12. Ethnography in mental health care settings

Gabriele Cerati (University of Milano-Bicocca), Stefan Sjöström (Uppsala University)

gabriele.cerati@unimib.it ; stefan.sjostrom@soc.uu.se

In the last 50 years, extensive transformations have occurred in how mental distress is conceived and treated. Two processes have been critical for this development.

First, the biopsychosocial model of understanding of mental health distress was introduced as the results of a compromise between the positions of different disciplines. From the evolving biological psychiatry with its focus on psychopharmacology, to the increasing use of psychological treatments, and the claim by social sciences to take into account contextual and cultural aspects concerning psychopathology. 

Second, political and social movements, coming from patients, families, psychiatrists, and academics, raised demands for reforms of clinical practices, including the elimination of asylums and the de-hospitalization of psychiatric services. An ideological shift thus occurred, guided by concerns about the oppressive aspects of psychiatric services and the rights of patients. 

These transformations brought a “democratization of psychiatry” to most the western contexts: psychiatric efforts are no longer limited to patients affected by severe psychosis as inpatients. Today, clinical services are extended to less severe distress, and increasingly provided in outpatient settings. Psychological and psychiatric treatments are now available to larger groups of the population, both in public and private facilities.

This restructuring of psychiatry in a broad sense has resulted in the development of different approaches, schools, practices, and spaces. Psychiatric diagnosis and treatment are applied in many different contexts, like the activities of general practitioners’, psychological consultations, support in community settings and coercive practices in closed psychiatric wards. Coercion, social control and medicalization of mental distress are established in various forms and through different types of treatments and practices, not only inside hospitals but also as everyday activities and treatments.

Social sciences can employ ethnographic and qualitative methods to understand how the re-institutionalization of psychiatric treatment gave birth to different approaches, practices, and facilities. Contributions for this panel present ethnographic and qualitative research conducted in different mental health settings. We propose a set of questions to guide the proposals.

  • Perspectives and ideologies: What perspectives on the nature of mental distress and its treatment are embraced among various professional groups?
  • Organization: How are psychiatric services organized and how do different arrangements affect practice and treatment ideologies? 
  • Patients, users, consumers: What perspectives do service users have on their own situations and the services they receive? 
  • Medicalisation: To what extent and how are social and life adversities medicalized as mental illness in? How are social aspects of mental distress taken into account by psychiatric services? What social interventions are applied to tackle these problems?
  • Coercion: How does coercion unfold in community and hospital settings? 

Other contributions describing work, spaces, practices in psychiatric and psychological facilities are welcome, as well as contributions concerning the evolution of mental care facilities into different facilities, with different nature, aims, professionals involved, degree of coercion in all parts of the world – not only from the western de-institutionalized contexts.

Mental Health – Psychiatry – Psychology – Coercion – Medicalization – Asylums – Psychiatric facilities

Sociology of Mental Health – Social Work – Critical Psychiatry – Critical Psychology –Anthropological Psychiatry – Mad Studies 

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