Psychiatry: A Social Institution in Process

T HIS paper will report upon the uses of social institutional analysis in the study of psychiatry. It will aim at indicating how well suited social process analysis is to the understanding of professional development. The background of this paper is a study of extra-mural psychiatry done for the Russell Sage Foundation several years ago. This study aimed at a sociological analysis of the developing profession. And it sought to indicate where, in the changing tasks and contexts of psychiatry's work, social science knowledge might profitably be mediated to it or collaborative research established. Extra-mural psychiatry is the name generally given to those aspects of psychiatry which are practiced outside of the state hospitals in which American psychiatry was born. The first order of business for the study was to determine how and why psychiatry had emerged from its exclusively state hospital concerns to confront the community in many new roles and with many new functions. It was also necessary to study the matrices in which it was now operating. The contingent problems of such expansion were of primary sociological interest. The problem of ordering the seeming chaos of this rapidly changing and widely sprawling field presented itself. Criteria for determining the relevant data and delimiting the scope of inquiry were urgently needed. Material on social institutions seemed best fitted to meet this need. The relevant framework was established by borrowing from a variety of widely separated sources. The eclectic scheme which resulted formed a model which seemed well suited for the study of the problems peculiar to the changing aspects of psychiatry. These problems were indicated in the first brief contacts with the field. An immediate impression was formed that a condition of great flux prevailed. Changes appeared to be many and rapid and seemed to be proceeding at different rates in different aspects of psychiatry. Problems of reorganizing the profession figured large in the literature. The effects of rapid changes made during World War II were being assayed. New associations were active. Controversies with ancillary professions flared along the margins of psychiatry. Considerable concern with the position of psychiatry within the medical profession was shown. There appeared to be in the present position of extra-mural psychiatry a laboratory of the processes involved in the establishment and maintenance of a profession. This was the problem complex at which study, in terms of social institutional analysis, was directed. The main terms of analysis of the eclectic framework are briefly noted as follows. For Cooley, a social institution was a "mature, specialized, and comparatively rigid part of the social structure."' In these terms the study of institutions is the study of the formally established aspects of group behavior. Malinowski added other dimensions to the concept. He viewed social institutions as the problemsolving organs of human society. Culture is an instrumental reality which has come into existence to satisfy the needs of man. And institutions, the "organized systems of human activities" are "the real component units of cultures which have a considerable degree of permanence, universality and independence."2 He added that there is not a simple correlation of need and function. "One need does not receive one satisfaction in one institution. But institutions show a pronounced amalgamation of functions....". Still further sophistication was contributed by Radcliffe-Brown. He emphasized the human internal organization of social institutions and their integration with the environing society. For him the function of an institution was "the part it plays in the total system of social integration of which it is a part." And by social integration he meant the