 The book is composed of four essays : " Characteristics of Total Institutions " ( 1957 ) ; " The Moral Career of the Mental Patient " ( 1959 ) ; " The Underlife of a Public Institution : A Study of Ways of Making Out in a Mental Hospital " ; and " The Medical Model and Mental Hospitalization : Some Notes on the Vicissitudes of the Tinkering Trades " . The first three essays focus on the experiences of patients ; the last , on professional @-@ client interactions . Goffman is mainly concerned with the details of psychiatric hospitalization and with the nature and effects of the process he calls " institutionalization " . He describes how institutionalization socializes people into the role of a good patient , someone " dull , harmless and inconspicuous " – a condition which in turn reinforces notions of chronicity in severe mental illness . Total institutions greatly affect people 's interactions ; yet , even in such places , people find ways to redefine their roles and reclaim their identities . 
