With the exception of a few studies, little systematic attention has been given to individuals in their postdeviant careers. Drawing on data collected through participant observation and informal interviews with 146 non-chronic ex-psychiatric patients, this article explicates dimensions of their exit process and social reintegration. Specifically, attention is given to ex-patients' perceptions of mental illness as a stgmatisable/stigmatising attribute, the problems they faced, the manner by which they manage discreditable/discrediting information about themselves, and the consequences of such for altering their deviant identities and social re-integration. This article suggests that ex-psychiatric patients are strategists and negotiators who play active roles in attempting to shape their deviant outcomes, techniques which have implications for identity transformation and reintegration.

Although scholars have addressed the exit phase of deviant careers (see Adler and Adler 1983; Faupel 1991; Frazier 1976; Glassner et al. 1983; Harris 1973; lnciardi 1970; lrwin 1970; Luckenbill and Best 1981; Meisenhelder 1977; Ray 1961), the issue of reintegrating deviants into society has received little sociological attention. So too has little attention been given to the wide array of factors affecting role exit and reintegration.

Brown (1991) focused on the reintegration of deviants who became "professional ex-s," individuals who capitalised on their deviant identity and status by moving into therapeutic counselling careers. Similarly, Braithwaite (1 989) studied the effects of shaming individuals into role exit. Only a few studies (Chambliss 1984; Shover 1983, 1985; Snodgrass 1982) cantered on the lives of ex-deviants in order to document their postdeviant worlds. These studies focused on the effects of former (prior) attributes, activities, or processing on their subsequent lives. Another notable exception is Adler (1992), who conducted a follow-up study of upper-level drug dealers and smugglers and the factors affecting reintegration into society. She found that individuals returned to the mainstream due to certain structural factors and when trafficking was no longer considered enjoyable but anxiety-provoking. Moreover, Adler documented the problems that ex-traffickers faced in attempting to secure or return to mainstream, legitimate, occupational realms and the career based factors that aided or inhibited reintegration.

With respect to the sociological literature on the stigma of the mentally retarded and social reintegration, scholars have addressed public attitudes toward the mentally ill (Bord 1970; Cochrane and Nieradzik 1985; D'Arcy and Brockman 1977; Farina and Ring 1965; Lamy 1966; Nunnally 1961; Taylor, Dear, and Hall 1979; Trute and Loewen 1978; Whatley 1959), correlates of societal acceptance or rejection of ex-psychiatric patients (Rabinowitz 1982), family acceptance or stigmatisation of former mental patients (Clausen 1981; Doll, Thompson, and Lefton 1976; Kreisman and Joy 1974), stigma experienced by relatives of former patients (Freeman and Simmons 1961; Segal, Baumohi, and Moyies 1980), the stigma of mental illness and available housing (Goldmeir, Shore, and Mannino 1977), the stigma of seeing a psychiatrist (Bar-Levav 1976), and employer responses to psychiatric stigmata (Miller and Dawson 1965; Webber and Orcutt 1982).

Despite the preponderance of sociological research on the mentally ill, there is a dearth of ethnographically-based studies dealing with the posthospital lives of ex-psychiatric patients. Such studies, as they do exist, deal largely with chronic ex-patients living in halfway houses or boarding homes, or involved in specific aftercare treatment programs (Cheadle, Freeman, and Korer 1978; Estroff 1981; Lamb and Goertzei 1977; Reynolds and Farberow 1977). Little systematic attention has been given to ex-patients' perceptions of mental illness as a stigmatisable/stigmatising (2) attribute, the numerous problems they face on the outside, the ways in which such persons manage discreditable information about themselves in the context of social interaction with others, and the consequences of employing these strategies for altering their deviant identities and social reintegration. In this article, I address these deficits in the sociological literature by presenting ethnographic evidence from a study of 146 nonchronic,(3) ex-psychiatric patients. I begin with a discussion of the setting and methods used in this study and then illustrate how ex-patients came to perceive their attribute as potentially stigmatising. Next, I analyse the five strategies that these persons developed and employed in their "management work." Finally, I address the implications of adopting such stratagems for identity transformation and social reintegration. With this article I hope to contribute to the existing literature on stigma, deviant career exit, management work, and the reintegration of deviants.

My interest in mental illness and psychiatric patients has been a long-standing one. My father was employed as an occupational therapist for 25 years at a large psychiatric institution in a metropolitan city in Ontario, Canada. Throughout my childhood and adolescent years, I made frequent trips to the institution, interacting with many of the patients on the "admission" and "back' wards, in the hospital canteen, in the occupational therapy workshop, and on the grounds. Moreover, during those years, my father often brought a number of his patients into our home (those, in particular, whose families had abandoned them or who did not have any relatives) to spend Easter, Thanksgiving, and Christmas holidays with our family.

My childhood interest in mental patients sparked my initial involvement in this topic, and I began to study mental patients in 1980 as a graduate student at McMaster University. Having a father who was highly esteemed by the institutional gatekeepers greatly facilitated my access, although I encountered numerous gatekeeper problems during the course of the study in their effort to secure control over 'constructions of reality" (Berger and Luckmann 1966) and "definitions of the situation" (Thomas 1931) (see Herman 1981 for details). I spent 8 months ethnographically studying the institutionalisation of psychiatric patients (Herman 1981). After completing this study on the pre- and inpatient phases of the patients’ careers, I became interested in learning about the postpatient phase of their careers. As a result of the movement toward deinstitutionalisation, chronic patients, once institutionalised for periods of years, were being released into the community. Moreover, newly diagnosed patients were being hospitalised for brief periods of time and shortly released. I became interested in examining the posthospital social worlds and experiences of these ex-psychiatric clients.

I began a 4-year research project on this topic in January 1981 (see Herman 1986). In contrast to my earlier study on institutionalised mental patients, where I encountered numerous problems with institutional gatekeepers, this time I encountered relatively few such problems. Rather than dealing with the same provincial institution to obtain a list of discharged patients, I contacted the Director of Psychiatric Services and Professor of Psychiatry at the medical school affiliated with my university. After hearing about my research proposal he granted his support for the project and served as my sponsor to the Ethics Committee of the hospital. Approximately 1 month later, I was given access to a listing of discharged (chronic(4) and nonchronic) ex-psychiatric patients who had been released from the psychiatric wards of seven general hospitals and from two psychiatric institutions in the southern Ontario area between 1975 and including 1981. To protect the identities of those ex-patients not wishing to participate in my study and to avoid litigation against the hospital for violating rights of confidentiality, I agreed to only be given access to the names of those individuals who agreed to participate. A stratified random sample of 300 ex-patients was formed from the overall discharge list. Upon drawing this sample, the hospitals sent out a letter to each potential subject on my behalf, outlining the general nature of the study, my identity, and my affiliation. Two weeks later, hospital officials made follow-up telephone calls asking potential subjects if they were willing to participate in the study. I was subsequently given a list containing the names of 285 willing participants, 146 nonchronic and 139 chronic ex-patients.(5)

I initially conducted informal interviews with each of the ex-patients in coffee shops, their homes, in malls, or at their places of work. The interviews lasted from 3 to 5.5 hours. These interviews not only provided me with a wealth of information about the social worlds of ex-patients, but many subjects invited me to subsequently attend and participate with them in various social settings, including self-help group meetings, activist group meetings and protest marches, and therapy sessions. In addition, I frequently met with ex-patients during coffee and lunch breaks where they worked and was able to observe them interacting with co-workers. I ate lunches and dinners in their homes (as they did in mine) and watched them interacting with family members, friends, and neighbors. Each Wednesday afternoon, I met a group of 6 ex-patients at a local donut shop where they would discuss the problems they were facing "on the outside" and collectively search for possible remedies.

In his classic work, Stigma, Goffman (1963) distinguished between stigmata that are "discrediting" and those that are "discreditable" (p. 4): The former refer to attributes that are immediately apparent to others, such as obesity, physical abnormalities, and blindness; the latter refer to attributes that are not visible or readily apparent to others, such as being a secret homosexual or ex-prisoner. Mental illness is conceptualised, for the most part, as a discreditable or potentially stigmatising attribute in that it is not readily apparent to others. It is equally important to note, however, that for some ex-psychiatric patients, mental illness is a deeply discrediting attribute. Many ex-patients, especially the chronic ones, were rendered discredited by inappropriate patterns of social interaction and the side-effects of medication, which took the forms of twitching, swaying, jerking, and other bizarre mannerisms (see Herman 1986).(6) When ex-patients made voluntary disclosures of personal information about their psychiatric histories or other people somehow became aware of their histories, ex-patients were categorised in negative terms, as representing some sort of personal failure to "measure up" to the rest of society. Tom, a 45-year-old, summed it up for most of the ex-patients:

The ex-psychiatric patients learned the social meaning of their 'failing," that they possessed a potentially stigmatising attribute, in the following manners: through formal societal reaction, official labelling, and institutional processing; through direct, negative, disvaluing posttreatment experiences with others; through a combination of the forgoing; or through self-labelling.

One of the major means by which ex-psychiatric patients learned that they possessed a stigmatisable attribute was through societal reaction, official labelling of their behavior as "mental illness," and subsequent institutional processing. In the context of the pre- and inpatient phases of their "moral careers" (Goffman 1961), these persons not only acquired a new conception of self as mental patient but also learned about the stigma attached to this label. In the prepatient phase, 25% of those studied learned this information through official labelling by such persons as the clergy, the police, and the family physician, whereas for others, it was learned through unofficial, informal labelling by family, friends, and co-workers. Billy, a 26-year-old, when discussing the role of official labelling in "educating" him about his identity and the stigma associated with it, stated,

Moreover, much of what mental patients learned about their stigma was transmitted to them during prolonged forced interaction with others in an institution who were also being transformed into mental patients by the institutional staff. Calling attention to the role of hospitalisation in educating him that he possessed a discreditable attribute, Mario, a middle-aged nonchronic, expressed,

A second means through which ex-psychiatric patients came to see their condition as discreditable or potentially stigmatising was through direct posthospital exposure to members of society who rejected or disapproved of them. Approximately 32% of the ex-patients in this study learned the social meaning of their "failing" in this manner. Joan, an elderly female released from the hospital 3 weeks before, indicated that she learned that she possessed a stigmatisable attribute through negative experiences with her family:

Just as family members sometimes "taught' ex-psychiatric patients that they possessed a stigmatisable attribute, so too did co-workers, neighbors, and friends sometimes provide such information. As Art stated,

A third group of ex-psychiatric patients reported discovering the social meaning of their failing through a combination of institutional and interpersonal means. Approximately 18% of the ex-patients in this study reported that they came to regard mental illness as a discreditable attribute through a combination of official labelling and negative posthospital experiences with family, friends, and others. Don, a 34-year-old recently released for the fourth time, remarked,

In a similar vein, Charlene, a 39-year-old ex-patient of Italian descent, spoke of the manner by which she learned the social meaning of her failing:

One final means by which nonchronic ex-patients came to view themselves as possessing a potentially stigmatising attribute was through self-labelling (see Lorber 1967; Robins 1980; Schur 1979; Sagarin and Kelly 1980; Thoits 1985). Schneider and Conrad (1980) described the importance of self-labelling:

Approximately 7% of the ex-patients in this study indicated that they subjectively perceived mental illness to be personally stigmatising, that is, likely to lead to personal debasement if discovered by others. Such persons labelled themselves as possessing some sort of "mental illness" or "psychological sickness" above and apart from any formal or informal reaction and official labelling. Similar to Scheff’s (1975, 1984) findings, expatients learned and internalised, early in life, stereotypical imagery of mental illness and insanity - imagery that was constantly reaffirmed throughout their adult lives in the context of social interaction with others and through the mass media. So too did such persons learn and internalise stereotypical images of normality early in life - images that were constantly reaffirmed in ordinary social discourse. In short, by incorporating the stereotypes of "normal" and "crazy," some individuals self-labelled their behavior as "mental illness"; moreover, on making such self-definitions, the ex-patients also realised the discreditable nature of the attribute of mental illness. Mabel, a 32-year-old hospitalised on four occasions in a psychiatric institution, recalled the manner by which she defined herself as being mentally ill and her perception of mental illness as personally stigmatising:

In short then, through internalisation of stereotypical images of normality and insanity, some ex-patients (prior to official or unofficial labelling), defined themselves as being mentally ill; moreover, such stereotypes provided ex-patients with self-definitions of discreditability.

Some studies on the discreditable (Edgerton 1967; Humphreys 1972; Ponse 1976) have suggested that individuals either disclose their attribute to others or make attempts to actively conceal such information about their selves. Other studies (Bell and Weinberg 1978; Miall 1986; Schneider and Conrad 1980; Veevers 1980) have suggested that being a "secret deviant" is far more complex than either choosing to disclose or not disclose one's 'failing.' These studies suggest that individuals selectively conceal such information about themselves at certain times, in certain situations, with certain individuals, and freely disclose the same information at other times, in other situations, with other individuals. Concealment and disclosure, then, are contingent on a "complex interaction of one's learned perceptions of the stigma [of their attribute], actual 'test’ experiences with others before/or after disclosure, and the nature of the particular relationship involved" (Schneider and Conrad 1980, 39).

The complex reality of how individuals selectively conceal and disclose information was evident in the case of nonchronic ex-psychiatric patients. Examination of their posthospital worlds revealed that many ex-patients not only faced economic hardships, had problems coping in the community, and experienced adverse side-effects from their "meds" but also their perception of mental illness as a potentially stigmatising attribute presented severe problems in their lives. Many lived their lives in states of emotional turmoil, afraid and frustrated deciding who to tell or not tell, when to tell and when not to tell, and how to tell. Joan, a 56-year-old waitress, aptly summed it up for most nonchronics:

Ex-psychiatric patients learned how, with whom, and under which circumstances to disclose or conceal their discreditable aspects of self, largely through a process of trial and error, committing numerous faux pas along the way. Frank, a 60 year-old factory worker, spoke of the number of mistakes he made in his "management work":

In fact, even if no faux pas were committed, there was no guarantee that others would accept proffered meanings and definitions of self. As Charlie, a 29-year-old graduate student hospitalised on three occasions, remarked,

Nearly 80% of the nonchronics in this study engaged in some form of information control about their illnesses and past hospitalisations. Specifically, the stratagems adopted and employed by the ex-patients resemble those observed in other deviant groups (see Davis 1961; Hewitt and Stokes 1978; Levitin 1975; Miall 1986; Schneider and Conrad 1980): selective concealment, therapeutic disclosure, preventive disclosure, and political activism-stratagems adopted by ex-patients in their effort to lessen or avoid the stigma potential of mental illness, elevate self-esteem, renegotiate societal conceptions of mental illness as a discreditable attribute, and alter deviant identities.

Selective concealment can be defined as the selective withholding or disclosure of information about the self perceived as discreditable in cases where secrecy is the major stratagem for handling information about an attribute. Especially during the time period directly following their psychiatric treatment, the majority of nonchronics had a marked desire to conceal such information about their selves from all others. Decisions about disclosure and concealment were made on the basis of their perceptions of others, that is, whether they were "safe others" or 'risky others.' So too were decisions based on prior, negative experiences with "certain types" of others. Speaking of her classification of others into "trustworthy" and "untrustworthy" others, Dawina, a 46-year-old secretary institutionalised on seven occasions, said,

Moreover, there was a hierarchical pattern of selective disclosure based on the individual's perceived degree of closeness and the ex-patient's revealing his or her discreditable attribute. In general, such information was most frequently revealed to family members, followed by close friends, and then acquaintances - a pattern also reflected in the literature on epileptics (Schneider and Conrad 1980) and involuntary childless women (Miall 1986). As Sarah, a 36-year-old mother of two, put it,

Further, selective disclosures to normal others were frequently made to test reactions. Similar to Schneider and Conrad's (1980) epileptics, the continued disclosure of ex-patients' mental illness was contingent upon responses they received to previous disclosures. Rudy, a 39-year-old hospitalised on ten occasions, stated,

In those cases where concealment was the dominant strategy of information management, ex-patients usually disclosed only to one or two individuals. As Simon, a 25-year-old ex-patient, aptly expressed,

The employment of concealment as a stratagem of information management took the following forms: avoidance of selected "normals," redirection of conversations, withdrawal, the use of disidentifiers, and the avoidance of stigma symbols. Speaking on his efforts to redirect conversations, Mark, a 34 year-old nonchronic, explained,

For still others, concealment of their discreditable attribute was achieved through withdrawal. Over two thirds of the ex-patients in this study engaged in withdrawal as a form of concealment, especially during the early months following discharge. Speaking of his use of this technique, Harry, a college junior, remarked,

A third technique employed by over one third of the ex-patients to conceal their discreditable aspects from others involved the use of disidentifiers (Goffman 1963, 44). That is, ex-patients used misleading physical or verbal symbols in an effort to prevent normal others from discovering their ‘failing.' Similar to homosexuals (Carrier 1976; Delph 1978), unwed parents (Christensen 1953; Pfuhl 1978), and lesbians (Ponse 1976), who frequently made use of disidentifiers in their management work, nonchronic ex-patients also employed such techniques. Specifically, disidentifiers took the form of making jokes about psychiatric patients when in the presence of "normal" others and participating in protests against the integration of ex-patients into the community. Mike, a 26-year-old recently released after three hospitalisations, remarked (with some remorse) on his use of this tactic:

In a similar vein, Morgan, a 49-year-old history professor, explained how his joke telling aided in the concealment of his attribute:

A final form of concealing information on the part of ex-patients was through the avoidance of stigma symbols (Goffman 1963, 43) - signs that would bring into the forefront or disclose individuals' discreditable attribute. It is interesting to note that the data presented here on nonchronics and their avoidance of stigma symbols supports observations made of other deviant groups - for example, transsexuals (Bogdan 1974; Kando 1973) and unwed fathers (Pfuhl 1978). Among the 146 ex-patients studied, over two thirds avoided contact with such stigma symbols as other ex-mental patients with whom they had become friends while institutionalised as well as self-help groups for ex-patients. They also avoided frequenting drop-in centers, attending dances and bingos for ex-patients, and, in general, placing themselves where other "patients and ex-patients hung out." For still others, avoidance of stigma symbols entailed not attending posthospital therapy sessions. Margarette, a stocky middle-aged female of German descent, explained her avoidance of postdischarge therapy sessions in the following manner:

In sum, as a strategy of information management, selective concealment of their attribute and past hospitalisations was done to protect themselves from the perceived negative consequences that might result from the revelation of their illness - an "offensive tactical maneuver" through which ex-patients attempted (although often unsuccessfully) to mitigate the stigma potential of mental illness on their daily lives. Notably, employing concealment as a strategy of information management was a temporal process. The majority of ex-patients employed this strategy primarily during the first 8 months following their discharge. During this time, in particular, they expressed feelings of anxiety, fear, and trepidation. However, as time passed, ex-patients began to test reactions, encountered both positive and negative responses from certain "normals," and their strong initial desires for secrecy were replaced by alternative strategies.

Therapeutic disclosure can be defined as the selective disclosure of a discreditable attribute to certain 'trusted," "empathetic" supportive others in an effort to renegotiate personal perceptions of the stigma of "failing."

Similar to Miall's (1986) study on involuntary childless women and Schneider and Conrad's (1 980) study on epileptics, 36% of the ex-patients felt that discussing their mental illnesses and past hospitalisations, getting it off their chests in a cathartic fashion, functioned to alleviate much of the burden of their loads. Attesting to the cathartic function disclosing served, Vincent, a 29-year-old ex-patient, remarked,

Therapeutic disclosure was most often carried out with family members, close friends, and with other ex-psychiatric patients - individuals 'sharing the same fate." Ida, a 52-year-old, discussing the circumstances surrounding her disclosure to a neighbor who had also been hospitalised in a psychiatric facility at one time, said,

Even in cases where ex-patients disclosed to individuals who turned out to be unsympathetic and unsupportive, some considered this therapeutic:

Just as therapeutic disclosure functioned to relieve expatients' anxieties and frustrations, it also allowed for the renegotiation of personal perceptions of mental illness as a discreditable attribute. Speaking of the manner by which she came to redefine mental illness in her own mind as a less stigmatising attribute, Edith explained,

In short, ex-patients employed therapeutic disclosure to relieve feelings of frustration and anxiety, to elevate their self-esteem, and to renegotiate (in their own minds) personal perceptions of mental illness as stigmatising.

Preventive disclosure can be described as the selective disclosure to "normals" of a discreditable attribute in an effort to influence others' actions and/or perceptions about the ex-patient or about mental illness in general (see Miall 1986; Schneider and Conrad 1980). Preventive disclosure of their mental illness and past hospitalisations occurred in situations where ex-patients anticipated future rejection by "normal" others. To minimise the pain of subsequent rejection, 34% of the sample decided that the best strategy to employ with certain people was preventive disclosure early in their relationships. As Hector, a 40-year-old janitor, stated,

Preventive disclosure, then, represented a way that ex-patients attempted to prevent a drop in their status at a later date or as a way of testing acquaintances in an effort to establish friendship boundaries.

Just as nonchronics used preventive disclosure to avoid future stigma and rejection, so too did they employ this strategy to influence normals' attitudes about themselves and about mental illness in general. Specifically, ex-patients used the following devices: medical disclaimers (see Hewitt and Stokes 1978; Miall 1986; Schneider and Conrad 1980), deception/coaching (see Goffman 1963; Miall 1986; Schneider and Conrad 1980), education (see Schneider and Conrad 1980), and normalisation (see Cogswell 1967; Davis 1961,1963; Levitin 1975; McCaghy 1968; Scott 1969).

Similar to Schneider and Conrad's (1980) epileptics and Miall's (1 986) involuntary childless women, 52% of the ex-patients frequently used medical disclaimers in their management work "blameless, beyond-my-control medical interpretation(s)" developed to "reduce the risk that more morally disreputable interpretations might be applied by naive others" discovering their failing (Schneider and Conrad 1980, 41). Such interpretations were often used by ex-patients to evoke sympathy from others and to ensure that they would be treated in a charitable manner. As Dick, an unemployed laborer, put it,

In a similar vein, Anna, a 29-year-old waitress, explained her use of medical disclaimers:

Further, 11 ex-patients revealed their mental illness and past hospitalisations as a side effect of another medical problem or disease, such as childbirth, stroke, or heart disease, thereby legitimising what otherwise might be considered a potentially stigmatising condition. As Rebecca, a 36-year-old ex-patient, confessed,

Whereas Sue spoke of her successes in influencing others' perceptions about her attribute and mental illness in general, Lenny lamented about his failure with the same strategy:

In sum, through the use of medical disclaimers, ex-patients hoped to elevate their self-esteem and to renegotiate personal perceptions of mental illness as a nonstigmatising attribute.

Deception differed from strategies of concealment in that with the former, ex-patients readily disclosed their illness and past hospitalisations but explicitly distorted the conditions or circumstances surrounding it. Similar to Miall's (1986) involuntary childless women and Schneider and Conrad's (1980) epileptics, about one third of the ex-patients employed deceptive practices developed with the assistance of coaches. Coaches included parents, close friends, spouses, and other ex-patients sharing the same stigma. Coaches actively provided ex-patients with practical suggestions on how to disclose their attribute in the least stigmatising manner and present themselves in a favorable light. Maureen, a 32-year-old ex-patient, explained her "coaching sessions" with relatives:

Moreover, it is interesting to note that about one quarter of the ex-patients employed deceptive practices together with medical disclaimers. As Benjamin, a 62-year-old ex-patient, aptly expressed,

A third form of preventive disclosure used by ex-patients to influence others' perceptions of them and their ideas about mental illness was education. Similar to Schneider and Conrad's (1980) epileptics and Miall's (1 986) involuntary childless women who revealed their attribute in an effort to educate others, 28% of the ex-patients revealed for the same educational purposes. Marge, a 39-year-old ex-patient, speaking on her efforts to educate friends and neighbors, stated,

Ex-patients did not automatically attempt to educate everyone they encountered but, rather, based on subjective typification of normals, made value judgements about whom to "educate." Brenda, speaking on this matter, explained,

Whereas education proved successful for some ex-patients in their management activities with certain individuals, others found it less successful. Jim, recalling one disastrous experience with a former poker buddy, said,

Following Goffman (1963), medical disclaimers, deception/coaching, and education are forms of "disclosure etiquette" they are formulas for revealing a stigmatising attribute "in a matter of fact way, supporting the assumption that those present are above such concerns while preventing them from trapping themselves into showing that they are not" (p. 101).

A final form of preventive disclosure employed by ex-psychiatric patients to manage stigma was normalisation. This concept is drawn from Davis's (1963) study on children with polio and is akin to deviance disavowal (see Davis 1961). Normalisation is a strategy that individuals use to deny that their behavior or attribute is deviant-it "seeks to render normal and morally acceptable that which has heretofore been regarded as abnormal and immoral" (Pfuhl 1986, 163). Similar to observations made on pedophiles (McCaghy 1968), the obese (Millman 1980), the visible handicapped (Levitin 1975), and paraplegics (Cogswell 1967), about one quarter of the ex-psychiatric patients I studied also employed this same strategy. Such persons were firmly committed to societal conceptions of normalcy and were aware that according to these standards they were disqualified-they would never "measure up.' Yet ex-patents made active attempts at rationalising and downplaying the stigma attached to their failing. So, for example, they participated in a full round of normal activities and aspired to normal attainments. They participated in amateur theater groups, played competitive sports such as hockey and tennis, enrolled in college, and so on. Ex-patients whose stigma could be considered "discreditable," that is, not readily or visibly apparent to others, would disclose such information for preventive reasons, thereby rendering them "discredited" in the eyes of others. They would then attempt to negotiate with normals for preferred images, attitudes, roles, and nondeviant conceptions of self and for definitions of mental illness as less stigmatising. Discussing his use of this technique, 'Weird Old" Larry, a 59-year-old ex-patient, stated,

If successfully carried out, this avowal normalised relations between ex-patients and others.

This is not to imply, however, that the strategy of normalisation worked for all patients in all situations. Similar to Millman's (1980) overweight females who were accepted in certain roles but treated as deviant in others, many ex-patients expressed similar problems. Frederick, speaking on this problem with respect to co-workers, said,

It is interesting to note that just as ex-patients whose attribute was discreditable employed the strategy of normalisation, so too did other ex-patients with discrediting attributes (conditions visibly apparent or known to others) employ this same technique. Explaining how medication side effects rendered him discredited and how he attempted to reduce the stigma of mental illness through normalisation, Ross said,

In short, by presenting themselves as normals, ex-patients hoped to elicit positive responses from others whose reactions were deemed important. From a social psychological perspective, others accepted and reinforced a nondeviant image of self through this process of negotiation, allowing ex-patients to achieve more positive, nondeviant identities.

In many cases, ex-psychiatric patients progressed from one strategy to another as they managed information about themselves. Specifically, they moved from a strategy of initial selective concealment to disclosure for therapeutic and preventive reasons. According to the ex-patients, such a progression was linked to their increased adjustment to their attribute as well as the result of positive responses from others to the revelation of their mental illness.

Just as ex-psychiatric patients developed and employed a number of individualised forms of information management to deal with the stigma potential of mental illness, enhance self-images, and alter deviant identities, they also employed one collective management strategy (7) to achieve the same ends, namely, joining and participating in ex-mental patient activist groups (see Anspach 1979). Such groups, with their goal of self-affirmation, represent what Kitsuse (1980) terms "tertiary deviation" - referring to the deviant's 'conformation, assessment, and rejection of the negative identity embedded in secondary deviation, and the transformation of that identity into a positive and viable self-conception" (p. 9).

Political activism served a threefold function for ex-patients: (a) it repudiated standards of normalcy (standards to which they could not measure up) and the deviant labels placed on these individuals; (b) it provided them with a new, positive, nondeviant identity, enhanced their self-respect, and afforded ex-patients a new sense of purpose; and (c) it served to propagate this new, positive image of ex-mental patient to individuals, groups, and organisations in society. The payoff from political activism, was, then, both personal as well as social.

Similar to such activist groups as the Gay Liberation Front, the Disabled in Action, the Gray Panthers, or the radical feminist movement, ex-mental patient activists rejected prevailing societal values of normalcy through participation in their groups. They repudiated the deviant identities, roles, and statuses placed on them. Moreover, these individuals flatly rejected the stigma associated with their identities. Steve, a 51 -year-old electrician, aptly summed it up for most ex-patient activists when he stated,

After repudiating prevailing cultural values and deviant identities, ex-patient activists collectively redefined themselves in a more positive, nondeviant light according to their own newly constructed set of standards. Speaking of her having embraced a new nondeviant identity, Susan, a 39-year-old ex-patient who recently returned to teaching school, said,

In contrast to other ex-patients who employed various individual management strategies to deal with what they perceived to be their own personal problem - personal failings - patient activists saw their problems not as personal failings or potentially stigmatising attributes but as societal problems. To the extent that ex-patients viewed their situations in this manner, it allowed them to develop more positive self-images. Speaking of this process as one of "stigma conversion" Humphreys (1972) stated,

Sally, a neophyte activist, placed the 'blame" on society for her deviant self-image:

Just as political activism, as contrasted with other adaptive responses to stigma, sought, in repudiating the dominant value system, to provide ex-patients with positive, nondeviant statuses, so too did it attempt to propagate this new positive, normal image of ex-psychiatric patient to others in society Thus, through such activities as rallies, demonstrations, protest marches, attendance at conferences on human rights for patients, lobbyist activities directed toward politicians and the medical profession, and the production of newsletters, ex-patient activists sought to promote social change. Specifically, they sought to counter or remove the stigma associated with their "differentness" and present society with an image of former psychiatric patients as human beings capable of self-determination and political action. Abe, the president of the activist group, aptly summed up the aim of political activism during a speech to the selected political figures, media personnel, and "upstanding" citizens:

In sum, then, through participation in political activist groups, many ex-patients internalised an ideology that repudiated societal values and conventional standards of normalcy, rejected their deviant identities and statuses, adopted more positive, nondeviant identities, and attempted to alter society's stereotypical perceptions about mental patients and mental illness in general.

With the exception of a few studies (Adler 1992; Chambliss 1984; Shover 1985; Snodgrass 1982), little systematic attention has been given to individuals' postdeviant careers. Centering on the lived experiences and accounts of 264 ex-psychiatric patients, this article has dealt with the key elements and dimensions of their exit process and their (albeit problematic) social reintegration. More generally, my research has attempted to make a contribution to the existing literature on deviant careers, the perception of stigmatising attributes, stigma management strategies, and the reintegration of deviants.

When psychiatric patients are discharged from the institutions or psychiatric wards of general hospitals, their problems (8) are far from over. In fact, numerous problems lie ahead for such persons in their efforts to return to a conventional life. As Erikson (1966), Ebaugh (1988), and others have noted in their studies on role exit and the reintegration of deviants into society, there exist virtually no formal rights of passage to mark the exdeviant's passage out of deviant identities and roles. Whereas society has developed and employed various "degradation ceremonies" (Garfinkel 1956) marking the passage of individuals from 'normal" to 'deviant' identities and statuses, there are no such comparable ceremonies to reinstate the "transformed" or " ex-deviant." My findings suggest that ex-patients realised not only that no such ritualistic ceremonies existed to "transform them back" but also that they possessed a stigma that severely impeded such a transformation of self and endangered their future participation in society. In response to their undesirable posthospital social situations, nonchronic ex-psychiatric patients employed five strategies, which if successfully carried out, lessened or mitigated the stigma of their failing, enhanced self-esteem, aided self-transformation, and also allowed for renegotiation of societal conceptions of mental illness as a discreditable attribute. Strategies of stigma management have important consequences for social identities. Ebaugh (1984), in her study of nuns leaving the convent, spoke of the process of becoming an "ex-" in terms of the concepts of "role exit" and "self-transformation." Specifically, she asserted that "ex" roles represent a unique sociological phenomenon in that definitions of self and societal expectations are shaped and often determined by a previous identity. That is, on the one hand, individuals are fighting to leave behind their old identities, statuses, and roles, while, on the other hand, others are continually taking those into account when interacting with them. Ebaugh (1984) further pointed out that there are some "e)e' roles in our society that are fairly well-defined, such as ex-president, but what we are seeing in society today is an increasing number of "ex" roles for which there are few well-defined normative expectations. In these situations, the "ex's" themselves have to create role definitions as they play out their lives. Supporting others' (Ebaugh 1984; Glassner et al. 1983; lrwin 1970; Meisenhelder 1977; Shover 1983) documentations of role-exiting experiences that portrayed individuals' attempts to shake off their old roles and create new roles designed to reformulate societal expectations of their selves, I discovered a similar process operating with respect to discharged nonchronic patients. In their process of self-transformation, former patients struggled to cast off their deviant identities and roles largely due to their perception of mental illness as a stigmatising attribute. As Goffman (1963) stated, "The stigmatised individual tends to hold the same beliefs about identity that we do. His deepest feeling about what he is may be his sense of being a 'normal person,' a human being like anyone else, a person, therefore, who deserves a fair break. What is desired by the individual is what can be called acceptance" (p. 78). The creation of a new identity of "ex-crazy" or "ex-mental patient," a positive, nondeviant, nonstigmatising identity, arose then through an ongoing process of negotiations with normals in a bid for "acceptance." In particular, ex-patients were successful in transforming their deviant aspects of self when (or if)(9) (a) they began to think of themselves in terms of current, nondeviant roles and began to project such an image to others and (b) others began to relate to them in terms of those new roles.

My findings suggest, then, and are supported by other research on deviants (e.g., Hewitt and Stokes 1978; Levitin 1975; Miall 1986; Schneider and Conrad 1980), that ex-psychiatric patients are not passive, powerless individuals; rather, they are strategists, expert managers, and negotiators who play active (although not always successful) roles in the shaping of deviant outcomes. In other words, ex-patients have their hands in shaping their own social fates; they attempt to elicit desired reactions through their own behaviors, through the techniques of stigma management they employ, and through the expectations and images they project.

Moreover, my data demonstrate the relationship between self-labelling and the perception of mental illness as a stigmatising attribute. Much of the empirical sociological work on the stigma of mental illness has assumed that (ex-)mental patients learn the meaning of their attribute primarily through societal reaction, specifically, formal and/or informal disvaluing responses. With the exception of Thoits (1985), relatively little attention has been placed on the role of self-labelling. Self-labelling occurs when individuals recognise on the basis of internalising normative conceptions that other people will likely label their attribute as deviant if they learn of them (Lorber 1967; Sagarin and Kelly 1980). The concept of self-labelling, then, places importance not only on the normative order for self-definitions of stigma but on the role of individuals' subjective perceptions in the definitional process.

My research also offers new insight into the various strategies that individuals use to manage potentially stigmatising information about themselves. Although the strategies employed by these ex-patients have been observed with respect to various other deviant groups, I documented an interesting difference. Specifically, I discovered that ex-patients perceived therapeutic disclosure to be helpful and desirable even in those instances where audiences reacted in a negative, unsupportive manner.(10)

Future research on the stigma of mental illness should also focus on the families of ex-psychiatric patients, in terms of the dynamic of family interaction. Although some studies (Freeman and Simmons 1961; Lefton et al. 1962) have concentrated on such family interaction patterns as exclusion and rejection, it would be naive to conclude that these are the only two responses that develop. Future research needs to examine families' efforts at co-operation with ex-patients and their efforts at attempting to reintegrate them into society, to manage stigma, and so on. So too should studies focus on the problems and frustrations experienced by family members in their efforts to cope with ex-patients. Specifically, studies should focus on the perceptions of stigma as it relates to the courtesy stigma (Goffman 1963, 30) potentially possessed by families and friends of ex-patients and their attempts to deal with it.

Finally, future research would benefit from focusing on the relationship between social power, management strategies, and identity transformation. Following Becker (1963), those in positions of power-those having basic resources at their command might deal with the stigma potential of mental illness in means different from those without such power. Those with powerful resources will likely be able to achieve more favorable outcomes than will those without such resources. Clearly, these factors merit future consideration with respect to ex-psychiatric patients.

Adler, Patricia. 1992. The 'post’ phase of deviant careers: Reintegrating drug traffickers. Deviant Behavior, 13:103-26.

Adler, Patricia, and Peter Adler. 1983. Shifts and oscillations in deviant careers: The case of upper-level drug dealers and smugglers. Social Problems 31:195-207.

Anspach, Renee. 1979. From stigma to identity politics: Political activism among the physically disabled and former mental patents. Social Science and Medicine 13A:765-73.

Bar-Levav, Reuven. 1976. The stigma of seeing a psychiatrist. American Journal of Psychotherapy 30:473-82.

Bartell, Gilbert D. 1971. Group sex., A scientist's eyewitness report on the American way of swinging. New York: Wyden.

Backer, H. S. 1963. Outsiders.. Studies in the sociology of deviance. New York: Free

Press.

Bell, Alan, and Martin S. Weinberg. 1978. Homosexualities: study of diversity among men and women. New York: Simon & Schuster.

Berger, P., and T. Luckmann. 1966. The social construction of reality. New York: Doubleday.

Bogdan, Robert. 1974. Being different.. The autobiography of Jane Fry. New York: Wiley Bord, Richard James. 1970. Rejection of the mentally ill: Continuities and further developments. Social Problems 18: 490-512.

Braithwaite, John. 1989. Crime, shame and reintegration. Cambridge: Cambridge University Press.

Brown, J. David. 1991. The professional ex-: An alternative for exiting the deviant career. Sociological Quarterly 32: 219-30.

Carder, J. M. 1976. Family attitudes and Mexican male homosexuality. Urban Life 50: 359-75.

Chambliss, William J. 1984. Harry King: .A professional thief’s journey. New York: Wiley. Cheadle, A. J., H. Freeman, and J. Korer. 1978. Chronic schizophrenic patients in the community. British Journal of Psychiatry 132: 221-27.

Christensen, Harold T. 1953. Studies in child spacing: Premarital pregnancy as measured by the spacing of the first birth from marriage. American Sociological Review 18: 53-59.

Clausen, John. 1981. Stigma and mental disorder: Phenomena and terminology. Psychiatry, 44 (4): 287-96.

Cochrane, R., and K. Nieradzik. 1985. Public attitudes towards mental illness-The effects of behavior, roles, and psychiatric labels. International Journal of Psychiatry 31 (1):23-33.

Cogswell, B. 1967. Rehabilitation of the paraplegic: Processes of socialisation. Sociological Inquiry 37: 11-26.

D'Arcy, Carl, and Joan Brockman. 1977. Public rejection of the ex-mental patient: Are attitudes changing? Canadian Review of Sociology and Anthropology 14 (1):68-80.

D'Arcy, Carl, and Joan Brockman. 1961. Deviance disavowal: The management of strained interaction by the visibly handicapped. Social Problems 9: 120-32.

Davis, Fred 1963. Passage through crisis: Polio Victims and their families. Indianapolis: Bobbs-Merrill.

Delph, E. 1978. The silent community.. Public homosexual encounters. Beverly Hills, CA: Sage.

Doll, Wm., Edward Thompson, Jr., and Mark Lefton. 1976. Beneath acceptance: Dimensions of family affect towards former mental patients. Social Science and Medicine 10 (6): 307-13.

1984. Leaving the convent: Role exit and self-transformation. In The existential self in society, edited by J. A. Kotarba and A. Fontana, 156-76. Chicago: University of Chicago Press.

Ebaugh, Helen Rose Fuchs. 1988. Becoming an ex., The process of role exit. Chicago: University of Chicago Press.

Edgerton, Robert. 1967. The cloak of competence: Stigma in the lives of the mentally retarded. Berkeley: University of California Press.

Erikson, Kai T. 1966. Wayward puritans. New York: Wiley.

Estroff, Sue E. 1981. Making it crazy. An ethnography of psychiatric clients in an American community. Berkeley: University of California Press.

Farina, Amerigo, and Kenneth Ring. 1965. The influence of perceived mental illness on interpersonal relations. Journal of Abnormal Psychology 70: 47-51.

Faupel, Charles E. 1991. Shooting dope: Career patterns of hard-core heron users.

Gainesville: University of Florida Press.

Frazier, Charles. 1976. Theoretical approaches to deviance. Columbus, OH: Charles Merrill.

Freeman, H. D., and 0. G. Simmons. 1961. Feelings of stigma among relatives of former mental patients. Social Problems 8: 312-21.

Garfinkel, Harold. 1956. Conditions of successful degradation ceremonies. American Journal of Sociology 61: 420-24.

Glassner, Berry, Margaret Ksander, Bruce Berg, and Bruce D. Johnson. 1983. A note on the deterrent effect of juvenile vs. adult jurisdiction. Social Problems 31: 219-21.

Goffman, Erving. 1961. Asylums. New York: Doubleday.

Goffman, Erving., 1963. Stigma. Englewood Cliffs, NJ: Prentice-Hall.

Goldmeir, J., M. Shore, and F. Mannino. 1977. Co-operative apartments: New programs in community mental health. Health and Social Work 2 (1): 120-40.

Herds, Mervyn. 1973. The daily boys. Rockville, MD: New Perspectives.

Herman, Nancy J. 1981. The making of a mental patient: An ethnographic study of the processes and consequences of institutionalisation upon self-images and identities. Master's thesis, McMaster University, Hamilton, Ontario, Canada.

Herman, Nancy J.1986. Crazies in the community: An ethnographic study of ex-psychiatric clients in Canadian society - Stigma, management strategies and identity transformation. Ph.D. diss., McMaster University, Hamilton, Ontario, Canada.

Herman, Nancy J. 1987. "Mixed nutters and looneytuners': The emergence, development, nature, and functions of two informal, deviant subcultures of chronic, ex-psychiatric patents. Deviant Behavior 8:235-58.

Hewitt, J., and R. Stokes. 1978. Disclaimers. In Symbolic interactionism, edited by

L. Manis and B. N. Meltzer, 308-19. Boston: Allyn & Bacon.

Humphreys, Laud. 1972. Out of the closets: The sociology of homosexual liberation.

Englewood Cliffs, NJ: Prentice-Hall.

lnciardi, James. 1975. Careers in crime. Chicago: Rand McNally.

lrwin, John. 1970. The felon. Englewood Cliffs, NJ: Prentice-Hall.

Kando, T. 1973. Sex change: The achievement of gender identity among feminised transsexuals. Springfield, IL: Charles C Thomas.

Kitsuse, John. 1980. Presidential address. Society for the Study of Social Problems 9: 1-13.

Kreisman, D. E., and V. D. Joy 1974. Family responses to the mental illness of a relative:

A review of the literature. Schizophrenia Bulletin 1 (10): 34-57.

Lamb, J., and V. Goertzei. 1977. The long-term patient in the era of community treatment. Archives of General Psychiatry 34: 679-82.

Lamy, Richard E. 1966. Social consequences of mental illness. Journal of Abnormal Psychology 70: 47-51.

Lefton, Mark, S. Angrist, S. Dinitz, and B. Pasamanick. 1962. Social class, expectations and performance of mental patents. American Journal of Sociology 68:79-87.

Levitin, T. 1975. Deviants as active participants in the labelling process: The case of the visibly handicapped. Social Problems 22: 548-57.

Lorber, J. 1967. Deviance as performance: The case of illness. Social Problems 14:302-10.

Luckenbill, David F., and Joel Best. 1981. Careers in deviance and respectability: The analogy's limitations. Social Problems 29: 197-206.

Lyman, Stanford M. 1970. The Asian in the West. Reno/Las Vegas, NV: Western

Studies Center, Desert Research Institute.

McCaghy, Charles H. 1968. Drinking and deviance disavowal: The case of child molesters. Social Problems 16: 43-49.

Meisenhelder, Thomas. 1977. An exploratory study of exiting from criminal careers.

Criminology 15: 319-34.

Miall, Charlene E. 1984. Women and involuntary childlessness: Perceptions of stigma associated with infertility and adoption. Ph.D. diss., York University, Toronto, Canada.

Miall, Charlene E. 1986. The stigma of involuntary childlessness. Social Problems 33 (4):268-82.

Miller, Dorothy, and Wm. Dawson. 1965. Effects of stigma on reemployment of ex-mental patents. Mental Hygiene 49: 281-87.

Millman, Marcia. 1980. Such a pretty face. New York: Norton.

Nunnally, J. 1961. Popular conceptions of mental health. New York: Holt, Rinehart & Winston.

Pfuhl, Erdwin H., Jr. 1978. The unwed father: A 'nondeviant' rule breaker. Sociological Quarterly 19: 113-28.

Pfuhl, Erdwin H., Jr . 1986. The deviance process. 2d ed. Belmont, CA: Wadsworth.

Ponse, Barbara. 1976. Secrecy in the lesbian world. Urban Life 5: 313-38.

Rabinowitz, Jonathan. 1982. Shared ethnicity as a correlation of acceptance of the formerly hospitalised mentally ill. Journal of Sociology and Social Welfare 9: 534-40.

Ray, Marsh. 1961. The cycle of abstinence and relapse among heroin addicts. Social Problems 9: 132-40.

Reynolds, David K., and Norman Farberow. 1977. Endangered hope: Experiences in psychiatric aftercare facilities. Berkeley: University of California Press.

Robins, L. 1980. Alcoholism and labelling theory. In The labelling of deviance, edited by W. Gove, 34-47.2d ed. Beverly Hills, CA: Sage.

Sagarin, E., and R. Kelly. 1980. Sexual deviance and labelling perspectives. In The labelling of deviance, edited by W. Gove, 347-79, 2d ed. Beverly Hills, CA: Sage.

Scheff, Thomas. 1975. Labelling madness. Englewood Cliffs, NJ: Prentice-Hall.

Scheff, Thomas. 1984. Being mentally ill. A sociological theory. 2d ed. Chicago: Aldine.

Schneider, J., and R Conrad. 1980. In the closet with illness: Epilepsy, stigma potential and information control. Social Problems 28: 32-44.

Schur, Edwin. 1979. Interpreting deviance: A sociological introduction. New York:

Harper & Row.

Scott, Robert. 1969. The socialisation of blind children. In Handbook of socialisation theory and research, edited by D. Goslin. Chicago: Rand McNally.

Segal, S. R. J. Baumohi, and E. W. Moyies. 1980. Neighborhood types and community reaction to the mentally ill: A paradox of intensity. Journal of Health and Social Behavior 21: 345-59.

Shover, Neil. 1983. The later stages of ordinary property offenders' careers. Social

Problems 31: 208-18.

Shover, Neil. 1985. Aging criminals. Beverly Hills, CA: Sage.

Snodgrass, John. 1982. The jack-roller at seventy: A fifty-year follow-up study Lexington, MA: Lexington.

Taylor, S. Martin, Michael Dear, and G. Hall. 1979. Attitudes toward the mentally ill and reactions to mental health Facilities Social Science and Medicine 13D: 281-90.

Thoits, Peggy 1985. Self-labelling processes in mental illness: The role of emotional deviance. American Journal of Sociology 91: 221-49.

Thomas, W. 1. 1931. The unadjusted girl. Boston: Little, Brown.

Trute, B., and A. Loewen. 1978. Public attitudes toward the mentally ill as a function of prior personal experience. Social Psychiatry 13:79-84.

Veevers, Jean. 1980. Childless by choice. Toronto: Butterworths.

Webber, Avery, and James D. Orcutt. 1982. Employers' reaction to racial and psychiatric stigmata: A field experiment. Paper presented at the 31st Annual Meeting of the Society for the Study of Social Problems, San Francisco.

Whatley, C.D. 1959. Social attitudes toward discharged mental patents. Social Problems 6:313-20.

NANCY J. HERMAN is currently an associate professor at Central Michigan University. Her research interests include social psychiatry, medical sociology, deviance, and symbolic interactionism.

1 I wish to thank the Social Sciences and Humanities Research Council of Canada for their generous support of this long-term research endeavor. In addition, I wish to thank Larry T. Reynolds and Bernard N. Meltzer for their helpful comments and suggestions on earlier drafts of this article.

2 The stigmatised status of individuals and the information management strategies they employ have been well-documented on other groups such as the retarded (Edgerton 1967), epileptics (Schneider and Conrad 1980), secret homosexuals (Humphreys 1972), involuntary childless women (Miall 1984, 1 986), swingers (Bartell 1971), and lesbians (Ponse 1976), among others.

3 For the purposes of this study, chronicity was defined not in diagnostic terms (i.e., 'chronic schizophrenic') but in terms of duration, continuity, and frequency of hospitalisations. Specifically, the term 'nonchronic' refers to those individuals hospitalised for time periods of less than 2 years, on a discontinuous basis, or on fewer than five occasions or those treated in psychiatric wards of general hospital facilities.

4 The term 'chronic' ex-psychiatric patient refers to those institutionalised in psychiatric hospitals for time periods of 2 years or more, institutionalised on a continual basis, or on five or more occasions.

5 The decision to stratify the sample by chronicity was based on my interests and prior fieldwork activities. My earlier study (Herman 1981) indicated that when we speak of 'deinstitutionalised' or ‘discharged' patients we cannot merely assume that they are one homogeneous grouping of individuals with like characteristics, similar posthospital social situations, experiences, and perceptions of reality. Rather, prior research led me to believe that there are likely distinct subgroups of individuals with varying perceptions of reality and experiences (see Herman 1986).

6 In Estroff's (1981) ethnography on chronic ex-mental patients, she points out the catch-22 situation in which they find themselves. Ex-patents need to take their medications on a regular basis in order to remain on the outside. However, ironically, in an effort to become more like others, they take 'meds' that make them 'different.' The various side effects reinforce their deviant identities.

7 Following Lyman's (1970) typology on deviant Voluntary associations, ex-mental patient political activist groups represent an 'instrumental-alienative' type of association. It is interesting to note that chronic ex-patents also employed one collective form of stigma management; specifically, they formed and participated in deviant subcultures (see Herman 1987).

8 For a detailed discussion of their problems as pre- and inpatients, see Herman (1986).

10 One notable exception is Miall's (1986) study on involuntary childless women, but, by and large, this finding has not been noted elsewhere with respect to therapeutic disclosure.