Research project Psychiatry and pastoral power

This thesis is about Swedish contemporary inpatient psychiatric care and power. While all forms of care involve some form of power, this is even more evident in inpatient psychiatric care. Within such care, a person can be cared for against their will if they suffer from a serious mental disorder, are considered to have an indispensable need for this type of care and resist voluntary care (the Compulsory Psychiatric Care Act 1991:1128). This thesis is concerned with the exercise of power that combines good intentions and concern for others, where interventions in the lives of others are made for the good of the individual as well as society at large, here understood as pastoral power in the words of Foucault (1982, 1988). The health care system may legally re- strict people’s autonomy to promote health through, for example, compulsory care, as well as locked doors, common rules, and schedules. Meanwhile, the healthcare system is also mandated by law (e.g. the Patient Act 2014:821) to strengthen patients’ participation, that is, to promote autonomy and independence. Taken together, this thesis investigates this dilemma between coercion and intervention in the lives of others while promoting individual autonomy, which has been central to psychiatry historically, but ‘turned up a notch’ in neoliberal times.

The analysis takes its starting point from the fact that inpatient psychiatry is practiced and governed at different levels: international, national, local authority, regional and everyday levels. In addition to the first four levels, which regulate the everyday level, psychiatry is permeated by more general norms and ideas in society, such as discourses on the autonomous subject or popular cultural conceptions of mental illness and practices in psychiatry. The power relations that exist in psychiatry have an influence on all these levels and more general norms and are expressed in several ways at the everyday level. Empirically, the focus of this thesis is on the everyday life of the institution and how this micro-level interacts with the other levels via, for example, laws, governing documents, formalized care ideologies, care methods, and dominant cultural beliefs.

The aim of the thesis is to describe and analyze how pastoral power – a form of power that is characteristic of psychiatric care – is exercised in a con- temporary neoliberal context that includes hegemonic ideals of individual autonomy. Specifically, this study examines how pastoral power is expressed and what consequences it has for patients and staff in inpatient psychiatric care, as well as how it relates to other types of power that also take place within the framework of the organization and in the wider society.

The study primarily belongs to a qualitative research tradition with a focus on ethnographic methods. Thus, for the contextualization of the empirical data and findings, I have drawn on both historically oriented studies and ethno- graphic studies of contemporary health and social care institutions, primarily psychiatry. While previous studies have mainly focused on one party in power relationships in the context of healthcare, i.e. either the caregivers’ or the patients’ perspective, this thesis contributes with a nuance by focusing on both patients and staff perspectives. In addition, the study considers the different ‘levels’ of psychiatry, that is, micro and macro perspectives to broader the perspective of power in the meaning, how the psychiatry is governed and operates.