Środowisko. Wykluczenie i reintegracja społeczna w praktyce psychiatrii środowiskowej
Community: Exclusion and social Reintegration in the Practice of Community Treatment in Psychiatry

Summary/Abstract: This paper is an attempt to analyze the problem of social exclusion and discrimination of persons with severe mental illnesses as a part of the experience of community psychiatry practitioners in Poland. It draws on ethnographic material collected during field research conducted from 2012 to 2014 in one of the psychiatric teams of community treatment in Bialystok. I focus on everyday practice, contextually shaped activities and the ethical perspective of the team’s therapists, confronted with the experience of illness, hospitalization and anticipated chronicity of psychiatric patients. The key aspect of the analyzed problem is chronicity as determined by medical, individual and social conditions. Chronicity includes consequences of mental illnesses and disorders, stigma associated with psychiatric hospitalization, mechanisms of discrimination, social exclusion and self-stigmatization. I refer to Paul Brodwin’s concept of the ethnography of futility, according to which the experience of psychiatry practitioners is determined by the internalized sense of inability to effectively improve patients’ health, the consequences of therapeutic limitations of psychiatry and the indefinite attachment of patients and their families to institutional psychiatry. Considered together, the experience of futility and the problem of chronicity allows us to explore the contradictions between practitioners’ everyday routines and the legitimizing discourse of psychiatry: between moral experience, care practice and real possibilities of therapy and effective reduction of social exclusion and discrimination.

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