Author:Elizabeth Davis (Princeton University)
Paper short abstract:
This paper is drawn from field research on psychiatric reform and community-based care in Greece. It addresses therapeutic contracts used to foster patients' responsible participation in treatment.
Paper long abstract:
Since the international movement for patients' rights began, law has played a perplexing role in mediating conflicts over responsibility for the mentally ill. In Greece, this contention has been shaped by the "democratic experiment" of psychiatric reform, designed and funded largely by the European Union, following a series of humanitarian scandals in Greek psychiatric hospitals. As elsewhere, psychiatric reform in Greece has aimed to shift treatment from custodial hospitals to outpatient settings, challenging patients to help care for themselves. This paper, grounded in field research in Thrace, addresses one therapeutic technique used to foster patients' responsible participation in treatment: the therapeutic contract, which attaches legalistic determinants to the responsibilities patients and therapists bear to each other. Exploring the experiences of two patients who entered therapeutic contracts at moments of crisis in their treatment, I argue that these contracts generated intractable debts and dependencies that could not be resolved in therapy. I explore these patients' "illiberal" reckonings of obligation that were occluded by the transactional frame of therapeutic ethics defined by their contracts.
Crisis and resolution: imagination and the transformation of psychiatric care