Power and the Psychiatric Apparatus by Dave Holmes & Jean Daniel Jacob & Amélie Perron

Author:Dave Holmes & Jean Daniel Jacob & Amélie Perron
Language: eng
Format: epub
Publisher: Ashgate Publishing Ltd.
Published: 2014-04-25T04:00:00+00:00

Reproducing the Biomedical Hegemony

In 1979, Jeffery spoke of illness as a “morally ambiguous condition” (p. 90), one that is negotiated within the medical encounter and inevitably bound to the context in which it is experienced. His analysis of ED patients reminds us of the fragile conception of belonging by exposing divisive practices that situate patients on opposite ends of a continuum—either good (interesting) or bad (rubbish)—and thus assigning them a “prognostic place” (Murray 2009: 8) in the vast healthcare infrastructure. As Jeffery (1979) notes, emergency departments tend to favor certain forms of illness over others. We quickly realize that with specialized knowledge also come specific forms of language, organization, spatial formation, and practices of differentiation and exclusion. The “smelly,” the “dirty,” and the “mentally ill” patients are often constituted through this knowledge, and are construed as being a difficult fit in medical emergency departments. This results in the subsequent production of boundaries (real and virtual) between patients of (dis)interest and the rest of the ED patients. Inadvertently, the ways by which we come to conceptualize patients end up defining us as health care providers—the way we define health and good practices. The implicit danger in the way we come to define “Others” is that we may experience these classifications as natural, necessary, and true—that is, they will constrain what we are permitted to think, say, feel, and do in any given situation (Murray 2009).

Along with Jeffery (1979), we may think of the ED as a place of biomedical hegemony. Evidently, psychiatric presentations (acute psychosis, odd behaviors, severe distress, and harm both to self and others) pose significant concerns to emergency department staff who often feel they lack the skills to address the needs of this clientele and, as a result, reinforce a divisive and controlling/coercive culture of care (Clarke et al. 2005, McArthur and Montgomery 2004). Uncertainty with psychiatric presentations, both in terms of validity of symptoms and of ways in which they can be dealt with in the ED, may foster frustration and hostility from staff towards patients (Jeffery 1979). We are thus inclined to think of the PED itself as Other, because psychiatric complaints, assessments, and treatment disrupt the normal flow of the ED as they do not fit within its dominant biomedical orientation (Clarke et al. 2005). As the results of this research indicate, there is a tension between the ED and PED in which psychiatric patients may be seen as taking up much needed space. In parallel, however, psychiatric staff are valued for their capacity to help secure the environment—a capacity we speculate contributes to reinforcing views that psychiatric patients need to be contained and restrained.

The medical side often perceives psychiatry as taking up beds which could be used for their medical cases. Some lack knowledge regarding psychiatry. But when there’s a code, they’re happy that we’re always there to fix the problem, from medication to restraints and securing the environment. (Nurse)

Despite clear distinctions between “ideal” ways of working with psychiatric patients in the ED, reproduction of the biomedical discourse within the PED remains pervasive.

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