Based on field research in Greek Thrace, this essay examines the problem of deception in psychiatric care, in the context of national psychiatric reform. Over the last 25 years, psychiatric treatment in Greece has shifted from custodial hospitals to outpatient settings, challenging the mentally ill to help care for themselves as they adapt to life “in the community.” I explore the consequent reworking of therapeutic relationships outside custodial institutions through verbal negotiation, as against methods of confinement and constraint associated with inhumane institutional care. I argue that an ambivalent intimacy is fostered in these relationships by suspicions of deceit, which speak as well to a problem of knowledge in contemporary psychiatry globally. Working through the case of a Gypsy outpatient diagnosed with antisocial personality disorder, whose life ended in a drug overdose, I trace suspicions of deceit across multiple terrains: from (neo)liberal reform, to clinical diagnosis, to constructions of minority culture. On these terrains, I do not attempt to determine the truth of speech in the clinic, but to discern the dynamics of suspicion through which that truth comes into question. Rather than clear refusals of responsibility, I show suspicions of deception in community-based care as refractions of psychiatric reform through a constitutive opacity in intimate ethical relations between patients and therapists.
In the February 2010 issue of Cultural Anthropology, Elizabeth Anne Davis examines the role of deception and lying in psychiatric care in Greece. Davis analyzes the role of deception from both patients and psychiatric care providers in constructing psychiatric disorder, and how such construction meets alternative needs of patients and providers not directly related to the psychiatric care being provided. Davis describes how patients use deception to procure pharmaceuticals and/or government assistance for disorders that they do not have, and how psychiatric care providers use a different form of deception to work with patients without adhering strictly to laws regarding who may receive government aid for psychiatric conditions. Psychiatric care involving deception is a process of negotiation between patient and provider, hinging on what 'symptoms' the patient presents, and what the provider is willing to do for them. In some cases, the patient's deception is itself a symptom of another underlying problem, which often goes untreated. Davis also deals with issues of racism and discrimination of the Gypsy population of Greece, who typically get subpar psychiatric care. In the words of one doctor, "If she were a Christian rather than a Gypsy, she'd have gotten better care."
Cultural Anthropology has published other essays on the intersections of humanitarian ethics, expert discourse, and national policy. See Didier Fassin's essay on the increasing involvement of psychologists in the study of traumas, "The Humanitarian Politics of Testimony: Subjectification through Trauma in the Israeli-Palestinian Conflict" (2008), as well as his "Compassion and Repression: the Moral Economy of Immigration Policies in France" (2005).
Cultural Anthropology has also published other essays on the subject of addiction, including Angela Garcia's "The Elegiac Addict" (2008) and Nancy Campbell and Susan Shaw's essay "Incitements to Discourse" (2008) on state-funded drug ethnography and public health projects.
About the Author
Elizabeth Davis is Assistant Professor of Anthropology, in association with Hellenic Studies. Before joining the Princeton faculty in 2009, she taught in the Department of Cultural Anthropology at Duke University, and held a Mellon Postdoctoral Fellowship in the Society of Fellows at Columbia University. Her work in Greece and Cyprus focuses on the psyche and the body, their implication in social conflict and in the ties that bind people to communities and states. Her book, Bad Souls: An Ethnography of Madness and Responsibility in Greek Thrace, forthcoming from Duke University Press, explores humanitarian psychiatric reform in the borderland between Greece and Turkey. She is currently starting a new project on suspicion, intelligence, and post-conflict statecraft in Cyprus, involving ethnographic research on both sides of the newly-porous border between north and south, as well as a documentary film on cross-border movement, surveillance, and memory.
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Questions for Classroom Discussion
1. Is intentional deception by patients or healthcare providers necessarily bad?
2. What are some other likely impacts of 'outsourcing' the care of psychiatric patients to themselves and their families?
3. How could health professionals better negotiate the balance between their obligations to their patients and their obligations to law? Or is there no conflict?
4. What kind of an obligation do health professionals have to diagnose underlying problems when they are aware that their patients are lying to them?
5. In what other areas is deception particularly problematic or beneficial?