What Counts, Who Counts? Standardization and emotional work in psychiatric care

Abstract

Work in the public health sector in Denmark (as well as in other European countries) has in the last 15-20 years been undergoing great changes due to ongoing rationalization under headings such as New Public Management, LEAN and Evidence Based Medicine. In this paper we focus on standardization as the heart of this process, and we scrutinize the complex ways that different forms of standardization affect work in a specific field, psychiatry. Psychiatric services comprise a special context for standardization. Psychiatry has a long history as a kind of stepchild of medicine, one of the reasons being the insistence on maintaining a humanistic focus, perceiving human beings as unique, and not whole-heartedly embracing the rational medical approach that categorizes humans based on diagnoses. Subsequently, work in psychiatric care in Denmark is often organized in interdisciplinary teams comprising social workers, care workers, nurses, psychologists and psychiatrists, all involved in work concerning diagnostics and treatment. This article explores how work in psychiatry is transformed through standardization. It takes inspiration from current theoretical discussions on standardization, professional identity and emotional work. The article illustrates how standardization both challenges the conceptions of what work in psychiatric care is about and consequently also strains social relations in the interdisciplinary team. In this way, standardization represents a push towards somatization or medicalization of psychiatry as an occupational field. The article also focuses on how emotional work, an important element of psychiatric work, is increasingly made invisible, and thus not counted or valued, and is not constituted as an object for professional development. The article is based on a case study of an ambulant unit within child psychiatry ‘producing’ diagnoses and treatment/education of children (and their families), using ethnographic field studies and semi-structured individual and group-based interviews.