Ute och inne: Kritisk dialog mellan personalkollektiv inom psykiatrin

Birgitta Höglund

Research output: ThesisDoctoral Thesis (monograph)


Treatment ideologies and working models replace each other quickly in today's society. During the 1980s a dramatic dismantling of the psychiatric institutions occurred. The health care system was supposed to be transferred to non-institutional care. This was, however, not possible for all groups of patients. At an institution, specialized in so called demanding patients and patients who received care according to the Compulsory Psychiatric Care Act or the Forensic Psychiatric Care Act, an alternation process was initiated during the 1990s as a de-institutionalization within. New rehabilitation oriented working operations were initiated alongside the already existing ward care. This resulted in two local cultures who developed different rhetorical forms, with one common denominator: to present oneself as professionally and morally competent in relation to the politically correct ideology. The personnel, who worked with the rehabilitation outside the ward used an offensive counter rhetoric. They worked with the generally celebrated methods. In criticizing the others' characteristics of the total institution were used. In the interviews the professional role and self-image of the outside personnel was intimately entwined: they let the light from the new methods shine on themselves as individuals. The personnel at the ward didn't openly criticize the new working method nor openly defended their own. Within the framework of a defensive rhetoric they avoided attacks on their own personal morale. E.g with the use of a collective "we-perspective" distance were built up between themselves as individuals and their professional role. They empazised the difficulty in integrating the rehabilitation idea with the demand of total security. They also used an accepted counter rhetoric: they agreed with the advantages of the new methods and the disadvantages of their own, but explained apologeticly why it was like this. With the help of contrast - their own work was described as heavy, difficult and dangerous, the outside personnel's as easy and fun- the effort's of their their own work value was emphasized. All interviewees used the same rhetorical cultural repertoire, e.g similar typifications of the personnel - strictly a contrast between a new and old working method- yet in different ways. The purpose was, however, the same: to turn the criticism away from one self by pointing towards other groups. The credibility in the delivered messages was built up with the use of e.g concrete examples, quotations as well as references to opinions and expressions from persons, who, through their positions were looked upon as confidence-inspiring. An unassailable argument, that everybody used, was that they worked for the greater good of the patients. Another reoccurring rhetorical strategy was the usage of subtle criticism, e.g. quoting a colleague's response and by doing so making oneself unimpeachable to attack. Critical messages were defused or softened by the use of particles, rephrases and less accurate wording.
Original languageSwedish
Awarding Institution
  • Sociology
  • [unknown], [unknown], Supervisor, External person
Award date2001 Oct 12
ISBN (Print)91-7267-103-3
Publication statusPublished - 2001

Bibliographical note

Defence details
Date: 2001-10-12
Time: 10:15
Place: Carolinasalen, Kungshuset, Lund University
External reviewer(s)
Name: Gustavsson, Anders
Title: Professor
Affiliation: Stockholm University

Subject classification (UKÄ)

  • Sociology (excluding Social Work, Social Psychology and Social Anthropology)

Free keywords

  • Sociology
  • local culture
  • selfpresentation
  • spiral of silence
  • rhetoric
  • normalization
  • personnel
  • alternation process
  • de-institutionalization
  • forensic care
  • psychiatric care
  • Social psychology
  • Psychiatry
  • clinical psychology
  • psychosomatics

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