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Accepted Paper:
The crisis of futility: clinical ethnography and the moral landscape of community psychiatry
Paul Brodwin
(University of Wisconsin-Milwaukee)
Paper short abstract:
Futility is a crisis for clinicians; it disrupts the logic of care that grounds biomedical practice. But the crisis can inhere in routine technologies. Fieldwork in US community psychiatry shows how futility implicates the norms of chronicity and the history and micropolitics of work.
Paper long abstract:
This paper builds a fully ethnographic account of clinical futility. Treatment failure disrupts the logic of care (Mol 2008), and it provokes a crisis for front-line providers: it subverts the hegemony of hope common to biomedical settings, and it pushes people to question the moral legitimacy of their work. The genealogy of such crises depends on specific therapeutic ideologies and technologies. A two-year ethnography of Assertive Community Treatment (a popular mental health service model in the US and UK) reveals how the technologies for everyday work enforce a mandatory narrative of progress. This temporal structuring creates an impasse for clinicians when treatments fail. Their readiness to intervene is a habitual disposition, in Bourdieu's sense. When ACT providers cannot alter the course of disease, they struggle with a mismatch between their trained disposition and the real opportunities to act. The mismatch - and crisis of futility - implicates the biopsychiatric construction of chronicity, the faultlines of mental health services, and the local micropolitics of work.
Medical knowledge, health, crises, and processes of diversification
Session 1