Patienthood Today: Exploring Normative Injunctions and Resistance in Two Ontarian Psychiatric Services
The shift towards deinstitutionalization of mental health services and socio-normative transformations towards a society based on ideals of autonomy, individual responsibility and personal initiative that occurred in the mid-late 20th century serves as a background for this study. In contrast with earlier, passive conceptions of the patient, patients nowadays are expected to play an active role not only in their own treatment, but in a broader sense within the system. These ideals are encouraged by approaches such as empowerment, recovery and patient participation. This shift towards a more “active” patient was the focus of this ethnographic research informed by Goffman’s (1961) concept of the moral career and Foucault’s (1975) works on social norms.
My research was conducted within two research sites: an inpatient acute mental health unit, and a “client advisory council” of a tertiary mental health institution. In the inpatient unit, patients must work towards becoming autonomous in regard to their mental health, while at the same time conforming to expectations of adherence and collaboration with the mental health team.
In the advisory council, a small number of past and current patients take on an emerging role representing patients’ interests. While the council expressed that their contributions led to some changes in the institution, they also experienced situations in which institutional constraints prevented them for effecting larger changes. Council members were implicitly and explicitly expected to support institutional objectives and values, notably through the construction of a legitimizing narrative promoting the image of an “ideal” patient. These two sites will allow me to depict two possible “figures” of the contemporary patient which can be placed on a spectrum between individual activation and collective/systemic activation.