"There Are Clear Delusions." The Production of a Factual Account

Abstract

This paper presents a case study of a psychiatric intervention as an example of an institutional ethnography of psychiatric work. Institutional ethnography, a mode of inquiry outlined by Dorothy Smith (1987), is conceived here as an approach to the analysis of work in institutions as the contingent, local and context-bound insertion of a particular "case" - a patron, a pupil, a client, a patient - into both institutional and other social (e. g. gender, class) relations. The case presented in this paper, shows how a psychiatric factual account is the outcome of a process of the recognition, and/or the production, of "mentionables," followed by the documentary interpretation of mentionables as symptoms. Subsequently it is demonstrated that, and how, the recognition of mentionables depends on non-professional interpretations which by their nature express other social (such as gender, class, etc.) relations. This description of psychiatric diagnostic work is produced by means of a method of discourse analysis that consists of the juxtaposition of the various institutional texts (the two reports) with the transcript of the interview. An analysis of only the interview data would undoubtedly have resulted in some insights about psychiatric interviewing but would have shown neither how the interview functioned as a stage in the institutional process of (re)writing reports nor how ideological evaluations entered the diagnostic process. On the other hand, an analysis of only the two reports would have resulted in some insights about psychiatric reporting but would not have shown how these reports were produced.