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Asylums, the token economy, and the metrics of mental life
BEHAVIOR THERAPY 7, 528-534 (1976)
Asylums, the Token Economy, and the Metrics of Mental Life JOHN H. GAGNON AND G E R A L D C . DAVISON State University o f N e w York at Stony Brook The history of asylums in this country reveals that these institutions were designed to provide a milieu in which disturbed citizens could escape from the economic opportunities in society-at-large that were assumed to cause insanity. The atmosphere of the asylum was believed to be curative by virtue of its replication of pre-revolutionary stability in status relationships without the encouragement of men's political and commercial ambitions. Numerous forces then contributed to making the asylum a repository of large numbers of chronic patients, dealt with primarily in a custodial fashion and comprising the endpoint of careers in downward social mobility. The growth in token economies has been one of the recent attempts to cope with this affront to our personal and professional sensibilities. Chaos, and presumably mental illness itself, would be reduced by introducing into the asylum just that set of conditions which had earlier been held to be pathogenic, namely, a replication of the outside market economy. The source of the disease now became the doctor. While a certain kind of order is probably produced by token economies, questions are raised as to what is being learned by the patients. It would seem that participants in this economy are taught that certain behaviors earn a just reward and that greater predictability is possible through application to mental life of a metric prevalent in commerce. It is suggested that the greater orderliness achieved exacts a serious price, namely that the patient acquires a set which does not match human relationships outside the hospital. Token economies will, to a degree, work because most mental patients do not suffer from economic irrationality. By concentrating on this metric, token economists fail to make changes that will transfer to the demands of nonhospital life.
Operant approaches to clinical behavior change have been scrutinized from the outset as to their appropriateness for and effectiveness in bringing about meaningful and therapeutic alterations in human behavior (e.g. Davison, 1969; Bandura, 1969). It is not the present purpose to review this work. Rather, we take a more historical and more basic perspective. The systematic application of reinforcement contingencies on a ward-wide Preparation of this paper was facilitated by NIMH grant number MH24327. Reprint requests should be sent to John H. Gagnon, Department of Sociology, SUNY, Stony Brook, NY 11790. 528 Copyright© 1976by Associationfor Advancementof BehaviorTherapy. All rights of reproductionin any form reserved.
TOKEN ECONOMY AND THE METRICS OF MENTAL LIFE
529
basis should be examined in a socio-historical context which goes beyond the body of learning theory. This appears all the more advisable as more and more questions are raised by legislators and other interested lay people with respect to the ethics of the controlled environments found in institutional token economies.
THE INVENTION OF THE ASYLUM Asylums, whether in our fantasies, literature, or in their concrete manifestations, possess a remarkable capacity to produce a violent sense of uneasiness, perhaps even terror, among those who are currently thought to be sane. The possibility that we may lose or go out of our minds evokes a deep sense of horror, a horror that is only exacerbated both by our sense that such a loss is likely to be irreparable and by our beliefs about how we will be treated while our minds are lost, stolen, or strayed. However rational, optimistic, or sensible we might be about madness, the idea of the asylum itself is sufficient incentive for us to cling to our current mental circumstances if only in fear of the alternative. This location of the asylum as a central institution in our modern chamber of horrors is remarkable since its history suggests that it was invented in the early nineteenth century in the United States out of a progressive, charitable and hopeful perspective and spirit. As Rothman (1971) chronicles, the asylum was created as the result of the view of early nineteenth century psychiatrists that the bulk of insanity was caused by the changes in the conditions of United States society since the end of the Revolutionary War. During the first decades of the nineteenth century the open democratic society with its endless opportunities and possibilities was held to be the breeding ground for madness. " 'In this country where no son is necessarily confined to the work or employment of his father, but all of the fields of labor, of profit, or of honor are open to whomsoever will put on the harness,' and where 'all are invited to join the strife for that which may be gained in each,' it was inevitable that t h e ' ambition of some leads them to aim at that which they cannot reach, to strive for more than they can grasp.' As a result, 'their mental powers are strained to the utmost tension; they labor in agitation . . . their minds stagger under the disp/'oportionate burden.' "1 These social conditions, which Durkheim would describe in very similar language at the end of the nineteenth century as productive of the state of anomie or normlessness, were contrasted with a mythic view of the order and harmony of the colonial past of the society. The psychiatrists were 1 The operative language is that of Edward Jarvis quoted and paraphrased by Rothman (1971, p. 115). Rothman's book is rich in such quotations and successfully demonstrates that this view of the causes and cures of insanity was both general and influential in the first decades of the nineteenth century.
530
GAGNON AND DAVISON
themselves caught in a double bind for it was not possible for them to attack directly the new freedom offered by post-revolutionary society. Indeed such arguments would have been antithetical to the spirit of national pride that characterized the Jacksonian era. However, they found themselves uneasy with the rapidly changing social landscape, and they shared with many of the educated classes a distrust of the potential for political disorder among the urban mob in contrast to the sturdy yeomen and mechanics of the countryside. What attracted them to prerevolutionary society was a belief that, when life was ruled by status, and orderly relations existed between and within generations and classes, a madness which was generated by releasing men's ambitions did not occur. The asylum, then, was a social invention designed to heal overexcitement and mania by providing an orderly environment in which passions could be cooled and rehabilitation could result from the experience of a set of stable expectancies. Those made mad by their immersion in the mentally ennervating pursuits of unchecked commerce and politics, unbridled personal and social desires, would be restored by spending time in the corrective and predictable world of the asylum--a safe harbor that would reflect the quiet virtues of a by-gone era. The cure for the driven and ambitious, the active participants in a nascent capitalism and democracy, was a return to the communitarian values of a more placid and stable status-oriented society that would be replicated in the asylum. These were the dominant intellectual views that served as the justification for the construction and practices of the early mental hospital. They had a remarkable success in promoting the building of the institutions, but the therapeutic practice itself and the order that was to characterize the asylum were swamped under the rising numbers of chronic patients of various types who have come to dominate the population and the imagery of the asylum since the Civil War. The outcome of a large set of historical processes (the increase in aged patients due to changes in family practices, the expense of the hospitals, the retention of dangerous patients resulting in more custodial regimes, the sheer inadequacy of medical practice) has resulted in turning this early optimistic social experiment into the great custodial mental hospitals that were built in the countryside of the United States away from the disorder of the cities. In some regions these have been overtaken by the expanding suburbs and appear as fortress oases in the suburban sprawl, while still others remain lodged in small towns, providing the primary source of low salaried employment for the unskilled. What was originally conceived as an institution that, in its order, would be an implicit critique of and an explicit corrective for the madness,producing conditions of the larger society became itself bedlam incarnate. The back wards of these institutions, filled with chronic patients who are the endpoint of careers of mental downward mobility, are the nightmare thfft replaced the dream.
TOKEN ECONOMY A N D T H E METRICS OF M E N T A L L I F E
531
TOKEN ECONOMIES: THE ASYLUM ON ITS HEAD In those rare moments when they have intruded upon our consciousness, this pool of chronic patients represented a challenge both to our therapeutic ingenuity as well as to what might be described as creative hospital management. In the hospitals, the chronic patients are both a permanent criticism of our therapeutic techniques (in comparison to them everyone else seems easy to treat) and--as a result of the conditions under which they often live--a critique of our Capacity to be humane. The recent growth in the application to such patient populations of reinforcement principles in the form of token economies is only our most recent attempt to actualize, at least in part, some of the mission of the nineteenth century mentalists when they created the asylum. At one level the token economy is an implementation of the idea that madness is a matter of differential frequency of mad and normal behaviors (cf. Ferster, 1965; Ullmann & Krasner, 1969). This belief embodies the therapeutic hope of the token economy. However, there is another justification which involves an attempt to introduce order into what is apparent chaos. (This imagery of anarchy, even for the back wards, might have been heavily overdrawn; the wards themselves had an order, even though they were not orderly.) It has been argued that, even if the token economies are not in themselves therapeutic, they might produce the conditions of another order that would make the patients more accessible to therapeutic interventions of other sorts (cf. Paul, 1969). Though the introduction of the token economy into the mental hospitals has represented a continuity with the efforts and even goals of the creators of the asylum, it must be recognized that the token economies represent an inversion of their intellectual values and therapeutic strategies. The conception of a token economy is drawn, at least in part, from the principles of a real market economy, the tokens being an analog to the abstract principle of money. To the nineteenth century hospital superintendant, it Was the hurley burley of the economy and a money-dominated society that were central to the social conditions that produced insanity. The mental hospital was to be a counter culture built on the pre-monetary values of status and communitarian relationships. The token economy in contrast, perhaps indicating how our social world creates our categories of thought, draws its principles of order directly from the economy itself, from the apparent success of bargaining and exchange in increasing the predictability and stability of personal conduct. This shift of principles, applying what is most distinctive about the market economy--money--for the purposes of stabilizing a disordered behavioral pattern--mental life in older nomenclatures--is to radically invert the nineteenth century theory. What was the source of the disease now becomes the doctor. Order does not reside in status relationships, say the tokenists, but in exchange relations.
532
GAGNON AND DAVISON
LEARNING THE WRONG METRIC The evidence is reasonably good that the application of these techniques has been quite successful in replacing the natural order of the chronic ward with a new order based on token economies (cf. Ayllon & Azrin, 1965; Kazdin & Bootzin, 1972). But one of the questions that must be asked is what do the patients learn from experiences in the token economies. It seems fair to assume that one thing that is learned is that producing certain kinds of behavior produces a stable response from the token-emitting behavioral engineer or machine. The value of any act is metrically stable, and its value can be compared to other acts through a comparison of the number of tokens made contingent on its appearance. Unlike the market economy, the token value of different behaviors generally rests upon a version of a just price set by the experimenter or by the administrator rather than by the action of the choices of the participants in the economy; even when patients have a say in how their institutional lives are to be governed, it is arguable whether such closed settings allow of truly free choices by the residents. To this extent, the token economy differs in some measure from the economy outside the asylum--in some part the choice and utilities of the participants in that latter economy set the value of those things that are desired. In contrast, in a token economy, the value of behavior and the value of that which can be purchased from the repertoire of resources in the asylum are usually set bv the ext~erimenters and not by patient demand. In this sense, the patients participate in an administered and monopolistic economy. In their likeness to money, the tokens introduce an element into social relations with which sociologists have been concerned since the middle of the nineteenth century. This is the effect which the imposition of money economies has on the value of what were previously noneconomic activities or activities the purity of which was contaminated by the presence or even the suggestion of the presence of money. ("You can't buy love with money" or "Rich men cannot be happy or get into heaven" love, happiness, and salvation cannot be bought.) One of the consequences of quantifying such sacred domains is that the underlying rules and ideologies that govern the management of money, including the rules of arithmetic, come to de-sacralize what was previously sacred. Further, as Simmel argues, if anything can be bought, everything becomes the color of money, green in the United States, or perhaps more appropriately could tak e on the taste of M & M's (Wolff, 1950). Indeed, there is a curious symbolic link between money and M & M's, for neither money nor M & M's, with their advertised candy shells, leave any mess on the hands. The creation of a set of stable expectancies and values through the existence of monopoly based token economies has effected in the asylum an order acceptable to middle class observers. The comparatively clean,
TOKEN ECONOMY AND THE METRICS OF MENTAL LIFE
533
well-ordered wards of a token economy contrast favorably with the order that evolves in wards operating under less visible principles. One dimension of the desires of the creators of the asylum can be met through the creation of the token economy: the asylum itself is orderly, stable and predictable. The question, however, is whether the order has anything to do with the experiences of persons living in a nonasylum. What is apparent about the exchanges that characterize most conventional social life is that things do not come out even. That is, while an aggregate of persons may report a mean level of satisfaction about a given exchange or while a given individual might report satisfaction with a number of similar exchanges, the individual exchanges themselves are often characterized by a feeling of uneasiness or wonder as to whether too much or too little has been paid or has been earned. If this uneasiness characterizes economic exchanges which have the powerful metric of money to stabilize them, how much more uneasy do people feel when they are involved in activities or relationships in which there is no unequivocal way to justify that they either got more or less than they feel they deserved? It is a rare relationship in which all parties feel that they have come out even at the end. There are simply too many utilities involved and further, not all utilities are reducible to the same metric. The assumption of the token economy is that a person is able to take a wide range of utilities and compare their value, using the neutral mechanism of money or tokens. Even if one avoids examining the unlikely assumption that the medium of exchange itself will not take on a particular symbolic meaning both generally and idiosyncratically among individuals, the dilemma is that life outside the token economy is commonly ambiguous and the patterns of valuation unstable. ~Things that you paid for one day are sold for half price the next, the dollar is devalued against imports, inflation takes away ten percent per year - - a nd as one moves through the life cycle what was valued changes in price with experience, satiation and desire. In noneconomic relationships, the same processes are involved with a far weaker fit to a standardized and neutral medium. We may exchange sex for love, but it is difficult to figure out what a unit of each is, and how to make them match up requires more than an accountant. (How many copulations = How many 'I love you's'?) We would argue that life is largely the capacity to tolerate interactions which have low predictability of outcome and in which the things that are exchanged are not easily reducible to each other or to some third medium. Staying out of asylums is a capacity to 2 The necessity to create the equivalent of inflation in token economies by reducing the value of tokens not spent in the month earned indicates that patients begin to value the token over what it is supposed to buy (Atthowe, 1973). Hoarding or miserliness must be reduced to maximize participation--the Keynesian principles of spend and consume rather than save and produce adds another aspect of modernity to the asylum.
534
GAGNON AND DAVISON
survive the fact that life is unjust: sometimes you get what you pay for, sometimes you get more than you pay for, sometimes you get less than you pay for. Said another way, sometimes you get what you deserve, other times what you need and still other times what you want. The ambiguity exists not only in the exchanges themselves, but in the changing ways in which exchanges are evaluated. Indeed to stay " s a n e , " you commonly have to doctor the books. The success of token economies in mental hospitals rests on the fact that patients are not suffering from economic irrationality, and that they will learn to adapt pre-existing economic modes of behavior to deal with token environments. However, the other promise of the asylum is that, after the experience of order within it, the mad will be released into the outside world, having regained that which had been lost. In this sense, the token economy teaches the wrong things--the first is that the world is just and the second that good behavior is generally rewarded. What everyone knows is that sometimes the world is just and sometimes it isn't, and that sometimes good behavior is rewarded and sometimes it is not. What is probably most troubling for most persons is that what constitutes justice itself undergoes change and the definition of the " g o o d " depends on time and place, history and culture, rather than on the existence of abstract counters. REFERENCES Atthowe, J. M. Token economies come of age. Behavior Therapy, 1973, 4, 646-654. Ayllon, T. & Azrin, N. H. The measurement and reinforcement of behavior of psychotics. Journal of Experimental Analysis of Behavior, 1965, 8, 357-383. Bandura, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Davison, G. C. Appraisal of behavior modification techniques with adults in institutional settings. In C. M. Franks (Ed.) Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969. Ferster, C. B. Classification of behavioral pathology. In L. Krasner and L. P. Ullmanrl:(Eds.) Research in behavior modification; New developments and implications. New York: Holt, Rinehart, & Winston, 1965. Kazdin, A. & Bootzin, R. R. The token economy: An evaluative review. Journal of Applied Behavior Analysis, 1972, 5, 343-372. paul, G. L. Chronic mental patient: Current status--future directions. Psychological Bulletin, 1969, 71, 81-94. Rothman, D. The discovery of the asylum. New York: Harper & Row, 1971. Ullmann, L. P. & Krasner, L. A psychological approach to abnormal behavior. Englewood Cliffs, N. J.: Prentice-Hall, 1969. Wolff, K. H. (Ed.) The sociology of George Simmel. Glencoe, IL: The Free Press, 1950. FINAL ACCEPTANCE:OCTOBER 1, 1975
Asylums, the Token Economy, and the Metrics of Mental Life JOHN H. GAGNON AND G E R A L D C . DAVISON State University o f N e w York at Stony Brook The history of asylums in this country reveals that these institutions were designed to provide a milieu in which disturbed citizens could escape from the economic opportunities in society-at-large that were assumed to cause insanity. The atmosphere of the asylum was believed to be curative by virtue of its replication of pre-revolutionary stability in status relationships without the encouragement of men's political and commercial ambitions. Numerous forces then contributed to making the asylum a repository of large numbers of chronic patients, dealt with primarily in a custodial fashion and comprising the endpoint of careers in downward social mobility. The growth in token economies has been one of the recent attempts to cope with this affront to our personal and professional sensibilities. Chaos, and presumably mental illness itself, would be reduced by introducing into the asylum just that set of conditions which had earlier been held to be pathogenic, namely, a replication of the outside market economy. The source of the disease now became the doctor. While a certain kind of order is probably produced by token economies, questions are raised as to what is being learned by the patients. It would seem that participants in this economy are taught that certain behaviors earn a just reward and that greater predictability is possible through application to mental life of a metric prevalent in commerce. It is suggested that the greater orderliness achieved exacts a serious price, namely that the patient acquires a set which does not match human relationships outside the hospital. Token economies will, to a degree, work because most mental patients do not suffer from economic irrationality. By concentrating on this metric, token economists fail to make changes that will transfer to the demands of nonhospital life.
Operant approaches to clinical behavior change have been scrutinized from the outset as to their appropriateness for and effectiveness in bringing about meaningful and therapeutic alterations in human behavior (e.g. Davison, 1969; Bandura, 1969). It is not the present purpose to review this work. Rather, we take a more historical and more basic perspective. The systematic application of reinforcement contingencies on a ward-wide Preparation of this paper was facilitated by NIMH grant number MH24327. Reprint requests should be sent to John H. Gagnon, Department of Sociology, SUNY, Stony Brook, NY 11790. 528 Copyright© 1976by Associationfor Advancementof BehaviorTherapy. All rights of reproductionin any form reserved.
TOKEN ECONOMY AND THE METRICS OF MENTAL LIFE
529
basis should be examined in a socio-historical context which goes beyond the body of learning theory. This appears all the more advisable as more and more questions are raised by legislators and other interested lay people with respect to the ethics of the controlled environments found in institutional token economies.
THE INVENTION OF THE ASYLUM Asylums, whether in our fantasies, literature, or in their concrete manifestations, possess a remarkable capacity to produce a violent sense of uneasiness, perhaps even terror, among those who are currently thought to be sane. The possibility that we may lose or go out of our minds evokes a deep sense of horror, a horror that is only exacerbated both by our sense that such a loss is likely to be irreparable and by our beliefs about how we will be treated while our minds are lost, stolen, or strayed. However rational, optimistic, or sensible we might be about madness, the idea of the asylum itself is sufficient incentive for us to cling to our current mental circumstances if only in fear of the alternative. This location of the asylum as a central institution in our modern chamber of horrors is remarkable since its history suggests that it was invented in the early nineteenth century in the United States out of a progressive, charitable and hopeful perspective and spirit. As Rothman (1971) chronicles, the asylum was created as the result of the view of early nineteenth century psychiatrists that the bulk of insanity was caused by the changes in the conditions of United States society since the end of the Revolutionary War. During the first decades of the nineteenth century the open democratic society with its endless opportunities and possibilities was held to be the breeding ground for madness. " 'In this country where no son is necessarily confined to the work or employment of his father, but all of the fields of labor, of profit, or of honor are open to whomsoever will put on the harness,' and where 'all are invited to join the strife for that which may be gained in each,' it was inevitable that t h e ' ambition of some leads them to aim at that which they cannot reach, to strive for more than they can grasp.' As a result, 'their mental powers are strained to the utmost tension; they labor in agitation . . . their minds stagger under the disp/'oportionate burden.' "1 These social conditions, which Durkheim would describe in very similar language at the end of the nineteenth century as productive of the state of anomie or normlessness, were contrasted with a mythic view of the order and harmony of the colonial past of the society. The psychiatrists were 1 The operative language is that of Edward Jarvis quoted and paraphrased by Rothman (1971, p. 115). Rothman's book is rich in such quotations and successfully demonstrates that this view of the causes and cures of insanity was both general and influential in the first decades of the nineteenth century.
530
GAGNON AND DAVISON
themselves caught in a double bind for it was not possible for them to attack directly the new freedom offered by post-revolutionary society. Indeed such arguments would have been antithetical to the spirit of national pride that characterized the Jacksonian era. However, they found themselves uneasy with the rapidly changing social landscape, and they shared with many of the educated classes a distrust of the potential for political disorder among the urban mob in contrast to the sturdy yeomen and mechanics of the countryside. What attracted them to prerevolutionary society was a belief that, when life was ruled by status, and orderly relations existed between and within generations and classes, a madness which was generated by releasing men's ambitions did not occur. The asylum, then, was a social invention designed to heal overexcitement and mania by providing an orderly environment in which passions could be cooled and rehabilitation could result from the experience of a set of stable expectancies. Those made mad by their immersion in the mentally ennervating pursuits of unchecked commerce and politics, unbridled personal and social desires, would be restored by spending time in the corrective and predictable world of the asylum--a safe harbor that would reflect the quiet virtues of a by-gone era. The cure for the driven and ambitious, the active participants in a nascent capitalism and democracy, was a return to the communitarian values of a more placid and stable status-oriented society that would be replicated in the asylum. These were the dominant intellectual views that served as the justification for the construction and practices of the early mental hospital. They had a remarkable success in promoting the building of the institutions, but the therapeutic practice itself and the order that was to characterize the asylum were swamped under the rising numbers of chronic patients of various types who have come to dominate the population and the imagery of the asylum since the Civil War. The outcome of a large set of historical processes (the increase in aged patients due to changes in family practices, the expense of the hospitals, the retention of dangerous patients resulting in more custodial regimes, the sheer inadequacy of medical practice) has resulted in turning this early optimistic social experiment into the great custodial mental hospitals that were built in the countryside of the United States away from the disorder of the cities. In some regions these have been overtaken by the expanding suburbs and appear as fortress oases in the suburban sprawl, while still others remain lodged in small towns, providing the primary source of low salaried employment for the unskilled. What was originally conceived as an institution that, in its order, would be an implicit critique of and an explicit corrective for the madness,producing conditions of the larger society became itself bedlam incarnate. The back wards of these institutions, filled with chronic patients who are the endpoint of careers of mental downward mobility, are the nightmare thfft replaced the dream.
TOKEN ECONOMY A N D T H E METRICS OF M E N T A L L I F E
531
TOKEN ECONOMIES: THE ASYLUM ON ITS HEAD In those rare moments when they have intruded upon our consciousness, this pool of chronic patients represented a challenge both to our therapeutic ingenuity as well as to what might be described as creative hospital management. In the hospitals, the chronic patients are both a permanent criticism of our therapeutic techniques (in comparison to them everyone else seems easy to treat) and--as a result of the conditions under which they often live--a critique of our Capacity to be humane. The recent growth in the application to such patient populations of reinforcement principles in the form of token economies is only our most recent attempt to actualize, at least in part, some of the mission of the nineteenth century mentalists when they created the asylum. At one level the token economy is an implementation of the idea that madness is a matter of differential frequency of mad and normal behaviors (cf. Ferster, 1965; Ullmann & Krasner, 1969). This belief embodies the therapeutic hope of the token economy. However, there is another justification which involves an attempt to introduce order into what is apparent chaos. (This imagery of anarchy, even for the back wards, might have been heavily overdrawn; the wards themselves had an order, even though they were not orderly.) It has been argued that, even if the token economies are not in themselves therapeutic, they might produce the conditions of another order that would make the patients more accessible to therapeutic interventions of other sorts (cf. Paul, 1969). Though the introduction of the token economy into the mental hospitals has represented a continuity with the efforts and even goals of the creators of the asylum, it must be recognized that the token economies represent an inversion of their intellectual values and therapeutic strategies. The conception of a token economy is drawn, at least in part, from the principles of a real market economy, the tokens being an analog to the abstract principle of money. To the nineteenth century hospital superintendant, it Was the hurley burley of the economy and a money-dominated society that were central to the social conditions that produced insanity. The mental hospital was to be a counter culture built on the pre-monetary values of status and communitarian relationships. The token economy in contrast, perhaps indicating how our social world creates our categories of thought, draws its principles of order directly from the economy itself, from the apparent success of bargaining and exchange in increasing the predictability and stability of personal conduct. This shift of principles, applying what is most distinctive about the market economy--money--for the purposes of stabilizing a disordered behavioral pattern--mental life in older nomenclatures--is to radically invert the nineteenth century theory. What was the source of the disease now becomes the doctor. Order does not reside in status relationships, say the tokenists, but in exchange relations.
532
GAGNON AND DAVISON
LEARNING THE WRONG METRIC The evidence is reasonably good that the application of these techniques has been quite successful in replacing the natural order of the chronic ward with a new order based on token economies (cf. Ayllon & Azrin, 1965; Kazdin & Bootzin, 1972). But one of the questions that must be asked is what do the patients learn from experiences in the token economies. It seems fair to assume that one thing that is learned is that producing certain kinds of behavior produces a stable response from the token-emitting behavioral engineer or machine. The value of any act is metrically stable, and its value can be compared to other acts through a comparison of the number of tokens made contingent on its appearance. Unlike the market economy, the token value of different behaviors generally rests upon a version of a just price set by the experimenter or by the administrator rather than by the action of the choices of the participants in the economy; even when patients have a say in how their institutional lives are to be governed, it is arguable whether such closed settings allow of truly free choices by the residents. To this extent, the token economy differs in some measure from the economy outside the asylum--in some part the choice and utilities of the participants in that latter economy set the value of those things that are desired. In contrast, in a token economy, the value of behavior and the value of that which can be purchased from the repertoire of resources in the asylum are usually set bv the ext~erimenters and not by patient demand. In this sense, the patients participate in an administered and monopolistic economy. In their likeness to money, the tokens introduce an element into social relations with which sociologists have been concerned since the middle of the nineteenth century. This is the effect which the imposition of money economies has on the value of what were previously noneconomic activities or activities the purity of which was contaminated by the presence or even the suggestion of the presence of money. ("You can't buy love with money" or "Rich men cannot be happy or get into heaven" love, happiness, and salvation cannot be bought.) One of the consequences of quantifying such sacred domains is that the underlying rules and ideologies that govern the management of money, including the rules of arithmetic, come to de-sacralize what was previously sacred. Further, as Simmel argues, if anything can be bought, everything becomes the color of money, green in the United States, or perhaps more appropriately could tak e on the taste of M & M's (Wolff, 1950). Indeed, there is a curious symbolic link between money and M & M's, for neither money nor M & M's, with their advertised candy shells, leave any mess on the hands. The creation of a set of stable expectancies and values through the existence of monopoly based token economies has effected in the asylum an order acceptable to middle class observers. The comparatively clean,
TOKEN ECONOMY AND THE METRICS OF MENTAL LIFE
533
well-ordered wards of a token economy contrast favorably with the order that evolves in wards operating under less visible principles. One dimension of the desires of the creators of the asylum can be met through the creation of the token economy: the asylum itself is orderly, stable and predictable. The question, however, is whether the order has anything to do with the experiences of persons living in a nonasylum. What is apparent about the exchanges that characterize most conventional social life is that things do not come out even. That is, while an aggregate of persons may report a mean level of satisfaction about a given exchange or while a given individual might report satisfaction with a number of similar exchanges, the individual exchanges themselves are often characterized by a feeling of uneasiness or wonder as to whether too much or too little has been paid or has been earned. If this uneasiness characterizes economic exchanges which have the powerful metric of money to stabilize them, how much more uneasy do people feel when they are involved in activities or relationships in which there is no unequivocal way to justify that they either got more or less than they feel they deserved? It is a rare relationship in which all parties feel that they have come out even at the end. There are simply too many utilities involved and further, not all utilities are reducible to the same metric. The assumption of the token economy is that a person is able to take a wide range of utilities and compare their value, using the neutral mechanism of money or tokens. Even if one avoids examining the unlikely assumption that the medium of exchange itself will not take on a particular symbolic meaning both generally and idiosyncratically among individuals, the dilemma is that life outside the token economy is commonly ambiguous and the patterns of valuation unstable. ~Things that you paid for one day are sold for half price the next, the dollar is devalued against imports, inflation takes away ten percent per year - - a nd as one moves through the life cycle what was valued changes in price with experience, satiation and desire. In noneconomic relationships, the same processes are involved with a far weaker fit to a standardized and neutral medium. We may exchange sex for love, but it is difficult to figure out what a unit of each is, and how to make them match up requires more than an accountant. (How many copulations = How many 'I love you's'?) We would argue that life is largely the capacity to tolerate interactions which have low predictability of outcome and in which the things that are exchanged are not easily reducible to each other or to some third medium. Staying out of asylums is a capacity to 2 The necessity to create the equivalent of inflation in token economies by reducing the value of tokens not spent in the month earned indicates that patients begin to value the token over what it is supposed to buy (Atthowe, 1973). Hoarding or miserliness must be reduced to maximize participation--the Keynesian principles of spend and consume rather than save and produce adds another aspect of modernity to the asylum.
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survive the fact that life is unjust: sometimes you get what you pay for, sometimes you get more than you pay for, sometimes you get less than you pay for. Said another way, sometimes you get what you deserve, other times what you need and still other times what you want. The ambiguity exists not only in the exchanges themselves, but in the changing ways in which exchanges are evaluated. Indeed to stay " s a n e , " you commonly have to doctor the books. The success of token economies in mental hospitals rests on the fact that patients are not suffering from economic irrationality, and that they will learn to adapt pre-existing economic modes of behavior to deal with token environments. However, the other promise of the asylum is that, after the experience of order within it, the mad will be released into the outside world, having regained that which had been lost. In this sense, the token economy teaches the wrong things--the first is that the world is just and the second that good behavior is generally rewarded. What everyone knows is that sometimes the world is just and sometimes it isn't, and that sometimes good behavior is rewarded and sometimes it is not. What is probably most troubling for most persons is that what constitutes justice itself undergoes change and the definition of the " g o o d " depends on time and place, history and culture, rather than on the existence of abstract counters. REFERENCES Atthowe, J. M. Token economies come of age. Behavior Therapy, 1973, 4, 646-654. Ayllon, T. & Azrin, N. H. The measurement and reinforcement of behavior of psychotics. Journal of Experimental Analysis of Behavior, 1965, 8, 357-383. Bandura, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Davison, G. C. Appraisal of behavior modification techniques with adults in institutional settings. In C. M. Franks (Ed.) Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969. Ferster, C. B. Classification of behavioral pathology. In L. Krasner and L. P. Ullmanrl:(Eds.) Research in behavior modification; New developments and implications. New York: Holt, Rinehart, & Winston, 1965. Kazdin, A. & Bootzin, R. R. The token economy: An evaluative review. Journal of Applied Behavior Analysis, 1972, 5, 343-372. paul, G. L. Chronic mental patient: Current status--future directions. Psychological Bulletin, 1969, 71, 81-94. Rothman, D. The discovery of the asylum. New York: Harper & Row, 1971. Ullmann, L. P. & Krasner, L. A psychological approach to abnormal behavior. Englewood Cliffs, N. J.: Prentice-Hall, 1969. Wolff, K. H. (Ed.) The sociology of George Simmel. Glencoe, IL: The Free Press, 1950. FINAL ACCEPTANCE:OCTOBER 1, 1975