Abstract
Almost all the knowledge now produced about psychiatry includes what is called “the patient’s or client’s perspective.” This paper analyzes how this notion has been framed in the discourses on mental health over the last two decades, particularly in mental health research and in anthropology. The very concept of the “patient’s perspective” is a social and historical construct. Despite its remarkable prevalence, the notion remains vague. Mental health research pictures it as a stable attribute of the individual. Anthropologists integrate the contextual nature of the patient view; but they still largely envision the psychiatric patient as a rational actor producing narratives based on common sense. However, in psychiatric practice, the client’s perspective is not something the patient individually produces; it is rather shaped by and in a context. To explore this process, my research investigated interactions between staff and patients in a French community mental health center, and showed that the client’s perspective is the result of a collective process. Further analysis demonstrates that eliciting or producing the patient’s view is sometimes considered a therapeutic goal in itself, since being granted the status of a rational and narrative actor gives access to the most valued model of care, one that is based on partnership. Being an outcome that is negotiated between patients and care providers, the “patient’s view” then becomes a new resource in mental health settings.
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Notes
On the sensitive topic of the patient/care provider relationship, the very terms employed are infused with meaning. Various terms have been proposed and used in the last decades to name the individuals who receive care from psychiatric services, each of them referring to a political stance toward psychiatric treatment (McLean 1995). In the French context, however, there has been remarkably little debate on this issue, and care recipients are still widely called “patients,” or sometimes ex-patients.
This trend is noticeable in medicine in general, as well as in other social realms. In this respect, integrating the consumer’s perspective has become a social imperative that extends well beyond psychiatry.
All names used in this paper are pseudonyms.
This is how Carla’s care providers refer to her disorder. I don’t refer here to a DSM IV diagnosis, since the staff very seldom used it.
Institutional psychotherapy appeared in French psychiatric hospitals after the Second World War, and aimed at transforming the hospital itself into a therapeutic tool. The term has been used for very diverse experiences, which share a strong reference to psychoanalysis, especially Jacques Lacan, and to group therapy.
Psychosocial (or psychiatric) rehabilitation refers to a great variety of treatment programs; all emphasize recovery and aim at restoring an optimal level of independent functioning in the community. Although the reference to psychosocial rehabilitation has greatly expanded in North American mental health services as well as in Europe in the last decades, its influence is still limited in the French public psychiatric sector.
This statement is by no means a judgment. It is based on complementary research I carried out in Washington, DC.
The nature of the interaction between patient and staff is unstable, meaning that interpretation is an ongoing process (Velpry 2008).
Here and throughout the paper, “resident” refers to patients living in supported housing.
“Folie des grandeurs” refers to grandiose delusions and is used as a synonym for megalomania.
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Statement on ethics: The research conducted for this paper followed the ethical guidelines of the University Paris 5. After being presented with the objectives of the study and informed of their right to withdraw from the study as well as of the rules of confidentiality, the staff members and the residents separately gave their oral and written consent.
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Velpry, L. The Patient’s View: Issues of Theory and Practice. Cult Med Psychiatry 32, 238–258 (2008). https://doi.org/10.1007/s11013-008-9086-2
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DOI: https://doi.org/10.1007/s11013-008-9086-2