Psychiatric Services: Organizing Impossibility

Abstract

This paper explores the proposition that elements of the work of psychiatric services are impossible. The notion of impossibility is considered from three perspectives: societal, interpersonal, and organizational. Organizational elements of impossibility are evidenced in attempts to work with madness, a phenomenon that defies clear definition. Resultant confusion in role and task boundaries is exacerbated by mad interpersonal interactions. The situation is compounded by societal conflicts between the mad and the sane. Attempts to house and treat the mad over the past 200 years are reviewed, and recent illustrative case material is presented from two community treatment teams. It is argued that primarily solution-focused approaches to madness have limited success. To acknowledge impossible elements of the work may enable psychiatric institutions to be designed in ways that help make individual and collective madness more bearable rather than something to be controlled and or denied.