Paper short abstract:

Drawing on fieldwork in community psychiatry in Tokyo, this paper asks how clinicians attempt to realize the values of their own profession in relationships with communities.  To do so, clinicians reinterpret the notion of clients' rights, which remains contested in psychiatric settings.

Paper long abstract:

Against the backdrop of the structural and institutional limitations clinicians face, and as psychiatry both expands its sphere of recognition and is increasingly critiqued globally, how do clinicians negotiate their own values in the process? Drawing on fieldwork in community psychiatry in impoverished areas of Tokyo, this paper responds to this question. Though in the U.S. the deinstitutionalization movement from the 1960s established community psychiatry, the shift also created new problems such as mass institutional closings. By contrast, in Japan, a strong antipsychiatry movement from the 1960s ultimately failed to bring deinstitutionalization. As a result, Japan now has the largest number of long-term psychiatric beds per population among OECD countries. Yet, with policy have changed from the 2000s towards shorter hospitalization, some clinicians have begun to shift toward community psychiatry and are exploring new values that psychiatry can stand for as they try to reestablish clients’ rights. However, clinicians face several setbacks: economic constraints of their institutions; the fact that the notion of rights remains a polysemous concept; and the struggle against contestations around the notion of rights as it tends to evoke a complex feeling of inferiority in clients. In this context, Clinicians often face ideological conflicts about what constitutes “rights” for their clients and ask themselves what it means to respect their autonomy/ agency. This paper thus explores how clinicians redefine and reinterpret the notion of rights, as they attempt to realize the values of their own profession in relationships with communities.