Discourse and Mental Health
Voice, Inequality and Resistance in Medical Settings
This book is the result of years of fieldwork at a public hospital located in an immigrant neighborhood in Buenos Aires, Argentina. It focuses on the relationships between diversity and inequality in access to mental healthcare through the discourse practices, tactics and strategies deployed by patients with widely varying cultural, linguistic and social backgrounds. As an action-research process, it helped change communicative practices at the Hospital’s outpatient mental healthcare service. The book focuses on the entire process and its outcomes, arguing in favor of a critical, situated perspective on discourse analysis, theoretically and practically oriented to social change.
It also proposes a different approach to doctor-patient communication, usually conducted from an ethnocentric perspective which does not take into account cultural, social and economic diversity. It reviews many topics that are somehow classical in doctor-patient communication analysis, but from a different point of view: issues such as the sequential organization of primary care encounters, diagnostic formulations, asymmetry and accommodation, etc., are now examined from a locally grounded ethnographic perspective. This change is not only theoretical but also political, as it helps understand patient practices of resistance, identity-making and solidarity in contexts of inequality.
Table of Contents
Introduction 1. Voice, Singularity and Emergency: A Discursive Perspective on Linguistic Inequality 2. Psychoanalysis in Public Hospitals: Context as a Discursive Problem 3. Invisible Landscapes: Diversity and the Semiosis of Space 4. Diagnosis and Treatment: Sequencing and Exclusion 5. Resisting Exclusion: Patients’ Tactics of Misunderstanding 6. Speaking with the Other’s Voice: An Attempt to Close the Gap 7. Discourse and Activism: Dissent, Protest and Resistance 8. Epilogue
Juan Eduardo Bonnin is Researcher at the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and Professor of Discourse Studies at the Universidad Nacional de San Martín (UNSAM). His latest book is Discurso político y discurso religioso en América Latina (Buenos Aires, Santiago Arcos, 2013).
'Bonnin offers us, apart from an outstanding case study, a passionate argument for recognizing a truly authentic Latin American approach to discourse analysis. The lived sociocultural and political experience of intellectuals in a thoroughly complex sociolinguistic area such as Latin America offers readers more than a theoretical and analytical reflection: it also invites us to rethink the geopolitics of voice in a globalized intellectual community.' — Professor Jan Blommaert, Department of Culture Studies, Tilburg University
'The circumference of the topic treated in this monograph, Discourse and Mental Health, necessarily demands a broad theoretical and analytical canvas. Bonnin meticulously lives up to the challenge in mapping the interactional/situational nexus of professional-patient encounters on to the sociocultural/political landscape of Argentinian public healthcare delivery. Marking a visible shift from the dominantly available ethnocentric perspective to a desirable ethnographic perspective, the monograph embodies what I consider a robust ethnopolitical ‘voice’ in order to facilitate a critical appraisal of mental healthcare delivery in an immigrant neighbourhood in Buenos Aires. Framed as action-research inclusive of silent diversities/discourses and patients’ resistance, it emanates an interventionist spirit, complemented by a wide-ranging but integrated discourse analytical approach informed by long-term fieldwork.' — Srikant Sarangi, Professor in Humanities and Medicine, Aalborg University, Denmark; Honorary Professor, Cardiff University, United Kingdom