Skip to main content
SpringerLink
Log in

Cultivating vagueness to treat the severely mentally ill

  • Original Article
  • Published:
Social Theory & Health Aims and scope Submit manuscript

Abstract

Classification systems have been widely discussed in psychiatric discourse and practices. Though criticized for their hegemonic and regulative implications, they nevertheless seem an unavoidable part of grasping and organizing life. This article aims to outline two different ways of dealing with classifications within the psychiatric daily routine. It attempts to demonstrate how certain types of knowledge, particular ideas regarding patient–professional relationships and the strict repertoire of therapeutic interventions are firmly entrenched within two different habits of diagnosing. Schofield's notion of the vague is introduced as a way of making sense of the institutional and individual-related factors that may have contributed to the diverging courses and outcomes of both therapeutic regimes. It provides a heuristic metaphor through which one might question the institutionalized treatment settings for treating the severely mentally ill.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Medicalization, as Conrad and others have noted, is never a one-sided process (Conrad, 1992; Bowker and Leigh Star, 2000; Martin, 2007). Patients and lay interests frequently play a significant role, and medicalization must be regarded as emerging out of interactive practices, not only as a hegemonic, imperialist endeavor of the professionals. We must therefore question simplistic top-down approaches that would imply that classifications are imposed upon patients by means of regulatory power and authoritative control. Taussig (1992) demonstrates how domination is often not transmitted through ideologies of those at the center, but through the fantasies of the marginalized. He frames his concept within the concept of fetishism, rendering power to a self-fulfilling fantasy, projected from the periphery to an imagined center rather than radiating outward from it.

  2. Classificatory manuals are technologies intended to discipline human differences (Luhrmann, 2000; Emrich, 2004; Martin, 2007). They make suffering comparable, though they fundamentally differ with regard to intensity, quality, length of duration and phenomenology. In producing a ‘standard taxonomy’ (Martin, 2007), they facilitate communication, allowing for a translation of individual suffering across many settings. Thus, they enable the easy juxtaposition of inherently idiosyncratic experiences and the interests of pharmaceutical companies, public health agencies and global statistics – certainly at the expense of contextualization and individualization processes.

References

  • Adler, L., Dumke, H. and Peukert, R. (2005) Chronisch psychisch krank – chronisch schlecht versorgt? Regensburg, Germany: Roderer Verlag.

    Google Scholar 

  • Anderson, H. (2008) Kollaborative Praxis – eine Antwort auf eine sich schnell ändernde Welt. Sythema 3 (22): 198–215.

    Google Scholar 

  • Benkel, T. (2007) Das Andere der Differenz. Zur Relativität von Gegensatzkonstruktionen am Beispiel des Diskursnetzes: Wahnsinn/Vernunft. Psychologie & Gesellschaftskritik 122/123 (31): 157–185.

    Google Scholar 

  • Bock, T. (2004) Eigensinn und Psychose. In: T. Bock, K. Dörner and D. Naber (eds.) Anstöße. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Bowker, G. and Leigh Star, S. (2000) Sorting Things Out. Classification and its Consequences. Cambridge, MA: MIT Press.

    Google Scholar 

  • Charmaz, K. (2000) Experiencing chronic illness. In: G.L. Albrecht, R. Fitzpatrick and S.C. Scrimshaw (eds.) The Handbook of Social Studies in Health and Medicine. Thousand Oaks, CA: Sage Publications Ltd. pp 277–292.

    Chapter  Google Scholar 

  • Combs, G. and Freedman, J. (2002) Relationships, not boundaries. Theoretical Medicine 23 (3): 203–217.

    Article  Google Scholar 

  • Conrad, P. (1992) Medicalisation and social control. Annual Review of Sociology 30 (11): 209–232.

    Article  Google Scholar 

  • Coultier, J. (1973) Language and the conceptualization of meaning. Sociology 7 (2): 173–189.

    Article  Google Scholar 

  • De Certeau, M. (1984) The Practice of Everyday Life. Berkeley, CA: University of California Press.

    Google Scholar 

  • Dörner, K. (2004) Verantwortung vom Letzten her. In: T. Bock, K. Dörner and D. Naber (eds.) Anstöße. Zu einer antropologischen Psychiatrie. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Douglas, M. (1966) Purity and Danger – An Analysis of the Concept of Pollution. London: Routledge.

    Book  Google Scholar 

  • Emrich, H. (2004) Das Gefühlhafte der Wirklichkeitserfahrung. In: T. Bock, K. Dörner and D. Naber (eds.) Anstöße. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Fengler, C. and Fengler, T. (1980) Alltag in der Anstalt. Wenn Sozialpsychiatrie praktisch wird. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Fischer, K. (2009) Wege aus psychotischen Krisen jenseits der psychiatrischen Versorgung. Forum Gemeindepsychologie 14.

  • Floeth, T. (1991) Ein bisschen Chaos muss sei. Die psychiatrische Akutstation als soziales Milieu. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Foucault, M. (1988) Die Geburt der Klinik. Eine Archäologie des ärztlichen Blicks. Frankfurt am Main: Suhrkamp.

    Google Scholar 

  • Goffman, E. (1961) Asylums. New York: Anchor.

    Google Scholar 

  • Greenspan, M. (1996) Out of bounds. In: K. Ragsdale (ed.) Boundary Wars. Intimacy and Distance in Healing Relationships. Cleveland, OH: Pilgrim Press.

    Google Scholar 

  • Hacking, I. (2006) Kinds of people: Moving targets. British Academy Lecture. Accessed 13 April 2006.

  • Haraway, D. (1991) Simians, Cyborgs and Women: The Reinvention of Nature. New York: Routledge.

    Google Scholar 

  • Heyward, C. and Harrison, B. (1996) Boundaries: Protecting the vulnerable or perpetrating a bad idea? In: K. Ragsdale (ed.) Boundary Wars: Intimacy or Distance Within Healing Relationships. Cleveland, OH: Pilgrim Press.

    Google Scholar 

  • Illouz, E. (2008) Die Errettung der modernen Seele. Frankfurt, Germany: Suhrkamp.

    Google Scholar 

  • Kagitcibasi, C. (2005) Autonomy and relatedness in cultural context. Journal of Cross-Cultural Psychology 36 (4): 403–422.

    Article  Google Scholar 

  • Keupp, H. (1993) Die (Wieder-)Gewinnung von Handlungskompetenz. Empowerment in der psychoszialen Praxis. Verhaltenstherapie und psychosoziale Praxis 3 (2): 365–381.

    Google Scholar 

  • Knuf, A., Osterfeld, K. and Seibert, U. (2007) Selbstbefähigung fördern. Empowerment und psychiatrische Arbeit. Bonn, Germany: Psychiatrie Verlag.

    Google Scholar 

  • Kupke, C. and Heiter, B. (2009) Andersheit, Fremdheit, Exklusion. Berlin Germany: Parodos.

    Google Scholar 

  • Latour, P. (1998) Wir sind nie modern gewesen. Versuch einer symmetrischen Anthropologie. Köln, Germany: Fischer.

    Google Scholar 

  • Latour, P. (2002) Pandora's Hope. Essays on the Reality of Science Studies. Boston, MA: Harvard University Press.

    Google Scholar 

  • Lester, R. (2009) Brokering authenticity. Current Anthropology 50 (3): 281–301.

    Article  Google Scholar 

  • Lock, M. (1993) Cultivating the body: Anthropology of epistemologies of bodily practice and knowledge. Annual Review of Anthropology 22: 133–155.

    Article  Google Scholar 

  • Lock, M. and Farquhar, J. (eds.) (2007) Introduction. In: Beyond the Body Proper. Durham and London: Duke University Press.

    Google Scholar 

  • Luhrmann, T. (2000) Of Two Minds. An Anthropologist Looks at American Psychiatry. New York: Vintage Books.

    Google Scholar 

  • Lütjen, R. (2007) Psychosen verstehen. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • Martin, E. (2007) Bipolar Expeditions. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • McMillan, M. (2004) The Person-Centred Approach to Therapeutic Change. London: Sage-Publication.

    Google Scholar 

  • Michael, M. (1996) Constructing Identities. London: Sage Publications.

    Google Scholar 

  • Miller, V. (2006) The unmappable. Vagueness and spatial experience. Space and Culture 9 (4): 453–467.

    Article  Google Scholar 

  • Mol, A. (2006) The Multiple Body: Ontology in Medical Practice. Durham, NC: Duke University Press.

    Google Scholar 

  • Mol, A. and Law, J. (2004) Embodied action, enacted bodies: The example of hypoglycaemia. Body and Society 10 (2–3): 43–62.

    Article  Google Scholar 

  • Rose, N. (1998) Inventing Our Selves, Psychology, Power and Personhood. Cambridge: Cambridge University Press.

    Google Scholar 

  • Schofield, B. (2003) Re-instating the vague. The Sociological Review 51 (3): 321–338.

    Article  Google Scholar 

  • Taussig, M. (1992) The Nervous System. London, NY: Routledge.

    Google Scholar 

  • Taussig, M. (2007) Tactility and distraction. In: M. Lock and J. Farquhar (eds.) Beyond the Body Proper. Durham, NC: Duke University Press.

    Google Scholar 

  • Utschakowski, J., Sielaff, G. and Bock, Th. (2009) Vom Erfahrenen zum Experten. Wie Peers die Psychiatrie verändern. Bonn, Germany: Psychiatrie-Verlag.

    Google Scholar 

  • van Loon, J. (2002) Social spatialization of everyday life. Space and Culture 5 (2): 88–95.

    Article  Google Scholar 

  • von Peter, S. (2010) The temporality of ‘chronic’ mental illness. Culture, Medicine and Psychiatry 34 (1): 13–28.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital Neukoelln, Schröderstrasse 11, Berlin, 10115, Germany

    S von Peter

Authors
  1. S von Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Peter, S. Cultivating vagueness to treat the severely mentally ill. Soc Theory Health 10, 141–155 (2012). https://doi.org/10.1057/sth.2011.23

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/sth.2011.23

Keywords

Search

Navigation