Culture, Medicine and Psychiatry

, Volume 30, Issue 1, pp 77–104 | Cite as


  • Jeannette PolsEmail author


Participation in the community and citizenship for patients are common ideals that inspire improvements in mental health care. But what is meant by citizenship? Here an analysis is made of washing practices in psychiatric nursing in long-term mental health institutions. Four repertoires of washing are described, each oriented towards a specific notion of citizenship. In the first repertoire, washing is part of individual privacy; the patient is “enacted” as an individual whose authenticity should be respected in order to equip him or her for participation in the community. In the second repertoire, washing is a basic skill; the patient must learn to take care of her body in order to become an independent citizen. In the third repertoire washing is a precondition to citizenship; patients are to be helped to develop their potentials so that they can find their way in the community. In the fourth repertoire, washing is one opportunity among others to develop social relations; the extent and quality of these relations define a citizen. This analysis opens up not the question if, but which type of citizenship should be promoted.


psychiatry citizenship participation care washing 



Research for this article was supported by N.W.O. (210–11–208). I am grateful to the hospital staff and clients for their cooperation. Many thanks also to the people who have contributed to this article with comments on early drafts: Dorine Bauduin, Marja Depla, Dixi Henriksen, Hans Harbers, Kor Grit, Hans Kroon, Jacomine de Lange, Inge Mans, Ingunn Moser, Jan Pols, Baukje Prins, Estrid Sörensen, Rita Struhkamp, Herma van der Wal, Wubbien Wesselink and Dick Willems. I especially thank Annemarie Mol for discussions on complexities, and for her patience in helping to make this into a readable article. I am grateful to John Law and Vicky Singleton for the philosophical debates on “washing.”


  1. Anthony, William, Mikal Cohen, and Marianne Farkas 1982 A Psychiatric Rehabilitation Treatment Program: Can I Recognize One If See One? Community Mental Health Journal 18(2): 83–95CrossRefPubMedGoogle Scholar
  2. Anthony, William, Mikal Cohen, and Marianne Farkas 1990 Psychiatric Rehabilitation. Boston: Boston UniversityGoogle Scholar
  3. Atkinson, Dorothy 1998 Living in Residential Care. In Care Matters: Concepts, Practice and Research in Health and Social Care. Ann Brechin , Jan Walmsley, Jeanne Katz, Sheila Peace, eds., pp. 13ᾢ25. London: Sage PublicationsGoogle Scholar
  4. Barret, Robert 1998 The ‘Schizophrenic’ and the Liminal Persona in Modern Society. Culture, Medicine and Psychiatry 22(4): 465–494CrossRefGoogle Scholar
  5. Boltanski, Luc, and Laurent Thévenot 1998 Des Justifications: Les Économies de la Grandeur. Paris: Editions GallimardGoogle Scholar
  6. Borgesisus, Els 1988 Tussen Therapie en ‘Gewoon Doen’. Het Werk van Psychiatrisch Verpleegkundigen. Tijdschrift voor Ziekenverpleging 42(25): 808–810PubMedGoogle Scholar
  7. Borgesisus, Els, Jacomine de Lange, and Pauline Meurs 1988 Verpleegkundigen Zonder Uniform. Over de Pluriformiteit van het Beroep van Psychiatrisch Verpleegkundigen. Lochem: De TijdstroomGoogle Scholar
  8. Boschma, Geertje 1997 Creating Nursing Care for the Mentally Ill. Mental Health Nursing in Dutch Asylums 1890–1920. Ph.D. dissertation, Nursing University of PennsylvaniaGoogle Scholar
  9. Boschma, Geertje 2003 The Rise of Mental Health Nursing: A History of Psychiatric Care in Dutch Asylums 1890–1920. Amsterdam: Amsterdam University PressGoogle Scholar
  10. Chiu, Edward, O. Jastrubetskaya, and M. Williams 1999 Psychosocial Rehabilitation of the Elderly with Mental Disorder: A Neglected Area in the Psychiatry of Old Age. Current Opinion in Psychiatry 12(4): 445–493CrossRefGoogle Scholar
  11. Constantinides, Pamela 1985 Women Heal Women: Spirit Possession and Sexual Segregation in a Muslim Society. Social Science and Medicine 21(6): 685–692CrossRefPubMedGoogle Scholar
  12. Dankers, Joost, and Jos van der Linden 1996 Van Regenten en Patiënten. De Geschiedenis van de Willem Arntsz Stichting: Huis en Hoeve, Van der Hoeven Kliniek en Dennendal. Amsterdam: BoomGoogle Scholar
  13. De Swann, Abram (see Swann, Abram de)Google Scholar
  14. Devisch, Renaat 1985 Polluting and Healing among the Northern Yaka of Zaire. Social Science and Medicine 21(6): 693–700CrossRefPubMedGoogle Scholar
  15. Douglas, Mary 1966 Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. London: Routledge and Kegan PaulGoogle Scholar
  16. Elias, Norbert 1976 Über den Prozess der Zivilisation. Soziogenetische und Psychogenetische Untersuchungen. Vol 1: Wandlungen des Verhaltens in den weltlichen Obersichten des Abendlandes. Vol 2: Wandlungen der Gesellschaft. Entwurf zu einer Theorie der Zivilisation. Baden-Baden: Suhrkamp Taschenbuch VerlagGoogle Scholar
  17. Estroff, Sue 1995 Brokenhearted Lifetimes: Ethnography, Subjectivity, and Psychosocial Rehabilitation. International Journal of Mental Health Care 24(1): 82–92Google Scholar
  18. Foucault, Michel 1985 The History of Sexuality Vol. II: The Use of Pleasure. New York: PantheonGoogle Scholar
  19. Foucault, Michel 1986 The History of Sexuality Vol. III: The Care of the Self. New York: PantheonGoogle Scholar
  20. Garfinkel, H. 1967 Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice HallGoogle Scholar
  21. Gastelaars, Marja 1994 Publiek Private Aangelegenheden. Een Essay over de Wc., Kennis and Methode 18(1): 69–89Google Scholar
  22. Gunsteren, van H.R. 1991 The Ethical Context of Bureaucracy and Performance Analysis. In The Public Sector-Challenge for Coordination and Learning. F. Kaufmann ed., pp. 309ᾢ325. Berlin: De GruyterGoogle Scholar
  23. Gunsteren, H.R. van 1992 Eigentijds Burgerschap. WRR-publikatie vervaardigd onder leiding van H.R. van Gunsteren. Wetenschappelijke Raad voor het Regeringsbeleid, ‘s-Gravenhage: SDU uitgeverijGoogle Scholar
  24. Law, John 1994 Organising Modernity. Oxford: Blackwell PublishersGoogle Scholar
  25. Maslow, Abraham 1970 Motivation and Personality. 2nd Edition. New York: Harper and RowGoogle Scholar
  26. Mol, Annemarie 1998 Missing Links, Making Links: The Performance of Some Atheroscleroses. In Differences in Medicine: Unraveling Practices, Techniques and Bodies. Berg Marc, Annemarie Mol, eds., pp.144ᾢ165. Durham: Duke University PressGoogle Scholar
  27. Mol, Annemarie 2002 The Body Multiple: An Ontology of Medical Practice. Durham: Duke University PressGoogle Scholar
  28. Nauta, Lolle W. 1992 Changing Conceptions of Citizenship. Praxis International 12(1): 21–34Google Scholar
  29. Pols, Jeannette 2006 Accounting and Washing: Good Care in Long-term Psychiatry. Science, Technology and Human Values. ForthcomingGoogle Scholar
  30. Pols, Jeannette, Marja Depla, and Jacomine de Lange 1998 Gewoon oud en Chronisch. Mogelijkheden en Beperkingen in de zorg voor Ouderen met een Psychiatrische Achtergrond in het Verzorgingshuis. Utrecht: Trimbos-instituut. Trimbosreeks 98–2Google Scholar
  31. Pols, Jeannette, Marja Depla, Harry Michon, and Hans Kroon 2001 Rehabilitatie als Praktijk. Een Etnografisch Onderzoek in Twee Psychiatrische Ziekenhuizen. Utrecht: Trimbos-instituutGoogle Scholar
  32. Rogers, Carl R. 1961 On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable and CoGoogle Scholar
  33. Swaan, de Abram 1988 In Care of the State. Cambridge: Polity PressGoogle Scholar
  34. Thompson, Catherine 1985 Perceptions of Female Power in a Hindu Village. Social Science and Medicine 21(6): 701–711CrossRefPubMedGoogle Scholar
  35. Tonkens, Evelien 1999 Het zelfontplooiingsregime. De actualiteit van Dennendal en de Jaren 60. Amsterdam: Bert BakkerGoogle Scholar
  36. Twigg, Julia 2000 Bathing: The Body and Community Care. London: RoutledgeGoogle Scholar
  37. Van Gunsteren, H.R. (see Gunsteren, H.R. van)Google Scholar
  38. Vigarello, George 1988 Concepts of Cleanliness: Changing Attitudes in France since the Middle Ages. New York: Cambridge University Press/Paris: Editions de la Maison des Sciences de l’HommeGoogle Scholar
  39. Watts F, Douglas Bennett, eds. 1983 Theory and Practice of Psychiatric Rehabilitation. Chichester: John Wiley and SonsGoogle Scholar
  40. Winance, Myriam 2001 Thèse et Prothèse. Le Processus d’Habilitation comme Fabrication de la Personne. L’Association Française contre les Myopathies Face au Handicap. Ph.D. dissertation, Department of Socio-Economie de l’Innovation, ENSMP, CSIGoogle Scholar
  41. Winance, Myriam 2002 The Making of the Person through the Process of ‘Habilitation.’ The French Muscular Dystrophy Association against Disabilities. Paper presented at the conference of the European Association for the Study of Science and Technology, York, August 2Google Scholar
  42. Withuis, Jolande 1990 Opoffering en heroiek. De mentale wereld van een Communistische vrouwenorganisatie in naoorlogs Nederland 1946–1976. Meppel/Amsterdam: BoomGoogle Scholar
  43. World Health Organization 1996 Psychosocial Rehabilitation. A Consensus Statement. Geneva: WHO/MNH/MND 96 (2)Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Department of General Practice, Clinical Methods and Public HealthAmsterdam Medical Center/University of AmsterdamAmsterdamThe Netherlands

Personalised recommendations