In a well-known, very influential and frequently quoted paper, ‘On the Characteristics of Total Institutions,’ Goffman (1961) calls attention to ideological disputes which are centred on total institutions. As he puts it: ‘It is widely appreciated that total institutions typically fall considerably short of their official aims. It is less well appreciated that each of these official goals or charters seems admirably suited to provide a key of meaning—a language of explanation that the staff, and sometimes the inmates, can bring to every crevice of action in the institution. Thus, a medical frame of reference is not merely a perspective through which a decision concerning dosage can be determined and made meaningful; it is a perspective ready to account for all manner of decisions, such as the hours when hospital meals are served or the manner in which hospital linen is folded…. Paradoxically, then, while total institutions seem the least intellectual of places, it is nevertheless here, at least recently, that concern about words and verbalized perspectives has come to play a central and often feverish role.’ (pp. 83–84.)