Real depression and clinical paternalism: an ethnography of the realness of depression diagnostics in Polish public health care
DOI:
https://doi.org/10.12775/lud105.2021.05Keywords
depression, diagnostics, postsocialism, reality, medical anthropologyAbstract
The article explores the cultural and economic dimensions in diagnosing depression in Polish psychiatric practice since the systemic transformation with a particular focus on strategies used by physicians. Based on ethnographic research in clinical settings, it discusses this issue in terms of realness and “realification” (urealnienie)– concepts referring to the relationship between categories of description and their objects. While the changes of diagnostic classifications since the 1990s had the explicit goal of tightening that relationship, in clinical practice it remains somewhat lose and unclear. What contributes to it is not just the specific ontology of mental disorders which is hard to reduce fully to objectively measurable symptoms, but several other factors: specific changes in the philosophy of diagnostic classifications and their complex nature as clinical, administrative and financial tools, as well as their referential nature, which connotes optimal, though unattainable, standards of care. It is also shaped by the pragmatics of clinical work and the patients’ limited resources, which render the diagnostics a tool of physicians’ “medical paternalism” – their informal, instrumental attempts to respond to the deficiencies of the system of care.
References
Adams, V. (Red.). (2016). Metrics: What Counts in Global Health. Duke University Press.
Barthes, R. (2012). Roland Barthes Efekt rzeczywistości (M. P. Markowski, Tłum.). Teksty Drugie, 4, 119–126.
Beer, M. D. (1996). The dichotomies: Psychosis/neurosis and functional/organic: a historical perspective. History of Psychiatry, 7(26), 231–255. https://doi.org/10.1177/0957154X9600702603
Béhague, D. P., & MacLeish, K. (2020). The Global Psyche: Experiments in the Ethics and Politics of Mental Life. Medical Anthropology Quarterly, 34(1), 5–20. https://doi.org/10.1111/maq.12570
Bemme, D., & Kirmayer, L. J. (2020). Global Mental Health: Interdisciplinary challenges for a field in motion. Transcultural Psychiatry, 57(1), 3–18. https://doi.org/10.1177/1363461519898035
Bowker, G. C., & Star, S. L. (1999). Sorting Things Out: Classification and Its Consequences. MIT Press.
Brenner, N., & Theodore, N. (2002). Cities and the Geographies of “Actually Existing Neoliberalism”. Antipode, 34(3), 349–379. https://doi.org/10.1111/1467-8330.00246
Burawoy, M., & Lukács, J. (1992). The Radiant Past: Ideology and Reality in Hungary’s Road to Capitalism. University of Chicago Press.
Burri, R. V., & Dumit, J. (2007). Biomedicine as Culture: Instrumental Practices, Technoscientific Knowledge, and New Modes of Life. Routledge.
Chodoff, P. (2002). The Medicalization of the Human Condition. Psychiatric Services.
Clarke, A. E., Shim, J. K., Mamo, L., Fosket, J. R., & Fishman, J. R. (2003). Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine. American Sociological Review, 68(2), 161–194. https://doi.org/10.2307/1519765
Collier, S. (2005). Budgets and biopolitics. W A. Ong & S. Collier (Red.), Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems (s. 373–390). Blackwell Publishing.
Collier, S. (2011). Post-Soviet Social: Neoliberalism, Social Modernity, Biopolitics. Princeton University Press.
Conrad, P., & Schneider, J. W. (1980). Deviance and Medicalization: From Badness to Sickness. Mosby.
Das, V., & Das, R. K. (2006). Pharmaceuticals in Urban Ecologies: The Register of the Local. W A. Petryna, A. Lakoff, & A. Kleinman (Red.), Global Pharmaceuticals: Ethics, Markets, Practices (s. 171–205). Duke University Press.
Davis, E. A. (2012). Bad Souls: Madness and Responsibility in Modern Greece. Duke University Press.
Dunn, E. C. (2008). Prywatyzując Polskę: O bobofrutach, wielkim biznesie i restrukturyzacji pracy (P. Sadura, Tłum.). Wydawnictwo Krytyki Politycznej.
Durkheim, É., & Mauss, M. (1963). Primitive Classification (R. Needham, Red.). The University of Chicago Press.
Fabian, J. (1983). Time and the Other: How Anthropology Makes Its Object (Repr. ed.). Columbia Univ. Press.
Faravelli, C., Ravaldi, C., & Truglia, E. (2005). Unipolar Depression. W E. J. L. Griez, C. Faravelli, D. J. Nutt, & J. Zohar (Red.), Mood Disorders: Clinical Management and Research Issues (s. 79–102). John Wiley & Sons.
Farmer, P. (2005). Pathologies of power: Health, human rights, and the new war on the poor: with a new preface by the author (2005 ed.). University of California Press.
Fisher, M. (2009). Capitalist realism: Is there no alternative? Zero Books.
Fisher, M. (2020). Realizm kapitalistyczny: Czy nie ma alternatywy? (A. Karalus, Tłum.). Instytut Wydawniczy Książka i Prasa.
Foucault, M. (1971). The Order of Things: An Archaeology of the Human Sciences: T. 1st American. Pantheon Books.
Foucault, M. (1980). The History of Sexuality. Volume 1: An Introduction. Vintage Books.
Freeman, D., & Garety, P. A. (2003). Connecting neurosis and psychosis: The direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy, 41(8), 923–947. https://doi.org/10.1016/S0005-7967(02)00104-3
Hacking, I. (1990). The Taming of Chance. Cambridge University Press.
Hacking, I. (2002). Historical Ontology. Harvard University Press.
Healy, D. (1997). The Antidepressant Era. Harvard University Press.
Horwitz, A. V., & Wakefield, J. C. (2007). The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford University Press.
ICD-10: International statistical classification of diseases and related health problems. (2011). World Health Organization.
Jutel, A., & Nettleton, S. (2011). Towards a sociology of diagnosis: Reflections and opportunities. Social Science & Medicine, 73(6), 793–800. https://doi.org/10.1016/j.socscimed.2011.07.014
Kiejna, A., Piotrowski, P., Adamowski, T., Moskalewicz, J., Wciórka, J., Stokwiszewski, J., Rabczenko, D., & Kessler, R. (2015). The prevalence of common mental disorders in the population of adult Poles by sex and age structure – an EZOP Poland study. Psychiatria Polska, 49, 15–27. https://doi.org/10.12740/PP/30811
Kleinman, A. (1986). Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China. Yale University Press.
Kokanovic, R., Bendelow, G., & Philip, B. (2013). Depression: The ambivalence of diagnosis. Sociology of Health & Illness, 35(3), 377–390. https://doi.org/10.1111/j.1467-9566.2012.01486.x
Lane, C. (2008). Shyness: How Normal Behavior Became a Sickness. Yale University Press.
Leder, S., Kuliszkiewicz, D., Grzelak, J., Hoser, J., & Potocka, A. (1968). Rozpowszechnienie zaburzeń nerwicowych wśród pracowników handlu m. St. Warszawy a czynniki społeczne. Psychiatria Polska, 2(4), 413–420.
Lévi-Strauss, C. (1963). Structural Anthropology. Basic Books.
Lévi-Strauss, C. (1966). The Savage Mind. University of Chicago Press.
Martin, E. (2007). Bipolar Expeditions: Mania and Depression in American Culture. Princeton University Press.
Matza, T. (2009). MOSCOW’S ECHO: Technologies of the Self, Publics, and Politics on the Russian Talk Show. Cultural Anthropology, 24(3), 489–522. https://doi.org/10.1111/j.1548-1360.2009.01038.x
Matza, T. A. (2018). Shock Therapy: Psychology, Precarity, and Well-Being in Postsocialist Russia. Duke University Press.
Metzl, J. (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease (1St Edition). Beacon Press.
Mol, A. (2002). The Body Multiple: Ontology in Medical Practice. Duke University Press.
Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice. Routledge.
Moskalewicz, J., Kiejna, A., & Wojtyniak, B. (2012). Kondycja psychiczna mieszkańców Polski: Raport z badań „Epidemiologia zaburzeń psychiatrycznych i dostęp do psychiatrycznej opieki zdrowotnej - EZOP Polska”. Instytut Psychiatrii i Neurologii.
Pickstone, J. V. (2001). Ways of Knowing: A New History of Science, Technology, and Medicine. University of Chicago Press.
Porter, T. M. (2000). Life Insurance, Medical Testing, and the Management of Mortality. W L. Daston (Red.), Biographies of Scientific Objects. University of Chicago Press.
Porter, T. M. (2006). Speaking Precision to Power: The Modern Political Role of Social Science. Social Research, 73(4), 1273–1294.
Potępa, E. (2021). Neurotyczna normalność: Realizm depresyjny i praktyki normalizacji depresji we współczesnej Polsce (3700-MGR-AL-280691) [Praca magisterska]. Uniwersytet Warszawski, Wydział „Artes Liberales”.
Rabinow, P. (1996). Artificiality and Enlightenment: From Sociobiology to Biosociality. W Essays on the Anthropology of Reason (s. 91–111). Princeton University Press.
Risør, M. B., & Nissen, N. (Red.). (2018). Diagnostic Fluidity: Working with Uncertainty and Mutability. URV.
Rose, N. (1989). Governing the Soul: The Shaping of the Private Self. Routledge.
Rose, N. (1996). Inventing Our Selves: Psychology, Power, and Personhood. Cambridge University Press.
Rose, N. (2006). Disorders Without Borders? The Expanding Scope of Psychiatric Practice. BioSocieties, 1, 465–484.
Rose, N. (2009). Normality and Pathology in a Biomedical Age. The Sociological Review, 57(2_suppl), 66–83. https://doi.org/10.1111/j.1467-954X.2010.01886.x
Rosenfeld, D., & Faircloth, C. (Red.). (2006). Medicalized Masculinities (annotated edition edition). Temple University Press.
Sokół, G. (2016). Working Through What Is: Depression and Agency in Poland’s 'New Reality" [Doctoral dissertation]. The New School for Social Research.
Ticktin, M. I. (2006). Where ethics and politics meet. American Ethnologist, 33(1), 33–49. https://doi.org/10.1525/ae.2006.33.1.33
Ticktin, M. I. (2011). Casualties of Care: Immigration and the Politics of Humanitarianism in France. University of California Press.
Witeska-Młynarczyk, A. (2019). Dziecięce doświadczenia ADHD: Etnografia spornej jednostki diagnostycznej. Oficyna Naukowa.
Wróblewski, M. (2018). Medykalizacja nadpobudliwości: Od globalnego standardu do peryferyjnych praktyk. Towarzystwo Autorów i Wydawców Prac Naukowych "Universitas.
Yurchak, A. (2006). Everything Was Forever, Until It Was No More: The Last Soviet Generation. Princeton University Press.
Žižek, S. (2008). The Sublime Object of Ideology. Verso.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 LUD. Organ Polskiego Towarzystwa Ludoznawczego i Komitetu Nauk Etnologicznych PAN
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
- The authors give the publisher (Polish Ethnological Society) non-exclusive license to use the work in the following fields:
- recording of a Work / subject of a related copyright;
- reproduction (multiplication) Work / subject of a related copyright in print and digital technique (ebook, audiobook);
- marketing of units of reproduced Work / subject of a related copyright;
- introduction of Work / object of related copyright to computer memory;
- dissemination of the work in an electronic version in the formula of open access under the Creative Commons license (CC BY - ND 3.0).
- The authors give the publisher the license free of charge.
- The use of the work by publisher in the above mentioned aspects is not limited in time, quantitatively nor territorially.
Stats
Number of views and downloads: 753
Number of citations: 0
