title: Patient or consumer? The colonization of the psychiatric clinic.
abstract: Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.
authors.affiliation: evansa@ramsayhealth.com.au
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Evans
mesh_terms: D000554:Ambulatory Care Facilities; D032821:Commodification; D003142:Communication; D004645:Empathy; D006801:Humans; D033181:Information Dissemination; D019359:Knowledge; D008389:Marketing of Health Services / Q000458:organization & administration; D008605:Mental Health Services / Q000458:organization & administration*; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration; D010687:Philosophy, Nursing; D011209:Power, Psychological; D011568:Psychiatric Nursing / Q000458:organization & administration*; D011573:Psychoanalytic Interpretation; D012650:Self Disclosure; D014167:Transference, Psychology