Distanse og involvering : Hvordan 18 psykiatere konstituerer forståelsen av sitt kliniske arbeid
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Do psychiatrists understand their clinical work in the same way? What do the practitioners of psychiatry focus on in their work? The thesis’ research topic is: In what way do 18 psychiatrists constitute an understanding of their clinical work? In the literature of psychiatry one often finds discussions of the profession’s identity or fundamental problems. The profession is composed of different traditions. Some authors point to a split field that contains unsolvable contradictions, while others argue that psychiatry today integrates different traditions by dissolving old contradictions. The thesis establishes an encounter between insights from theoretical work and the clinician. It is a contribution to an empirically informed discussion of fundamental issues in psychiatry. The thesis is also a contribution to the psychiatrists’ professional ethics in shedding light on key aspects of their self-understanding. The thesis’ data is 18 qualitative interviews with adult psychiatrists. The focus is on how the psychiatrist views himself, the patient and the patient’s mental difficulties when meeting the patient. Through analysis and interpretation I establish two ideal types: The doctor and The interpreter. The two ideal types emphasize different aspects of the clinical work by highlighting various points of orientation as the key for a psychiatrist’s understanding. The doctor distinguishes between mental illness and the person. This implies an orientation towards disease. The clinical work is viewed through what The doctor perceives as unified professional knowledge, where scientifically certain knowledge is essential. A descriptive approach, as we find it in the diagnostic system of today, is regarded as a key entrance for getting to know the patient's mental difficulties. The central point is to establish a reliable approach that ensures that the psychiatrist addresses the key issues of the patient's mental difficulties. The interpreter is working with the patient’s mind. The focus is on getting to know the patient as a person to a greater extent than only some aspects of a disturbed function or behavior. The patient’s subjective experience is given precedence. The psychiatrist’s professional judgment is emphasized, which implies an emphasis on implicit knowledge. The essential issue is how to apply knowledge and use experience when meeting the unique patient. The interpreter underlines the significance of the relationship for the psychiatrist’s clinical work and understanding, relationship that is being developed and established in the patient encounter. The interpreter is concerned with the involvement with the patient. The two different ways to constitute an understanding of the clinical work establishes different ideals of what is meant by professionally good clinical work. The psychiatrist's clinical work is located between distance and involvement. The doctor emphasizes on being a distant participant to be able to assess the patient's mental difficulties and ensure a respectful distance to the patient as a person. The interpreter describes the psychiatrist as significant involved. The involvement is essential for the development of an understanding of the patient’s mental difficulties, and for the patient’s experience of connections between his or her mental difficulties and life in general. The psychiatrist’s way of constituting an understanding of the clinical work is considered as closely linked to the practice of psychiatry.