H-Net Review Publication: Mole on Davis, 'Bad Souls: Madness and Responsibility in Modern Greece'
Elizabeth Anne Davis.
Bad Souls: Madness and Responsibility in Modern Greece. Durham
Duke University Press, 2012. x +
331 pp.
$94.95 (cloth), ISBN 978-0-8223-5093-4; $25.95 (paper),
ISBN 978-0-8223-5106-1.
Reviewed by Noelle Mole (NYU)
Published on H-SAE (February, 2013)
Commissioned by Michael B. Munnik
The Ethical Onus of Psychiatric Care
In _Bad Souls_,_ _Elizabeth Anne Davis examines how the
treatment of mental illness in contemporary Greece hinges on an underlying
conflict: navigating and diffusing the moral
responsibility for care between patients, doctors, and the state, as well as
families and communities. In Greek, a "bad soul" implies "a
craven person disabled by moral cowardice and irresponsibility," and so,
too, the book probes the problem of how psychiatric patients become
positioned--incompletely and unevenly--as atomized subjects, endowed with the
capacity to self-manage their illness, treatment, and recovery (p. 20). Both
theoretically rigorous and ethnographically nuanced, the book investigates the
effects and erasures of current Greek psychiatry after a quarter century of
reform, which adopted community-based care and dismantled and decentralized the
state apparatus, especially for mandatory psychiatric institutionalization.
For Davis, we must understand the "liberal 'rights
culture' of personal responsibility" not merely as an effect of
neoliberalism but rather as an emergent practice and value of Greek psychiatric
reform (p. 123). Influenced especially by Italian Franco Basaglia's
deinstitutionalization movement, and the international turn toward
community-based care in mental health, Greece--with significant assistance from
the European Union--began reforming its infrastructure in the 1980s. As a
whole, Davis accounts for how, within mental healthcare's move away from
dehumanizing institutional confinement, the apparatus came to promote and value
patient self-care, if unevenly. She documents, for example, patients'
"countermoralism," that is, the ways in which
patients refuse--consciously and unconsciously, directly and indirectly--these
collaborations and reroute the ethic of responsibility back to the doctor, the
clinic, and the welfare state (p. 16).
Of its many distinguishing features, this ethnography
investigates and theorizes various mental illnesses, including psychosis,
paranoid schizophrenia, obsessive compulsive disorder, and bipolar disorder.
She corrals the stories of many individuals--some of
whom, however, disappear abruptly in ways that, perhaps, mirror the way
patients enter and exit sites of care. Her approach, therefore, is quite unlike
single-illness ethnographies (such as Junko Kitanaka's _Depression in Japan:
Psychiatric Cures for a Society in Distress _[2011]; Emily Martin's _Bipolar
Expeditions: Mania and Depression in American Culture _[2009]; and Jonathan
Metzl's _The Protest
Psychosis: How Schizophrenia Became a Black Disease _[2011]._
_By calibrating our attention to the institutional, Davis successfully makes
psychiatry and its attending practices and sustaining ethics her objects of
study. The breadth of _Bad Souls _is quite spectacular as we come to inhabit
multiple spaces within and adjacent to psychiatric institutions: mobile
psychiatric units, case presentations, group therapy for psychotics, an
immigration detention center, and numerous informal and formal interviews with
doctors and patients both in hospitals and in private homes. At the same time,
however, this necessarily means that questions about the particular qualities
or symbolic manifestations of mental illness are not always explored with the
same depth as single-illness studies. As an analytical strategy, however, it is
this pan-illness lens that makes Davis uniquely able to bring this domain of
knowledge--and the morally fraught micro-positionings of patients, doctors, and
the state--into close relief.
Davis devotes the first section of the book to mapping
how deception and "suspicions of lying" represent a central feature
in the truth-making apparatus of diagnosis (p. 74). Often, she finds, this
pivots on whether the patient is understood as deliberately lying and thus
manipulating the doctor, as opposed to offering unreliable accounts or
unintentionally omitting pertinent details of her or his history. To
psychiatrists, the former kind of deception often represents either a
"difficult" patient or, possibly, a symptom of personality disorders,
which are understood as chronic and hard-to-treat conditions. Davis also
reflects on how, in counterintuitive ways, these suspicions of deception
actually suture the patient-doctor dyad and limit patients' autonomous
self-care; this represents, at least in part, patients' "refusal" of
this mode of discipline.
Davis's ethnography is situated within Greece's region of
Thrace, borderland of Bulgaria and Turkey, and we learn that psychiatrists
regularly treat minority patients--Gypsies, Turks, Pontii--and diagnose their
illnesses as "cultural pathologies" (p. 4). She shows us that somatic
symptoms have within Greek psychiatry become intertwined with the notion of
"cultural" illness and aligned with psychoanalytic understandings of
hysteria and conversion disorder. To intervening psychiatrists, women's
subordination, for instance, if expressed in bodily as opposed to psychic
distress, serves as apparent proof of the patients' "cultural
difference" and, furthermore, their purportedly outdated expression of
distress.
Davis's insights are exceptionally sharp here as she
shows us that narratives of humanitarian psychiatric reform, together with
cultural relativism, merge with the discourse of culture difference such that
clinicians effectively become mobilized toward "urging clinical distresses
out of the body and into the discursive domain of therapeutic persuasion"
(p. 126). Davis uncovers the hidden logic:
just as the traditional becomes modern and the hysteric
precedes the depressive, so too, the rationale follows, must patients' unconscious
denial give way to individual responsibility.
In the third section of the book, Davis argues that
treating severely ill patients as autonomous and capable of self-care can
undermine their capacity to heal and receive effective treatment. For Davis,
the shifted onus of moral responsibility onto patients is "more than a
story of governmentality" (p. 15). By contrast, in a recent ethnography of
Italy, _The Moral Neoliberal__: Welfare and Citizenship in Italy _(2012),_
_Andrea Muehlebach argues that portions of care work (for the elderly and the
sick) now partially under the guise of volunteer workers represent a way in
which the neoliberal state produces a "highly moralized kind of
citizenship"
(p. 6). Though the contexts are, of course, not
symmetrical, it bears noting that Davis positions the cultivation of moral
responsibility as more highly intertwined with the particular logic of Greek
psychiatric reform than with neoliberal governance. Davis's historical
understanding of moral responsibility lives at the threshold of the political
and the medical but does not, in ways that run counter to some debates on
neoliberalism, theorize either the state or late capitalism as primary
generators of citizens' mandate to self-manage morally.
_Bad Souls _provides a compelling and detailed
examination of ethics, relationality, medicine, and citizenship in modern
Greece. This is also a story, a self-proclaimed study of "madness,"
about the investigator's ethical onus to attend carefully to human suffering
and its complex formations and inexplicable silences. In Davis, we find an
exceptionally graceful awareness of her quandaries and limitations as the
critical investigator, as well as an ethnographic sensibility well suited to
this complex material. The book deserves as much admiration and attention in
the fields of psychiatry, anthropology, medical humanities, and European
studies, as it does from scholars interested in ethics, governance, and
citizenship.
Citation: Noelle Mole. Review of Davis, Elizabeth Anne,
_Bad Souls:
Madness and Responsibility in Modern Greece_. H-SAE,
H-Net Reviews.
February, 2013.
This work is licensed under a Creative Commons
Attribution-Noncommercial-No Derivative Works 3.0 United States License.