theytoldher.Shelivedwithwhomevertheysaidshehad
to.Therewasasuccessionofroommates,neverchosen
withherinputandallwithcognitiveimpairments.Some
were quiet. One kept her up at night. She felt
incarcerated, like she was in prison for being old.
The sociologist Erving Goffman noted the likeness
betweenprisonsandnursinghomeshalfacenturyagoin
his book Asylums. They were, along with military
trainingcamps,orphanages,andmentalhospitals,“total
institutions”—placeslargely cutofffromwidersociety.
“Abasicsocialarrangementinmodernsocietyisthatthe
individual tends to sleep, play, and work in different
places, with different co-participants, under different
authorities, and without an over-all rational plan,” he
wrote. By contrast, total institutions break down the
barriersseparating ourspheres oflife in specificways
that he enumerated:
First,allaspectsoflifeareconductedinthesameplace
andunderthesamecentralauthority.Second,eachphase
of the member’s daily activity is carried on in the
immediate company of a large batch of others, all of
whomaretreatedalikeandrequiredtodothesamething
together. Third, all phases of the day’s activities are
tightly scheduled, with one activity leading at a
prearranged time intothe next,thewhole sequence of
activities being imposed from above by a system of
explicitformalrulingsandabodyofofficials.Finally,the
various enforced activities are brought together into a
single plan purportedly designed to fulfill the official
aims of the institution.