Dramaturgical Model

The dramaturgical model, introduced by Erving Goffman in The Presentation of Self in Everyday Life (1959), holds that social life can be analyzed using the vocabulary of theatrical performance. Individuals manage the impressions others form of them by presenting a “front” appropriate to the occasion, collaborating with co-performers to sustain a shared definition of the situation, and retreating to “back regions” where the performance is relaxed and the machinery of impression management is visible. The model has proved especially productive in medical sociology, where the doctor-patient encounter, the hospital ward, and the clinical team all exhibit the structural features Goffman identified.

Core Metaphor: Social Life as Theatre

Goffman stated his method explicitly in the preface to The Presentation of Self: “The perspective employed in this report is that of the theatrical performance; the principles derived are dramaturgical ones.”(Goffman, 1959) He proposed that interaction be analyzed not by asking what is genuinely felt or sincerely believed but by asking how individuals guide and control the impressions formed of them by others.

The framework rested on a distinction between two channels of communication: the expressions an individual “gives” (deliberate verbal symbols) and those he “gives off” (the wide range of actions others treat as symptomatic, performed for reasons other than the information conveyed).(Goffman, 1959) This gap between intentional expression and inadvertent revelation creates an asymmetry that forces observers to rely on cues and inferences rather than direct access to facts.(Goffman, 1959)

Goffman defined a “performance” as all the activity of a given participant on a given occasion that serves to influence any other participant, and “front” as the expressive equipment regularly employed during a performance.(Goffman, 1959) The “part” or “routine” is the pre-established pattern of action that a performance unfolds and that may be repeated on future occasions. A social status, on this account, is not a material thing to be possessed and displayed but a pattern of appropriate conduct that must be enacted — Goffman quoted Sartre’s waiter who is “playing at being a waiter in a café” as the paradigm case of a role that requires active performance rather than passive occupancy.(Goffman, 1959)

Social encounters do not rest on genuine consensus about what is true but on a “working consensus,” defined as an agreement about whose claims concerning which issues will be temporarily honored.(Goffman, 1959) Participants collaborate to avoid open conflict between competing definitions of the situation. When a projected definition is discredited, interaction breaks down: participants experience shame, hostility, and a form of anomie generated when “the minute social system of face-to-face interaction” collapses.(Goffman, 1959) The dramaturgical perspective treats this control of first impressions as an active project from the outset: mental hospital attendants may feel that if the new patient is “sharply put in his place the first day on the ward and made to see who is boss, much future difficulty will be prevented.”(Goffman, 1959)

Goffman positioned the dramaturgical perspective as one of five analytic approaches to social establishments (alongside the technical, political, structural, and cultural perspectives), each of which illuminates a distinct layer of institutional life.(Goffman, 1959) On this account, power of any kind must be clothed in effective means of displaying it, and physical coercion itself often functions primarily as a display for persuading an audience rather than as a naked exercise of force.

Performance, Front, and Back Region

Performers regulate the impression they make by controlling what audiences see, hear, and infer. Goffman identified several structural features of this control.

Idealization and concealment. Performers tend to offer an idealized impression that embodies the officially accredited values of their society, more fully than their actual behavior warrants.(Goffman, 1959) This requires concealing what Goffman called “dirty work” — the tasks and facts incompatible with the idealized front.(Goffman, 1959) Professionals reinforce idealized impressions through a “rhetoric of training” that cultivates the impression that practitioners have been reconstituted by their learning experience and set apart from ordinary people; Goffman cited pharmacists who acknowledge that a few months’ training would suffice for licensure but support the four-year university requirement as “good for the profession.”(Goffman, 1959)

The sincerity-cynicism spectrum that Goffman described has a characteristic arc in medical training. Students of medical schools typically begin with idealistic aspirations, set those ideals aside during the early years when the task is simply getting through examinations, spend the next two years too absorbed in learning about diseases to show much concern for the persons who are diseased, and only after medical schooling has ended may reassert their original ideals about medical service.(Goffman, 1959) Whether this reassertion is experienced as sincere or strategic varies. Goffman drew an analogy with the shaman: most shamans “help along with sleight-of-hand in curing and especially in exhibitions of power,” the attitude being “as toward a pious fraud”; field ethnographers find that even shamans who know they add fraud still believe in their powers and consult other shamans when ill.(Goffman, 1959)

Front and personal front. The “front” of a performance encompasses the setting (physical props and décor) and the “personal front” (insignia, clothing, sex, age, posture, facial expressions). Appearance signals social status; manner signals the interaction role the performer expects to play.(Goffman, 1959) Fronts are typically not invented by individual performers but selected from a pre-existing repertoire of social fronts. The case of anesthesiology illustrates this: to establish anesthesiology as a medical specialty, practitioners had to argue that the work was complex and vital enough to justify “the ceremonial and financial reward given to doctors” rather than the subordinate front nurses occupied.(Goffman, 1959) The hospital itself functions as a setting in this sense: “it is increasingly important for a doctor to have access to the elaborate scientific stage provided by large hospitals, so that fewer and fewer doctors are able to feel that their setting is a place that they can lock up at night.”(Goffman, 1959)

The dramaturgical demands on medical nursing differ structurally from surgical nursing. The physician’s diagnosis rests on careful observation of symptoms over time, while the surgeon’s depends more on visible findings. This invisible quality of medical nursing creates a specific problem: a patient may watch his nurse stop at the next bed and assume she is “just visiting,” not realizing she is observing breathing shallowness and skin tone. As Goffman noted: “so, alas, does his family who may thereupon decide that these nurses aren’t very impressive.”(Goffman, 1959)

Mystification through social distance. Performers generate awe by maintaining social distance, allowing the audience’s imagination to idealize. Goffman quoted Cooley: “authority, especially if it covers intrinsic personal weakness, has always a tendency to surround itself with forms and artificial mystery, whose object is to prevent familiar contact.”(Goffman, 1959)

Front and back regions. The front region is where a performance is given; the back region, or backstage, is “a place, relative to a given performance, where the impression given by the performance is knowingly contradicted as a matter of course.”(Goffman, 1959) Backstage, the performer can relax, drop the front, forgo speaking lines, and step out of character. Goffman drew the transition vividly from Orwell: a waiter who seconds before was screaming in rage glides across the dining room carpet “with a solemn priest-like air.”(Goffman, 1959) Backstage language — reciprocal first-naming, profanity, open sexual remarks, rough dress, mumbling, flatulence — is systematically proscribed in front regions.(Goffman, 1959)

The back region is also where the work of impression management becomes legible. In service trades, “the customer is asked to leave the thing that needs service and to go away so that the tradesman can work in private”; when the customer returns, the item is presented in good order, “an order that incidentally conceals the amount and kind of work that had to be done, the number of mistakes that were first made before getting it fixed, and other details the client would have to know before being able to judge the reasonableness of the fee.”(Goffman, 1959) A parallel pattern governs the hospital: workers in many establishments understand that they must “appear busy when the supervisor makes her rounds,” saving genuine relaxation for unobserved periods.(Goffman, 1959)

A crucial technique of impression management is audience segregation: presenting different faces to different audiences so that incompatible impressions do not collide. Goffman noted that the use of two examining rooms — allowing a practitioner to dart rapidly between separate patients who cannot compare notes — was “increasingly popular among American dentists and doctors.”(Goffman, 1959)

Performers also manage back regions by controlling access to them. Mental hospitals restrict visitors to specially prepared visiting rooms with presentable furnishings and well-dressed patients, barring them from chronic wards where conditions would contradict the impression of therapeutic care.(Goffman, 1959) The concealment extends to fabrication: undertakers hide the workroom where corpses are drained, stuffed, and painted to give bereaved families the illusion that the dead one is “in a deep and tranquil sleep.”(Goffman, 1959)

Teams and Impression Management

Much social performance is collaborative. Goffman used the term “performance team” for any set of individuals who co-operate in staging a single routine.(Goffman, 1959) Team membership creates bonds of reciprocal dependence: any member can give the show away or disrupt it by inappropriate conduct, which compels teammates to rely on each other’s good behavior.

Teams operate as “secret societies” in a specific sense: the audience may know who is on a team but does not know how they are co-operating to maintain a particular definition of the situation.(Goffman, 1959) This shared conspiracy structures much of professional life. Medical professional etiquette required, Goffman observed, that a consultant in a patient’s presence must never say anything that would “embarrass the impression of competence that the patient’s doctor is attempting to maintain” — what Everett Hughes called the body of ritual that grows up to “preserve, before the clients, the common front of the profession.”(Goffman, 1959) When superordinates must correct teammates, they wait until the audience has departed: “nurses [show consensus] when before patients.”(Goffman, 1959)

Information control is the central management task of any team. Goffman catalogued the types of secrets a team must protect: “dark secrets” (facts incompatible with the image the team maintains), “strategic secrets” (intentions concealed to prevent the audience from adapting), “inside secrets” (shared only among team members), and “entrusted secrets” (held in confidence from third parties).(Goffman, 1959) A vivid medical example: to prevent cancer patients from inferring their diagnosis from ward assignment, hospital staff scattered them throughout the building — at the cost of more staff walking and more equipment movement.(Goffman, 1959)

Performers systematically derogate absent audiences backstage, consolidating team solidarity through shared mockery of those before whom they maintain respectful fronts. Goffman documented how Shetland Hotel kitchen staff referred to guests by belittling code-names and imitated their mannerisms.(Goffman, 1959) Medical teams exhibit the same pattern: in the patient’s absence, physicians refer to a patient as “the cardiac” or “the strep,” assimilating persons to diagnostic categories that sustain clinical distance.(Goffman, 1959)

Goffman identified two virtues required of team performers: dramaturgical loyalty (not betraying team secrets between performances)(Goffman, 1959) and dramaturgical discipline (maintaining affective dissociation from one’s presentation while appearing spontaneously engaged)(Goffman, 1959). The professional’s claim that only the colleague group can judge performance insulates the performance from audience scrutiny and enables full commitment without dramaturgical prudence.(Goffman, 1959)

Discrepant Roles: Informers, Shills, Spies

Not everyone present at a performance occupies the role of performer or audience. Goffman identified a set of “discrepant roles” occupied by individuals who have access to information that would disrupt the performance if it became known to the audience.

The informer participates in backstage preparation and then reveals what was concealed: the renegade colleague who exposes fee-splitting, unnecessary operations, and “the rhetoric of medicine” (Kenneth Burke’s term for medical equipment used as imagery rather than diagnosis, so that a patient who has been subjected to “a fulsome series of tappings, scrutinizings, and listenings” feels satisfied, “though absolutely no material thing has been done for him”).(Goffman, 1959) The gravity of such exposure is registered in the differential treatment of impersonation: it is “an inexcusable crime against communication to impersonate someone of sacred status, such as a doctor or a priest,” while impersonating a low-status, profane figure draws far less censure.(Goffman, 1959)

The service specialist (lawyer, accountant, doctor, dentist) learns the secrets of the client’s show without sharing the risk of its performance. Professional ethics address this asymmetry by obliging the specialist to show “discretion,” as Goffman put it: “not to give away a show whose secrets his duties have made him privy to.”(Goffman, 1959) Psychotherapists who “vicariously participate so widely in the domestic warfare of our times are pledged to remain silent about what they have learned, except to their supervisors.”(Goffman, 1959) A structural inequity compounds this arrangement: middle-class doctors on charity duty treating shameful diseases in shameful surroundings “make it impossible for a lower-class person to protect himself from the intimate insight of his superordinates”; the discretion obligation runs in one direction only.(Goffman, 1959)

The non-person is someone present but treated as if absent — servants, the very young, the very old, and the sick, who are accorded no audience role and before whom performers may behave as backstage.(Goffman, 1959) The sick occupy this position structurally, making the hospital ward a peculiar hybrid space in which patients are simultaneously the nominal audience for clinical performance and non-persons who may be discussed as if not present.

The go-between learns the secrets of each team and gives each the false impression of exclusive loyalty.(Goffman, 1959) In medical settings, the referring doctor who communicates with the operating surgeon and then “presents himself to the patient’s kinfolk as someone who is participating in the medical action” plays a version of this role.(Goffman, 1959) General practitioners compound this structure when they present a specialist to a patient as the best choice on technical grounds while in fact the specialist may have been chosen partly because of collegial ties, a split-fee arrangement, or some other quid pro quo between the two medical men.(Goffman, 1959)

Significance for Medical Sociology

The dramaturgical model has been applied to medical settings at four levels of analysis.

The clinical encounter. The doctor-patient meeting is a performance in which the doctor maintains an image of disinterested competence while the patient responds with deference.(Goffman, 1959) Goffman observed that doctors must simulate memory of previous encounters: patients believe their situation is uniquely important and are deeply wounded if the doctor allows them to perceive that he does not carry in mind “precisely what kind of tablets he prescribed on his last visit.”(Goffman, 1959) Performers range from sincere belief to cynicism: doctors who give placebos exemplify practitioners “whose audiences will not allow them to be sincere.”(Goffman, 1959)

The clinical encounter is also governed by the risk that invisible management will become visible and the structural frame will be acknowledged by both parties. When a patient dies in a way that implicates staff competence, other patients (ordinarily disposed to give the staff trouble) may tactfully ease their warfare and maintain the false impression that they have not absorbed the meaning of what happened.(Goffman, 1959) At inspections in hospitals (as in schools and barracks), patients and staff converge: “the audience is likely to behave itself in a model way so that the performers who are being inspected may put on an exemplary show.”(Goffman, 1959) When both teams recognize that this tact is being performed and tacitly acknowledge each other’s awareness, “the whole dramaturgical structure of social interaction is suddenly and poignantly laid bare, and the line separating the teams momentarily disappears,” producing shame or laughter before the teams draw rapidly back into their appointed characters.(Goffman, 1959)

The hospital as dramaturgical establishment. Goffman defined a “social establishment” as any place surrounded by fixed barriers to perception in which a particular kind of activity regularly takes place, and proposed that any establishment could be analyzed through the dramaturgical perspective.(Goffman, 1959) Goffman included hospitals, clinics, and psychiatric wards as examples of such establishments that can be analyzed as closed systems.(Goffman, 1959) Nurses who prefer operating-room work to ward duty do so because the anaesthetized patient cannot witness weaknesses in the team’s performance, which allows the operating team “to relax and devote itself to the technological requirements of actions as opposed to the dramaturgical ones.”(Goffman, 1959) The anaesthetized patient also represents an extreme limit case of backstage substitution: once the audience is fully insensible, a “ghost surgeon” can be brought in to perform the tasks that others who were present will later claim to have done.(Goffman, 1959) Disruptions at this level carry structural weight: when a surgeon and nurse both turn from the operating table and the anaesthetized patient accidentally rolls off to his death, the reputation of the doctor as doctor and as man, and also the reputation of the hospital, may be weakened.(Goffman, 1959)

The diffusion of the “laboratory complex” (glass, stainless steel, rubber gloves, white tile, lab coat) across an expanding range of occupations provides increasing numbers of workers connected with unseemly tasks “a way of self-purification.”(Goffman, 1959) Island communities show a variant of this front management: in one Shetland community, aging crofters were permitted by tradition to retire from arduous duties by feigning illness, and local doctors were expected to tacitly restrict their unequivocal diagnoses to externally visible complaints, allowing the retirement fiction to stand.(Goffman, 1959)

The medical team. Medical teaching hospitals stage performances for interns: two staff internists split chart preparation the night before rounds to ensure a “good staff showing” at the intern’s expense.(Goffman, 1959) When team integrity breaks down — when a nurse “allows her sexual needs to be met in an overt way by the patient” — the disruption “alters the patients’ attitude towards the whole nursing group and makes the nurses’ therapeutic role a less effective one.”(Goffman, 1959)

In milieu therapy, Maxwell Jones deliberately abandoned white coat, stethoscope, and percussion hammer to avoid pretense and reduce status distance between doctors and nursing staff.(Goffman, 1959) In group therapy, patients often try to establish a secret alliance with the doctor by catching his eye when another patient says something that sounds “crazy,” and if they succeed in getting a response it can disrupt the group; the doctor must especially control his own non-verbal activity.(Goffman, 1959) The Bettelheim Orthogenic School requires “staff coherency” to prevent children from splitting staff members against each other, re-enacting the oedipal strategy of playing one parent against the other.(Goffman, 1959) On wards with experimental metabolic treatment, the usual sharp line between doctor and patient was blunted: doctors respectfully consulted with patients at length about symptoms, and patients came to think of themselves in part as research associates.(Goffman, 1959)

Mental ward attendants illustrate the limits of impression management under institutional constraint. If attendants must both maintain order and avoid hitting patients, and if that combination is difficult to sustain, “the unruly patient may be ‘necked’ with a wet towel and choked into submission in a way that leaves no visible evidence of mistreatment,” since “those rules which are most easily enforced are those which leave tangible evidence of having been either obeyed or disobeyed.”(Goffman, 1959) The ward audience is not passive in the face of such performances: at a Valentine party organized by student nurses without consulting patients, many patients attended unwillingly and played games they found silly, “motivated solely by reluctance to hurt the feelings of the student nurses who had organized the party.”(Goffman, 1959)

Self, identity, and the performed patient. Goffman argued that the self is not “an organic thing that has a specific location, whose fundamental fate is to be born, to mature, and to die; it is a dramatic effect arising diffusely from a scene that is presented.”(Goffman, 1959) The individual as performer is divided from the individual as character: the performer is a harried fabricator of impressions involved in staging a performance, while the character is a typically fine figure whose sterling qualities the performance is designed to evoke.(Goffman, 1959) The self is imputed to a performed character by the audience: it is a product of a scene that succeeds, not its cause.(Goffman, 1959) Performance disruptions carry consequences simultaneously at three levels: the immediate interaction (confusion and embarrassment), social structure (team and establishment reputation), and individual personality (self-conception discredited).(Goffman, 1959) Goffman’s summary formulation on risk is worth stating plainly: “there is no interaction in which the participants do not take an appreciable chance of being slightly embarrassed or a slight chance of being deeply humiliated. Life may not be much of a gamble, but interaction is.”(Goffman, 1959)

Goffman’s most unsettling formulation was that performers are not primarily moral but dramaturgical: “Performers are merchants of morality: social activity is largely concerned with moral matters, but as performers individuals have not a moral concern but an amoral concern with engineering a convincing impression that moral standards are being realized.”(Goffman, 1959)

See Also

• erving-goffman
• total-institution
• stigma
• sick-role
• medicalization
• medical-sociology
• symbolic-interactionism

Sources

All claims cite evidence cards from:

• Goffman, E. (1959). The Presentation of Self in Everyday Life. New York: Anchor Books. [Source ID: goffman-presentationself-1959]