Att mötas i skarvarna – Svensk öppenvårdspsykiatri under formalisering

Abstract

The organisation of knowledge and practice within Swedish psychiatric outpatient-clinics is under transformation. Many of the changes, often characterised by standardisation, rationalisation and higher demands of efficiency, can be associated to the implementation of New Public Management (NPM) and Evidenced based medicine/practice (EBM-P). This study aims to explore the effects of the current knowledge and governance on the staff’s practice within psychiatry. Drawing on 13 interviews with staff from ten psychiatric outpatient clinics in four county councils, I analyse the intertwined processes of emotions and knowledge present in the staff’s practice of treating patients within the current governance. The material is analysed with theory from sociology of emotions, more specific structural and macro-level theory, with an integration of concepts of governmentality. I suggest that there is a pronounced disbelief in the governing and knowledge present among the staff, but that adaption still occur because of an internalised moral about the security of objectivity and standardisation as well as an established perception that previous governing of psychiatry was too autonomous and unsound. I argue that there’s ambivalence as well as opposition present among staff, sparked between an appreciation of the patients' subjective and relational needs and the current governing of psychiatry with ideals of formalisation. I also argue that this, through processes of deficits in trust, confidence and status, comes with emotional processes of distancing from the patient and from the presence of social injustice as a reason for suffering. Furthermore, I argue that the structural power of psychiatry is made partly invisible through the preoccupation with the considered risks of subjective emotions and relations, autonomous application of knowledge and through dislocating guilt to the patients and the staff.