Organizing Norwegian Psychiatry: Security as a Colonizing Regime

Abstract

Teig investigates how the notion of ‘security’ has become central within the legal framework of health care, in mass-media discourses, as well as in a concrete institution of Norway. She addresses how the notion of ‘risk’ and the ‘sequestration of experience’ of mental illness has led to the establishment of specified and rigid routines, managerial risk modules, and clinical guidelines for professional work. The chapter draws attention to the correlation between a pronounced and increasing managerialism in psychiatric institutions, society’s preoccupation with risk, and the consequent reductive localization of danger in the individual patient.

Appendices

Appendix: A Chronological Timeline of Headlines of Local Newspapers2006

Maximum-security unit in crisis—February 20 (news article)

Insurrection at the NN [the hospital]—February 20 (head news title)

Praises the working environment—February 21 (news article)

Health with muzzle—February 21 (editorial)

The truth about the NN [the hospital]—February 25 (editorial)

The NN [the hospital] is rebuked after the suicide of a mother—March 18 (news article)

The hospitals are silent—March 18 (news report)

The responsibility slips away after discharge—March 18 (news report)

Threatening to cut up doctor—March 21 (news report)

Psychiatric health worker ran amok—April 5 (news report)

Inmate attacked a health worker and escaped—April 8 (news report)

Eighteen-year-old will be sentenced for violence against nurse—April 11 (news report)

Was killed by knife while daughter (10) was in the house—July 22 (news article)

Investigating the hospital—July 22 (news report)

Does not separate security patients from other patients—July 23 (news article)

Third time he escaped. Accused for murder (34) was categorised as ‘not presumed escaping’—July 24 (news article)

Have to introduce separate psychiatric prisons—July 24 (news article)

Impossible guarantees—July 25 (editorial)

Strange that the hospital didn’t ask for guard—July 25 (news article)

This must never happen again—July 25 (news article)

The family of the victim requires an investigation of the routines—July 25 (news report)

For the society’s best—July 28 (reader’s letter)

The ticking bombs—July 30 (headline including several news articles)

How dangerous are they really?—July 30 (news article)

Do not know what triggered the murder—August 1 (news article)

Patient sentenced for murder threatened LL [health professional]—August 3 (news article)

Armed patient sent alone in taxi—August 10 (news article)

Asked armed patient to take a taxi to the NN [the hospital]—August 10 (news report)

Won five years struggle against the NN [the hospital]—August 16 (news article about a former patient)

Required to take a leave, claim compensation—August 21 (news article)

The police warn against dangerous murderer (33)—August 22 (news article)

I will return—August 22 (news report citing a patient)

The police: Should have been spared for this—August 22 (news article about the affected family)

Family hides from escaped murderer—August 23 (news report)

The convicted murderer jumped over the fences—August 23 (news report)

Crime and punishment—August 23 (editorial)

The Health Supervision investigates the case—August 23 (news report)

Is watched over day and night—August 23 (news report)

What is it with the NN [the hospital]?—August 24 (chronicle)

Mistook inmate for member of staff—August 24 (news report)

We have done too bad work—August 29 (news report)

The police are upset about chief psychiatrist violating the professional secrecy—August 31 (news article)

The NN [the health enterprise] will not answer—August 31 (news report)

The family is shocked—August 31 (news report)

Chief psychiatrist is called on the carpet—September 1 (news article)

About danger within psychiatry—September 4 (chronicle by patient)

The maximum security unit at the NN [the hospital]—September 4 (reader’s letter from clinicians)

The NN [the hospital]-workers beaten up by inmate—September 8 (news report)

Wants to make a stop of the escapes—September 20 (news report about the Minister of Law’s intentions)

Raped at the NN [the hospital]—September 20 (news article)

The NN [the hospital] gets harsh critique—December 21 (news report)

The NN [the hospital] promises to put things straight—December 21 (news report)

Another escape from the NN [the hospital] yesterday evening—December 22 (news report)

The hospital admits harsh critique—December 22 (news article)

2007

The fog of the hospital—January 2 (chronicle by health worker)

The NN [the hospital]—a destructive hospital—January 3 (reader’s letter)

Less fog at the NN [the hospital]—January 3 (chronicle by clinicians)

What will people think?—January 14 (chronicle by clinician)

This was a very unlucky mistake—January 30 (news article)

I am not dangerous to the public—February 3 (news article citing the patient)

Surely people react, but they do not know me—February 3 (news article)

The maximum-security unit—February 3 (News article)

Delicate TT [political party] conflict about the NN [the hospital]—February 13 (news report)

RR [local politician] withdraws from TT [political party]—February 14 (news article about political consequences of the upheavals at the hospital)

Misplaced patients at the NN [the hospital]. Should have been discharged long ago—February 16 (news article)

Foreign experts will investigate the NN [the hospital]—February 28 (news article)

This is how they will heal the NN [the hospital]—March 8 (news article)

Patient convicted for murder (29) escaped from the NN [the hospital]—March 8 (news report)

Psychiatric patients suffer more than enough and should not be wrongly exposed by the media—March 26 (reader’s letter from a patient)

Talks about the MM [a specific case]-murder for the first time—April 16 (news article)

Cannot explain why he killed—April 17 (news article)

Still day fines at the NN [the hospital]—April 17 (news article)

He could not deal with intimacy—April 20 (news article)

Happy day for NN [the hospital]—April 24 (news article)

Action plan approved and day fines stopped—April 24 (news article about organizational steps)

The PP’s [press agency] psychiatry coverage—April 30 (reader’s letter)

Relief after sentence of murder—May 4 (news article)

Prisoners become more dangerous under strict regimes—May 21 (news article)

Thirty-nine captured in the NN [the hospital]-trap—May 23 (news report)

Health workers at the NN [the hospital] were reported [to the police] for breaching the professional secrecy’—July 5 (news report)

The NN [the health enterprise] is taken to court—September 10 (news article)

Whistle blowers lost their job—October 8 (news report)

The NN [the hospital] receives a giant fine because of corridor patients—October 2 (news report)

Trial on labour legislation is the only way out—October 13 (reader’s letter)

FF [a minister] interferes in the case of whistle blowing—October 14 (news article)

Ambiguous about whistle blowing—October 15 (news report)

Time to make a diagnosis of the NN [the hospital]—October 19 (reader’s letter)

The NN [the hospital]-workers oppose the ‘regime of fear’—November 14 (news article)

The press stigmatizes the entire hospital—November 15 (news report)

Muzzle on staff—December 15 (chronicle)

Professional terminology: restructuring. The truth: destroying—December 21 (reader’s letter, patient)

Heroes and troublemakers—December 22 (editorial)

New political party born out of the hospital troubles—December 23 (news article)

2008

I’m about to die, I thought—March 16 (news article citing a health worker)

The hospital’s fines are cancelled—May 7 (news article)

The NN [the hospital] rejects the accusations—May 16 (news article)

The assumed whistle blowing was vague—May 20 (news article)

Claims that the management threatened with police report—May 22 (news article)

We did not receive a warning from the health worker—May 23 (news article citing the management)

Claimed that it was safe to make a warning—May 27 (news article)

I am deeply disappointed—July 8 (news article citing the whistle blower)

Considers submitting an appeal in the whistle blower case—July 8 (news article)

Hope to restore peace at the NN [the hospital]—July 9 (editorial)

Notes

• 1. I thank all participants in the workshop ‘Reassessing Trauma and Violence: Reframing the Bodily, the Spoken and the Self’ for insightful comments and helpful advices. I am also deeply grateful to Kjetil Fosshagen, who has read, discussed, contributed insights to the argument, and offered encouragement for this work.

• 2. The psychiatric hospital is a separate division in a local health enterprise. The Norwegian specialist hospital services (somatic and psychiatric) were reorganized into five regional health enterprises and numerous local health enterprises in 2002, as a result of a large-scale reform in 2001. The ownership was transferred from counties to the central state.

• 3. The ethnographic extended-case or situational analysis (both terms refer to the methodology associated with Gluckman) is an ethnographic method developed by the British anthropologist Max Gluckman at the Manchester School of Social Anthropology. Gluckman proposed through this method to trace the relationship between the general and analytical statements through the dynamic particularity of the case. The empirical investigation of particular situations of conflict was one of Gluckman’s strong ideas in order to identify mechanisms underlying the conflict. He argued that by taking the actors and their roles in any particular incident and tracing these actors through other incidents, one could link the varied incidents to one another and identify the mechanisms operating in the relevant social order (Evens and Handelman 2006). For Gluckman, it was in the event and the situation the suggestions for analysis were to be found, and the event or situation was never merely illustrative or a gimmick (Kapferer 2005). The idea was to scrutinize particular situations, especially conflicts, as complexes of connected incidents that were occurring in the field, in order to isolate and identify the actual mechanisms that were underlying the development of the situation/the conflict. The concept of the situation as crisis demands an understanding that micro dynamics are always integral within macro forces.

• 4. In Scull’s description of this transition, it is not a move from mental hospital care to community care but from segregation in the asylum to neglect and misery within the community. He argues that the main reason for this new policy in the UK was economic considerations. He introduced the concept of ‘decarceration’ to denote that ‘segregative modes of social control became, in relative terms, far more costly and difficult to justify’ (Scull in Busfield 1986:328). This kind of economy-based argument is reflected in the statements from some of the psychiatrists in this study when speaking critically about the de-institutional process of moving patients out of the hospitals.

• 5. Similar to what Jones and Sidebotham (1998:7) describe, it is also a normal practice in Norwegian psychiatric hospitals to refer to patient numbers in terms of ‘beds’, even though the fact is that most patients are ambulant.

• 6. The Mental Health Care Action Plan 1998–2008 [Opptrappingsplanen for psykiatri] was proposed in 1997 as the latest plan in the process of de-institutionalization. The Plan was based upon the white paper no. 25 (prop. no. 25 1996–1997) Openness and entirety: About psychiatric illnesses and health services. In 2006, the Mental Health Care Action Plan was extended two years, until 2008, due to the necessity for more time to implement municipal arrangements, such as housing facilities, etc.

• 7. The method for measuring risk and potential acts of violence is based on the clinical instrument of HCR-20 among others.

• 8. Escapes from psychiatric hospitals are normal incidents, as also Strauss et al. (1964/1981) describe from a large American state mental hospital in the 1960s. They describe how escapes happened quite frequently.

• 9. The title is from an article in the local newspaper that critically debates the situation at the hospital.

• 10. See the Governmental Report no. 48, 2008; the Mæland Report.

• 11. http://www.dagensmedisin.no/nyheter/2008/11/28/vil-tvangsinnlegge-plagsomme-personer/ (accessed May 25, 2012). See also the view from The Norwegian Medical Association http://www.legeforeningen.no/id/168011.0 (accessed May 25, 2013).