Advertisement

Culture, Medicine, and Psychiatry

, Volume 42, Issue 3, pp 584–604 | Cite as

“The Rowdy Ones:” Configurations of Difference in a Private Psychiatric Hospital

  • Seth Donal Hannah
Original Paper

Abstract

Drawing on participant-observation and semi-structured interviews, this paper examines the local forms of clinical practice in a 26-bed acute psychiatric inpatient unit located within a private psychiatric hospital in the Northeastern United States. It focuses on how clinicians, staff, and management understand and utilize the concepts of culture, race, and ethnicity in their daily work, finding that a humanistic approach to care that that treats patients as “individuals” was dominant. Clinicians and staff categorized patients using descriptive, behavior based categories including language, propensity for violence, and whether patients are “from the streets.” They also used additional forms of difference such as the patient’s pathway to care, their illness category or severity, and whether they use drugs. These forms of difference were shaped by the urgent needs of daily work. These local practices of categorization directly affected the quality of care when staff members assigned cultural characteristics to group members and treated them differently as a result. These findings suggest that anthropologists and clinicians should focus on the way new forms of cultural difference are constructed in small social settings in order to provide equitable treatment to all patients.

Keywords

Social categorization Psychiatry Culture Diversity Health care disparities 

Notes

Funding

This study was funded by the Russell Sage Foundation, Grant Number 87-05-03.

Compliance with Ethical Standards

Conflict of interest

The author declares that has no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Agamben, Giorgio 1995 Homo sacer Il potere sovrano e la nuda vita.Google Scholar
  2. Barth, Fredrik. 1969. Ethnic Groups and Boundaries: The Social Organization of Culture Difference. Boston: Little, Brown.Google Scholar
  3. Blalock, Hubert. 1967. Toward a Theory of Minority-Group Relations. Wiley: New YorkGoogle Scholar
  4. Blumer, Herbert. 1958. “Race Prejudice as a Sense of Group Position.” The Pacific Sociological Review 1(1): 3-7.CrossRefGoogle Scholar
  5. Brodwin, Paul. 2012. Everyday Ethics: Voices from the Front Line of Community Psychiatry. University of California Press, Berkeley.Google Scholar
  6. Brubaker, Rogers. 2009. “Ethnicity, Race, and Nationalism.” Annual Review of Sociology 35:21-42.CrossRefGoogle Scholar
  7. Butler, Judith. 2005. Giving an Account of Oneself. New York: Fordham University Press.CrossRefGoogle Scholar
  8. Carpenter-Song, Elizabeth. 2009. “Caught in the Psychiatric Net: Meanings and Experiences of ADHD, Pediatric Bipolar Disorder and Mental Health Treatment Among a Diverse Group of Families in the United States.” Culture, Medicine, and Psychiatry 33:61-85.CrossRefGoogle Scholar
  9. Carpenter-Song, Elizabeth 2011 Recognition in Clinical Relationships: Theorizing “Good Doctors” and “Good Patients”. In Shattering Culture: American Medicine Responds to Cultural Diversity. Mary-Jo DelVecchio Good, Sarah S. Willen, Seth Donal Hannah, Ken Vickery and Lawrence Taesing Park, eds., pp. 35–69. New York: Russell Sage Foundation.Google Scholar
  10. Estroff, Sue. 1981. Making it Crazy: An Ethnography of Psychiatric Clients in an American Community. Berkeley: University of California Press.Google Scholar
  11. Fortin, Sylvie. 2006. “Urban Diversity and the Space of the Clinic. Or When Medicine Looks at Culture.” Medische Antropologie 18(2): 365-385.Google Scholar
  12. Foucault, Michel. 1965. Madness and Civilation: A History of Insanity in the Age of Reason. New York: Random House, Inc.Google Scholar
  13. Gaines, Atwood D., 2005. “Race: Local Biology and Culture in Mind,” in A Companion to Psychological Anthropology: Modernity and Psychocultural Change, edited by Conerly Casey and Robert Edgerton, 274-297. Malden, MA: Blackwell Publishing.CrossRefGoogle Scholar
  14. Gates, Henry Luis Jr. 2012 Finding Your Roots with Henry Louis Gates, Jr. Public Broadcasting Service Television Series.Google Scholar
  15. Goffman, Erving. 1961. Asylums: Essays on the Social Situaiton of Mental Patients and their Other Inmates. Aldine: Aldine Publishing Company.Google Scholar
  16. Gone, Joseph, ed. 2015 Evidence-Based Practice and Cultural Competence, Transcultural Psychiatry 52(2) Special Issue.Google Scholar
  17. Good, Byron J. 1977. “The Heart of What’s the matter: The Semantics of Illness in Iran.” Culture, Medicine, and Psychiatry 1(1): 25-58.CrossRefGoogle Scholar
  18. Good, Mary-Jo DelVecchio. 1995. American Medicine, the Quest for Competence. Berkeley: University of California Press.CrossRefGoogle Scholar
  19. Good, Mary-Jo DelVecchio, Cara James, Byron J. Good, and Anne E. Becker 2003 The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcre. In Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. B. D. Smedley, Adrienne Y. Stith, Alan R. Nelson, eds., 594–625. Washington, D.C.: National Acadamies Press.Google Scholar
  20. Good, Mary-Jo DelVecchio, Sarah S. Willen, Seth D. Hannah, Ken Vickery, and Lawrence T. Park, eds. 2011 Shattering Culture: American Medicine Responds to Cultural Diversity. New York: Russell Sage Foundation.Google Scholar
  21. Good, Mary-Jo DelVecchio, and Seth D. Hannah. 2014. “’Shattering Culture’: Perspectives on Culture in and of Psychiatry in Relation to Cultural Competence and Evidence Based Practice in Mental Health Services.” Transcultural Psychiatry 52(2): 198-221.CrossRefGoogle Scholar
  22. Hannah, Seth D. 2011 “Clinical Care in Environments of Hyperdiversity.” In Shattering Culture: American Medicine Responds to Cultural Diversity. Mary-Jo DelVecchio Good, Sarah S. Willen, Seth Donal Hannah, Ken Vickery, and Lawrence Taesing Park, eds., pp. 35–69. New York: Russell Sage Foundation.Google Scholar
  23. Hannah, Seth. D., and Elizabeth Carpenter-Song. 2013. “Patrolling Your Blind Spots: Introspection and Public Catharsis in a Medical School Faculty Development Course to Reduce Unconscious Bias in Medicine.” Culture, Medicine, and Psychiatry 37(2):314-339.CrossRefGoogle Scholar
  24. Hunt, Linda M., Nicole D Truesdell, and Meta J. Kreiner. 2013. “Genes, Race, and Culture in Clinical Care.” Medical Anthropology Quarterly 27(2): 253-271.CrossRefGoogle Scholar
  25. Hunt, Linda M., and Meta J. Kreiner. 2013. “Pharmacogenetics in Primary Care: The Promise of Personalized Medicine and the Reality of Racial Profiling.” Culture, Medicine, and Psychiatry 37: 226-235.CrossRefGoogle Scholar
  26. Jenkins, Janis H., ed. 2010. Pharmaceutical self: The global shaping of experience in an age of psychopharmacology. Santa Fe: School for Advanced Research Press.Google Scholar
  27. Jenks, Angela. 2011. “From ‘Lists of Traits’ to ‘Open-Mindedness’: Emerging Issues in Cultural Competence Education. Culture, Medicine, and Psychiatry 35(2): 209–235.CrossRefGoogle Scholar
  28. Kirmayer, Laurence, ed. 2012 Rethinking Cultural Competence, Transcultural Psychiatry 49(2) Special Issue.Google Scholar
  29. Kirmayer, Laurence. 2013. “Embracing Uncertainty as a Path to Competence: Cultural Safety, Empathy, and Alterity in Clinical Training. Culture, Medicine, and Psychiatry 37(2): 365-372.CrossRefGoogle Scholar
  30. Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.Google Scholar
  31. Krieger, Nancy 2010 The Science and Epidemiology of Racism and Health Racial/Ethnic Categories, Biological Expressions of Racism, and the Embodiment of Inequality. In What’s the Use of Race?: Modern Governance and the Biology of Difference. Ian Whitmarsh and David S. Jones, eds., pp. 225–258. Cambridge, MA: MIT Press.Google Scholar
  32. Lamont, Michèle. 1992. Money, Morals, and Manners: The Culture of the French and American Upper-Middle Class. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  33. Martinez-Hume, Anna C., Allison M. Baker, Hannah S. Bell, Isael Montemayor, Kristan Elwell, and Linda M. Hunt. 2017. “’They Treat you a Different Way:’ Public Insurance, Stigma, and the Challenge to Quality Health Care.” Culture, Medicine, and Psychiatry 41: 161-180.CrossRefGoogle Scholar
  34. Meyers, Neely. 2015. Recovery’s Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville: Vanterbilt University Press.Google Scholar
  35. Mishler, Elliot. 1984. The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, N.J.: Ablex Pub. Corp.Google Scholar
  36. Omi, Michael, and Howard Winant. 1994. Racial Formation in the United States: from the 1960s to the 1990s. New York: Routledge.Google Scholar
  37. Rabinow, Paul. 1996. Essays on the Anthropology of Reason. Princeton, NJ: Princeton University Press.Google Scholar
  38. Rhodes, Lorna A. 1991. Emptying Beds: The Work of an Emergency Psychiatric Unit. University of California Press: Berkeley.Google Scholar
  39. Rhodes, Lorna A. 2004. Total Confinement: Madness and Reason in the Maximum Security prison. Berkeley: University of California Press.Google Scholar
  40. Santiago-Irizarry, Vilma. 2001. Medicalizing Ethnicity: The Construction of Latino Identity in a Psychiatric Setting. Ithaca, N.Y.: Cornell University Press.Google Scholar
  41. Shaw, Susan J. 2012. Governing How We Care: Contesting Community and Defining Difference in US Public Health Programs. Philadelphia, PA: Temple University Press.Google Scholar
  42. Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, ed. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academy Press.Google Scholar
  43. Tavory, Iddo. 2009. “Of Yarmulkes and Categories: Delegating Boundaries and the Phenomenology of Interactional Expectation.” Theory and Society 39(1):49-68.CrossRefGoogle Scholar
  44. van Ryn, Michelle. 2002. “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care.” Medical Care 40: 1-140.CrossRefGoogle Scholar
  45. Willen, Sarah S., and Elizabeth Carpenter-Song. 2013. “Cultural competence in action: “Lifting the hood” on four case studies in medical education.” Culture, Medicine, and Psychiatry 37(2): 241-252.CrossRefGoogle Scholar
  46. Wimmer, Andreas. 2009. “Herder’s Heritage and the Boundary-Making Approach: Studying Ethnicity in Immigrant Societies.” Sociological Theory 27(3): 244-270.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Social Sciences DepartmentCalifornia Polytechnic State UniversitySan Luis ObispoUSA

Personalised recommendations