Hvad tæller, og hvem tæller? Standardisering og emotionelt arbejde i psykiatrien

Work in the public health sector in Denmark (as well as in other European countries) has in the last 15-20
years been undergoing great changes due to on-going rationalization under headings such as New Public
Management, LEAN and Evidence Based Medicine. In this paper we focus on standardization as the heart of
this process, and we scrutinize the complex ways that different forms of standardization affect work in a
specific field, psychiatry, asking questions such as: What counts as work? How do social relations and
hierarchies change? What are the implications for emotional work?
Psychiatric services comprise a special context for standardization. Psychiatry has a long history as a kind of
stepchild of medicine, one of the reasons being the insistence on maintaining a humanistic focus,
perceiving human beings as unique, and not whole-heartedly embracing the rational medical approach that
categorize humans based on diagnoses. Subsequently, work in psychiatric care in Denmark is often
organised in interdisciplinary teams comprising social workers, care workers, nurses, psychologists and
psychiatrists, all involved in work concerning diagnostics and treatment. Emotional labour is an on-going
part of the working process which takes place in interaction with the patients and their network. We
perceive emotional labour as a highly skilled activity, which may both be rewarding and stress-full, and
which comprises many different types of activity. It may for example be the very core of work, or it may be
involved ‘in getting the job done’.
This paper explores how work in psychiatry is transformed through standardization. It is based on a case
study of an ambulant unit within child psychiatry ‘producing’ diagnoses and treatment/education of
children (and their families), using ethnographic field studies and semi-structured individual and groupbased
interviews. The paper illustrates how the social relations in the interdisciplinary team are strained,
how the conception of work is subject to negotiation and struggle, and how emotional work is affected.