Representations are the socially and textually produced patients as presented in clinical discussion and the clinical chart. An understudied aspect of representations in medicine is the way in which they are used to highlight contests of expertise and authority between clinicians, which have consequences over control of critical hospital resources. The author uses ethnographic research in a public urban hospital psychiatry department in New York City to examine the rounds meetings of a psychiatric emergency room, exploring the way in which representatives of a variety of occupational groups portray patients as they present and debate alternative diagnoses. He uses narratives of rounds meetings to illustrate the interactions, debates, and work of psychiatric and nonpsychiatric clinicians as they struggle to diagnose and develop treatment plans for patients. The enhanced authority of nonpsychiatrist clinicians that emerges from successful contests of representations illustrates a possible future for psychiatry as a multidisciplinary medical specialty.
Abbott, A. D. (1988). System of professions: An essay on the division of expert labor. Chicago: University of Chicago Press.
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
3.
Baer, H. (2001). Biomedicine and alternative healing systems in America: Issues of class, race, ethnicity, and gender. Madison: University of Wisconsin Press.
4.
Barrett, R. J. (1988). Clinical writing and the documentary construction of schizophrenia. Culture, Medicine, and Psychiatry, 12(3), 265-299.
5.
Barrett, R. (1996). Psychiatric team and the social definition of schizophrenia: An anthropological study of person and illness. New York: Cambridge University Press.
6.
Berg, M., & Mol, A. (1998). (Eds.). Differences in medicine: Unraveling practices, techniques, and bodies. Durham, NC: Duke University Press.
7.
Brown, P. (1993). Psychiatric intake as mystery story. Culture, Medicine and Psychiatry, 17(2), 255-280.
8.
Casper, M. J. (1998). Working on and around human fetuses: The contested domain of fetal surgery. In M. Berg & A. Mol. (Eds.), Differences in medicine: Unraveling practices, techniques, and bodies (pp. 28-52). Durham, NC: Duke University Press.
9.
De Montigny, G. A. J. (1995). Social working: An ethnography of front line practice. Toronto, Canada: University of Toronto Press.
10.
Floersch, J. (2001). Meds, money and manners: The case management of severe mental illness. New York: Columbia University Press.
11.
Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason. New York: Vintage. (Original work published 1965)
12.
Fox, R. (1989). Sociology of medicine: A participant observer’s view. Englewood Cliffs, NJ: Prentice Hall.
13.
Freidson, E. (1988). Profession of medicine: A study of the sociology of applied knowledge. Chicago: University of Chicago Press.
14.
Gal, S. (1991). Between speech and silence: The problematics of research on language and gender. In M. Di Leonardo. (Ed.), Gender at the crossroads of knowledge: feminist anthropology in the postmodern era (pp. 175-203). Berkeley: University of California Press.
15.
Garfinkel, H. (1984). Studies in ethnomethodology. Cambridge, UK: Polity. (Original work published 1967)
16.
Gonzalez, J. (1998, April 30). Rudy puts city hosps on starvation diet. Daily News (New York), p. 8-8.
17.
Goode, E. (2002, March 26). Psychologists get prescription pads and furor erupts. The New York Times, p. F1-F1.
18.
Hirschauer, S. (1998). Performing sexes and genders in medical practices. In M. Berg & A. Mol. (Eds.), Differences in medicine: Unraveling practices, techniques, and bodies (pp. 13-27). Durham, NC: Duke University Press.
19.
Jingo, M. (Producer), & Kurosawa, A. (Director). (1950). Rashomon [Motion picture]. Tokyo, Japan: Daiei Motion Picture Company.
20.
Katz, P. (1992). Conflicts of cultures in a state mental hospital system. In A. D. Gaines (Ed.), Ethnopsychiatry: The cultural construction of professional and folk psychiatries (pp. 355-378). Albany: State University of New York Press.
21.
Kelley, T. (2000, April 25). Like a doctor’s office, with a little more time. The New York Times, p. F7-F7.
22.
Larkin, G. L., Claassen, C. A., Emond, J. A., Pelletier, A. J., & Camargo, C. A. (2005). Trends in U.S. emergency department visits for mental health conditions, 1992-2001. Psychiatric Services, 56(6), 671-677.
23.
Leslie, C. (1978). Introduction. In C. Leslie (Ed.), Asian medical systems: A comparative study (pp. 1-16). Berkeley: University of California Press.
24.
Littlewood, R. (2002). Pathologies of the West: An anthropology of mental illness in Euro-America. Ithaca, NY: Cornell University Press.
25.
Loeb, M. B., & Smith, H. L. (1957). Relationships among organizational groupings within the mental hospital. In M. Greenblatt, D. J. Levinson, & R. H. Williams (Eds.), The patient and the mental hospital: Contributions of research in the social sciences (pp. 9-13). New York: Free Press.
26.
Luhrmann, T. M. (2000). Of two minds: The growing disorder in American psychiatry. New York: Knopf.
27.
Manderscheid, R. W., Atay, J. E., Hernández-Cartagena, M., Edmond, P. Y., Male, A., Parker, A. C. E., et al. (2000). Key elements of the national statistical picture. Mental health, United States, 2000. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAHMSA), United States Department Of Health and Human Services.
28.
Mechanic, D., McAlpine, D. D., & Olfson, M. (1998). Changing patterns of psychiatric inpatient care in the United States, 1988-1994. Archive of General Psychiatry, 55(9), 785-791.
29.
Metzl, J. (2003). Prozac on the couch: Prescribing gender in the era of wonder drugs. Durham, NC: Duke University Press.
30.
Mizrahi, T. (1986). Getting rid of patients: Contradictions in the socialization of physicians. New Brunswick, NJ: Rutgers University Press.
31.
Reverby, S. (1987). Ordered to care: The dilemma of American nursing, 1850-1945. New York: Cambridge University Press.
32.
Rhodes, L. A. (1984). This will clear your mind: The use of metaphors for medications in psychiatric settings. Culture, Medicine and Psychiatry, 8(1), 49-70.
33.
Rhodes, L. A. (1991). Emptying beds: The work of an emergency psychiatric unit. Berkeley: University of California Press.
34.
Skoll, G. (1992). Walk the walk and talk the talk: An ethnography of a drug abuse treatment facility. Philadelphia: Temple University Press.
35.
Starr, P. (1982). Social transformation of American medicine. New York: Basic Books.
36.
Steinhauer, J. (2000, June 17). Workers cut as hospitals tighten belts. The New York Times, p. B1-B1.
37.
Taussig, M. (1992). Nervous system. New York: Routledge.
38.
Tice, K. W. (1998). Tales of wayward girls and immoral women: Case records and the professionalization of social work. Chicago: University of Illinois Press.
39.
Thorpe, K. E. (2004, January 21). The medical malpractice “crisis”: Recent trends and the impact of state tort reforms [Web exclusive]. Health Affairs. Retrieved January 21, 2004, from http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.20v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=thorpe&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
