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Everyday Ethics: Voices from the Front Line of Community Psychiatry
Brodwin, Paul
University of California Press / Softcover / 2013-01-01 / 0520274792
Community Psychiatry / Ethics
price: $37.95 (may be subject to change)
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This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates. At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. The experiences of these clinicians pose a single overarching question: how should we bear responsibility for the most vulnerable among us?

Reviews and Endorsements:

“Paul Brodwin’s rich and historically sensitive ethnographic account, Everyday Ethics: Voices from the Front Line of Community Psychiatry, is a highly accessible introduction to the ethical dilemmas of Assertive Community Treatment (ACT). While clearly demonstrating the system’s flaws, this dynamic and well-researched work avoids the common tendency to villainize, lionize, or otherwise simplify its professionals, allowing their ethical quandaries to become our own.” E. Summerson Carr, author of Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

"Everyday Ethics is a crucial account that deserves to be widely read. A serious anthropological contribution to medical ethics. This book unpacks community care-so key to global health-and does the same for the ethics of practice. It leaves the reader with wonder, puzzlement and ultimately acknowledgment of the impossible yet unavoidable struggles at the heart of caregiving."—Arthur Kleinman, author of What Really Matters

"This is a masterful, disturbing ethnography of ethical decision making at 'the rough edges of community psychiatry."—Mary-Jo DelVecchio Good, co-author of Shattering Culture: American Medicine Responds to Cultural Diversity



Introduction: The Terrain of Everyday Ethics

Background to practice
1. Genealogy of the Treatment Model
2. Expert knowledge and Encounters with Futility

Tools of the trade
3. Treatment Plans: Mandatory Narratives of Progress
4. Representative Payeeships: The Deep Logic of Dependency
5. Commitment Orders: The Practice of Consent and Constraint

From Everyday to Formal Ethics
6. Coercion, Confidentiality, and the Moral Contours of Work


About the Author:

Paul Brodwin is Professor of Anthropology at the University of Wisconsin-Milwaukee and Adjunct Professor of Bioethics and Medical Humanities at the Medical College of Wisconsin. He is the editor of Biotechnology and Culture: Bodies, Anxieties, Ethics, author of Medicine and Morality in Haiti: The Contest for Healing Power, and coeditor of Pain as Human Experience: Anthropological Perspectives.

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