぎに「入院する前＝患者にされる前の諸相（The Prepatient Phase ）」、として「入院後＝患者にされた後の諸相（The
Inpatient Phase）」という３つの部分から構成される。
さて、標題のモラル・キャリアとは、精神疾患の作業 療法が古くはmoral treatment と呼ばれるように、モラルとは心や精神のことを指しているが、ここでは心の内面のことであり、キャリアは、日本語のキャリアパスのように、経歴（＝その人 の人生における経験）のことをさす。したがって、モラル・キャリ アとは、その人の「心の経歴」のようなものである。人の心は外界から観察することはできないので、言い方をかえると、その人がもっている心の経歴。あるい は、その人の「アイデンティティ史」ないしは「アイデンティティの経歴」と言っても差し支えないだろう。
キャリアについてはゴッフマンは次のように説明す る。
"Traditionally the term career has been reserved for those who expect to enjoy the rises laid out within a respectable profession. The term is coming to be used, however, in a broadened sense to refer to any social strand of any person's course through life... "(p.119)
"The career of the mental patient falls popularly and naturalistically into three main phases: the period prior to entering the hospital, which I shall call the prepatient phase; the period in the hospital, the inpatient phase the period after discharge from the hospital, should this occur, namely the ex-patient phase." (p.122)
モラルキャリアについては、最後の「入院後＝患者に された後の諸相（The Inpatient Phase）」において、実質的に初めて言及される。
"The moral career of a person of a given social category involves a standard sequence of changes in his way of conceiving of selves, including, importantly, his own. These half-buried lines of development can be followed by studying his moral experiences - that is, happenings which mark a turning point in the way in which the person views the world -- although the particularities of this view may be difficult to establish. And note can be taken of overt tacks or strategies-that is, stands that he effectively takes before specifiable others, whatever the hidden and variable nature of his inward attachment to these presentations. By taking note of moral experiences and overt personal stands,· one can obtain a relativelyobjective tracing of relatively subjective matters." (p.168)
そして、モラル・キャリアへの着目が、我々が抱いて
いる「自己」という概念に再考を促すものなのである。
"Each moral career, and behind this, each self, occurs within the confines of an institutional system, whether a social establishment such as a mental hospital or a complex of personal and professional relationships. The self, then, can be seen as something that resides in the arrangements prevailing in a social system for its members. The self in this sense is not a property of the person to whom it is attributed, but dwells rather in the pattern of social control that is exerted in connection with the person by himself and those around him. This special kind of institutional arrangement does not so much support the self as constitute it. "(p.168)
精神病者は、ひとつは、自分の内面の経験が、外界の 社会（＝オーディエンス）との齟齬をおこし、それが異常とみなされていき、内面化される面と、それ以外はまったく平静にも関わらず、一旦、精神科医の診断 にかかると、精神病患者というレッテルを生きることを余儀なくされる。これらの内面的過程、および外面的なオーディエンスからの取り扱いにより、精神病患 者のモラル・キャリアは形成されてゆくことになる。ゴッフマンは「市民」から「患者」への移行という言葉で説明する。
入院患者――ゴッフマンの調査した米国は、かつての 日本と同様、精神病患者は閉鎖病棟に収容すること（＝アサイラム＝収容所という題名がこれを語る）が一般的だったので、入院と共に、精神病患者は、全く別 の新しい秩序に適応することを余儀なくされる。そこには、病院の外とは、全く異なったルールが厳然とあり、秩序づけられている。その意味では、閉鎖病棟の 世界は、日常から隔絶した世界であるが、人びとはその秩序原則にしたがって「正常に」生活している。
入院患者の世界は、入院した収容者だけからなる世界 ではなく、医療スタッフや病院で働くさまざまな人たちからなるミクロコスモスである。しかしながら、被収容者は、医療者の指示にしたがうことを余儀なくさ れ、両者のグループ関係間の違いは歴然である。しかしながら、被収容者たちのモラル・キャリアは、入院時のカルテや、噂などによって、おぼろげながら理解 されているものの完全に知られているわけではない。したがって、それらの情報の交換には、参与者たちは細心の注意を払う。
このような、システムからなるものを、ゴッフマンは
「病棟システム」と呼んでいる。
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冒頭でゴッフマンは、精神病患者へのアプローチは、 文化人類学者がおこなう、異文化へのアプローチに似ていると述べている。
"This general
sociological perspective is heavily reinforced by one key finding of
sociologically oriented students in mental-hospital research. As has
been repeatedly shown in the study of non-literate societies, the
awesomeness, distastefulness, and barbarity of a foreign culture can
decrease to the degree that the student becomes familiar with the
point of view to life at is taken by his subjects. Similarly, the
student of mental hospitals can discover that the craziness or "sick
behavior" claimed for the mental patient is by and large a product of
the claimant's social distance from the situation that the patient is
in, and is not primarily a product of mental illness." - pp.129-130.
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"There is an interesting contrast here with the moral career of the tuberculosis patient. I am told by Julius Roth that tuberculous patients are likely to come to the hospital willingly, agreeing with their next-of-relation about treatment. Later in their hospital career, when they learn how long they yet have to stay and how depriving and irrational some of the hospital rulings are, they may seek to leave, be advised against this by the staff and by relatives, and only then begin to feel betrayed." - p.144 の脚注26番
"The final point I want to consider about the prepatient's moral career is its peculiarly retroactive character. Until a person actually arrives at the hospital there usually seems no way of knowing for sure that he is destined to do so, given the determinative role of career contingencies." - p.145
"Now a general point
may be made about the moral career of inpatients which has bearing on
many moral careers. Given the stage that any person has reached ill a
career one typically finds that he constructs an image of his life
course-past, present, and future-which selects, abstracts, and distorts
in such a way as to provide him with a view of himself that he can
usefully expound in current situations." - p.150.
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アサイラムに収載されている論文は、以下４本であ る。
１．On the Characteristics of Total Institutions
２．The Moral Career of the Mental Patient
３．The Underlife of a Public Institution,
４．The Medical Model and
Mental Hospitalization
内容の紹介、シノプシスはウィキペディア（英語）に よると次のようになっている。２つの部分にわかれ、最初のパラグラフは、註に示された３つの文献（すべて社会学者によるものではなく精神医学者によるもの らしい）から書かれように思われる。そして２番目のパラグラフは、たぶん別の執筆者により書かれ、別のレビュアーにより「出典が必要」とコメントされてい る。
"In Asylums, Goffman is mainly engrossed with the details of having been hospitalized to a psychiatric hospital and the nature and effects of the process he defines as ‘institutionalization’.[7]:150 He describes how the institutionalisation process socialises people into the role of a good patient, someone ‘dull, harmless and inconspicuous’, which in turn reinforces notions of chronicity in severe mental illness.[8] A basic process of Goffman's asylums is mortification of self. A patient's notions of self are subjected to a dramatic change for the worse due to the debilitating atmosphere in all total institutions, regardless of how therapeutic or non-therapeutic a hospital is.[4] While people come from a social context in which they have some sense of a personal identity and occupy different roles, these aspects of their lives are systematically stripped from them as their sense of themselves are mortified, pathogolized and negated, leading to what Goffman defines as ‘disculturation’.[7]:154 Rather than curing or reducing the illness, this process leads to demoralization, skill deterioration and role dispossession and renders people less capable of managing life in the outward world.[7]:154 In addition to disculturation from their identity and previous roles, acculturating inmates to life in a total institution does little, if anything, in preparing them for the contingencies they will encounter once again after discharge and prepares them only for remaining within the setting.[7]:154 Goffman concludes from his investigation that taking a mentally ill person out of his or her life context, hospitalizing him or her to a psychiatric hospital and then returning the person to the same life context is similar to taking a drowning man out of a lake, teaching him how to ride a bicycle and putting him back into the lake.[7]:154 In the inpatient phase, patients come to realize that society has forsaken them.[4] Goffman states that inmates in total institutions have a strong feeling that time spent there is time taken from one's life or time wasted.[4] Human needs are handled in an impersonal and bureaucratic mode.[4] The social distance between the staff and inmates is great, and each group tends to be unfriendly toward the other.[4]
The book concludes that
adjusting the inmates to their role has at least as much importance as
"curing" them. In the essay "Notes on the Tinkering Trades," Goffman
concluded that the "medicalization" of mental illness and the various
treatment modalities are offshoots of the 19th century and the
Industrial Revolution and that the so-called "medical model" for
treating patients was a variation on the way trades- and craftsmen of
the late 19th century repaired clocks and other mechanical objects: in
the confines of a shop or store, contents and routine of which remained
a mystery to the customer.[citation needed]"
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