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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Elizabeth Anne Davis' book is about the psychiatric reform in Greece and its primary task of deinstitutionalization that followed the movements of political liberation worldwide since the 1950s. The main aim of the book is to call attention to how psychiatric diagnosis is speculative in its very nature and how clinical encounters entailed a certain amount of "communicative ambiguity" (p.4) -- an ambiguity that seems in the view of the author to be engrained in all verbal communication due to what Foucault calls "suspiciousness of language" (p.244). Due to the "suspicious" character of language, Davis considers the interpretation of both paradigms of clinical speech, of diagnosis so much as of encounters between therapists and patients or even family members, as an "enactment of power" (p.65). This conclusion leads the author to deduce that the relationships generated from such encounters were "primarily and fundamentally moral" (p.159), thus raising to all participants the issue of responsibility.
The psychiatric reform in Greece inaugurated after the fall of the dictatorship in 1974, required the devolution of psychiatric care from large, inpatient, custodial hospitals to outpatient, community-based services. The author is considered mostly with the psychiatric reform as it took place in Thrace, a rural region in northeastern Greece including a great number of minority groups such as Turks, Gypsies, Pomaks and Pontii, which remained to a great extent isolated from Greek society. The book is divided in three sections, each interspersed with actual cases of people in treatment and their therapists that the author came to know during her research in Greece. A narration of those stories appears in tandem with her proposed subject of madness and responsibility in modern Greece.
In the first section Elizabeth Anne Davis deals with the issue of deception. In their clinical engagement with therapists, patients sometimes raised illegitimate demands, using lying in order to secure the fulfillment of a variety of needs such as housing, disability income or exemption from military service. Therapists were reluctant either to discharge such demands as deceptive or to validate them as legitimate and thus raised in their turn suspicions of deception on behalf of their patients. It is the author's view that such suspicions of deception were a diversion of responsibility from both sides. Patients behind and despite their ruses and manipulations secretly wished for the perpetuation of their therapy and their dependence on their therapists. Therapists in their part refused to make definite decisions in the interest of avoiding responsibility for them.
In the second section the author confronts the problems raised by the cultural diversity of minority groups in Thrace. Most of these groups belonged to what she called -quoting Livaditis --"sociocentric" communities and constituted "referential/relational selfhood(s)" (p.132).[ (This terminology appears in a study coauthored by Miltos Livaditis, cf. Androutsopoulou, C., et al. (2002) "Psychological Problems in Christian and Moslem Primary Care Patients in Greece" International Journal of Psychiatry in Medicine 32 (3): 286).] They had thus difficulties integrating in Greek society, often exhibiting a deviant social identity that included "chronic unemployment", "evasions of compulsory education and military service" that sometimes led to "outright criminal activity" (p.158). More often than not they were diagnosed as "antisocial personalities" and had their culture itself turned into pathology. Psychiatrists according to the author distanced themselves from the social dimension of the problem, claiming to be "impersonal guardians of scientific knowledge" (p.159). Minority groups on the other hand claimed themselves victims of the state and of medical healthcare. These relationships were mainly moral in Davis' view, because they actually preserved a mutual dependency.
In the third and last section the author deals with the impasse mental healthcare itself was faced in the cases of severe pathology, where compulsory treatment contravened with the demand for personal freedom and the right to autonomy. According to the author, Greek law authorizes compulsory treatment in two cases: when a patient is considered a danger to self and/or others or when a patient's mental health is bound to deteriorate if he/she does not receive the appropriate treatment. This double requirement is a real deadlock considering these cases where freedom itself is negated in the name of the best possible care. Davis claims that psychiatrists themselves are responsible for developing "an ad hoc rationale for this judgment" (p.203) -- that is for developing an etiology that allows them to both treat patients and respect their personal freedom.
Elizabeth Anne Davis' book is a combination of a preeminent narrative of the research she conducted in person as a cultural anthropologist in Thrace at the time of psychiatric reform and of her thoughts about madness and responsibility generated from that research. The narrative, exceptionally engaging though it may be, finds the reader somehow perplexed with the proposed theme which is actually not stated very clearly, as it extends to a single paragraph in the Introduction (p.4). The title of the book remains for a great part the main guide as to what the book wants to argue about, as this is not particularly imparted to the reader from the beginning.
Davis intersperses her book with her own thoughts on madness and responsibility rather than systematically presenting them in an integrated argument. A less scattered analysis might have made the main point clearer and thus open for further and perhaps more prolific discourse. For example it is claimed, with a precision of thought and with a great insight, that clinical encounters are moral because they stem from issues of responsibility that Davis identifies and thoroughly describes. A little space is dedicated though to considering what morality entails and how we as theorists and those working in mental healthcare have delimited the concept responsibility. This inhibition deprives us of further discussions on Davis' indeed penetrating insight on the morality of dependency in modern Greece.
Τo conclude some revisions need to be made in a limited number of Greek renderings of English words and phrases. This need is vindicated on the author's decision to include these renderings, as she herself says, in order "to facilitate the comprehension and evaluation of modern Greek readers" (p. vii). In p.77 it is said "to reveal to the other [να ανακαλύψει στον άλλον]" when the correct translation is "να αποκαλύψει στον άλλον", in p.129 "(στενοχωρημέν)" should be "στενοχωρημένη", in p.141 "of Turko-Gypsy descent (τουρκο-γύφτης καταγωγής)" is "τουρκογύφτικης καταγωγής" and "culture-economic/social status [κουλτούρα-οικονομική/κοινωνική κατάσταση" is "πολιτισμικο-οικονομική/κοινωνική κατάσταση". In p.149 "swelling" is rendered as "(φούσκωση)" when the correct translation is "οίδημα", in p.155 "preclusions [αποκλεισμές]" is "αποκλεισμούς/εξαιρέσεις", in p.175 "mixed up (θόλος)" is "συγκεχυμένος" and finally in p.235 "obsessive/compulsive disorder (ψυχανανγαστική/κατανανγαστική διαταραχή)" is correctly written as "ψυχαναγκαστική/καταναγκαστική διαταραχή".
© 2013 Galateia Kapralou
Galateia Kapralou, Ph.D. Panteion University of Athens
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