May 17, 2022

Sociology

Fátima Alves e Sílvia Portugal

In Portugal and many European countries, mental illness care is frequently centred in the hospital. Although efforts have been made to deinstitutionalize, successive delays in restructuring services and little interest from the political, public, and scientific fields have contributed to the lesser visibility of what it means to experience mental illness, and other ways of dealing with it beyond psychiatry. This study contributes to shortening the knowledge gap and even though it is based on an ethnographic account of a hospital context, it documented the variety of activities practiced there and the multiplicity of combinations they assume according to the different parties involved, spaces and resources available, beyond the customary dynamic between psychiatrist, nurse and user. The analysis of the fieldwork notes registered during six months participant observation in two day-care units, in a Portuguese general hospital, is based on empirical ethics and method assemblage, therefore fitting in science and technology and material semiotics studies. I situate myself within a pragmatic and postmodern approach to mental illness, one where the research experience gives up on neutrality and interweaves the researcher's experience. This option, alongside its commitment with rigorous analysis, is rooted in an ethical posture present in every research phase and accepting of the methodological consequences it entails for the knowledge presented. In pursuit of my declared goal of studying what good care for severe mental illness meant and how it was reified in the lively practice of users, professionals and relatives, I have described and analysed activities related to food and drinking, psychiatric medication and performative care, have empirically identified the ethical ideals in the making and the tensions produced by different measures of what is good in the daily life of these units. From this analysis, I was able to identify the hospitals inside the hospital, that is four hospital repertoires based on four care dimensions: psychiatric, rehabilitative, recreational and collaborative. The latter is an emergent and less developed alternative for care practices, and it is set as a reconciliatory proposal between the different contributes and resources available in the remaining hospital compositions. Its advantage resides on weaving together several ideals and strategies to deal with mental illness and suggesting a constant intercommunication and knowledge adaptation inside a care collective, where the user is only one of the knots, according to the situation in need of improvement. Faced with the different modalities of good care identified, I conclude that this is a daily compromise between an idealised perfectness and a feasible present, within the material and symbolic conditions available at each moment. Hence, these may be as unfavourable inside a hospital institution as in the community to which mental health policies are directed, whenever a negotiation of the norms of belonging, action and thinking is not sought for as to include who and what is different.

Keywords: mental illness; good care; ethnography; daily life; empirical ethics