Paul Brodwin | University of Wisconsin Milwaukee (original) (raw)
Books by Paul Brodwin
This book explores the moral lives of mental health clinicians who serve the most marginalized in... more This book explores the moral lives of mental health clinicians who serve the most marginalized individuals in the U.S. healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Paul Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront challenges to their self-image as competent and compassionate. At times they openly question the coercion built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. These clinicians’ experience poses a single overarching question: how should we bear responsibility for the most vulnerable among us?
Papers by Paul Brodwin
Medical Anthropology Quarterly, Sep 1, 2001
ABSTRACT Living and Working with the New Medical Technologies: Intersections of Inquiry. Margaret... more ABSTRACT Living and Working with the New Medical Technologies: Intersections of Inquiry. Margaret Lock. Allan Young. and Alberto Cambrosio. eds. New York: Cambridge University Press, 2000. ix+295 pp.
Anthropological Approaches to the Study of Ethnomedicine, 2021
... Just as health care seekers routinely deal in many different" medical idioms" over ... more ... Just as health care seekers routinely deal in many different" medical idioms" over the course of a single illness episode, practi-Paul Brodwin is an Assistant Professor of Anthropology at the University of Wisconsin-Milwaukee, PO Box 433, Milwaukee, WI53201. ...
Philosophy, Psychiatry, & Psychology, 2019
Understanding Health Inequalities and Justice, 2017
This chapter raises a key question for the interdisciplinary study of health and justice: is dial... more This chapter raises a key question for the interdisciplinary study of health and justice: is dialogue possible between theoretical models and first-person testimony about the harms caused by injustice? To consider this question, the chapter examines the claim that disrespect—the systematic devaluation of others in a way that excludes them from reciprocal social relations—is a form of injustice. The philosopher Stephen Darwall and social theorist Axel Honneth conceptually elucidate the links between justice, respect, and recognition. Their normative arguments offer a high-order conceptual framework for recognizing people’s equal worth as human beings (and the harmful effects of denying such recognition). This chapter compares their abstract frameworks with a landmark autobiography by a founder of the psychiatric survivor movement. The search for commensurability between these texts exposes the precise difference between experience-far and experience-near genres of ethical expression....
Anthropological Quarterly, Jul 1, 2003
Encyclopedia of Ethical, Legal and Policy Issues in Biotechnology, 2002
Contemporary bioethics arose in the 1960s in the wake of innovations in dialysis, transplants, ar... more Contemporary bioethics arose in the 1960s in the wake of innovations in dialysis, transplants, artificial organs, and assisted reproduction. These biotechnologies sparked debates about the allocation of scarce resources and the quality and limits of life. In response, ...
Culture, medicine and psychiatry, 2014
This article investigates the ambivalence of front-line mental health clinicians toward their pow... more This article investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people's will. Ambivalence denotes both inward uncertainty and a collective process that emerges in the midst of everyday work. In their commentaries about ambivalence, providers struggle with the distance separating their preferred professional self-image as caring from the routine practices of constraint. A detailed case study, drawn from 2 years of qualitative research in a U.S. community psychiatry agency, traces providers' response to the major tools of constraint common in such settings: outpatient commitment and collusion between the mental health and criminal justice systems. The case features a near-breakdown of clinical work caused by sharp disagreements over the ethical legitimacy of constraint. The ethnography depicts clinicians' experience of ambivalence as the complex product of their professional socialization, their relationships...
Medicine and Morality in Haiti, 1996
The American Journal of Bioethics, 2008
Anthropology & Medicine, 2010
In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical com... more In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show how case managers use this assemblage in their everyday routines, but also how it undercuts key elements of the original ACT mission. Reflecting its roots in the deinstitutionalization movement, the ACT model gives case managers limitless responsibilities for clients' lives, but then narrowly defines their role as the prosthetic extension of psychiatric authority. To produce compliance, case managers depend on the medication cassette, analyzed here as a human/non-human hybrid woven into their ordinary work. The medication cassette has pre-scripted uses that enlist clinicians in biopsychiatric thinking and also silently impose compliant behavior on clients. The elements in the assemblage of compliance depend on each other, but they do not form a seamless whole, as evidenced by the dilemmas and micropolitics of the clinical front-line. Theoretical notions of assemblages and technologies of compliance, drawn from science and technology studies, illuminate a core conundrum of practice in psychiatric case management.
This book explores the moral lives of mental health clinicians who serve the most marginalized in... more This book explores the moral lives of mental health clinicians who serve the most marginalized individuals in the U.S. healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Paul Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront challenges to their self-image as competent and compassionate. At times they openly question the coercion built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. These clinicians’ experience poses a single overarching question: how should we bear responsibility for the most vulnerable among us?
Medical Anthropology Quarterly, Sep 1, 2001
ABSTRACT Living and Working with the New Medical Technologies: Intersections of Inquiry. Margaret... more ABSTRACT Living and Working with the New Medical Technologies: Intersections of Inquiry. Margaret Lock. Allan Young. and Alberto Cambrosio. eds. New York: Cambridge University Press, 2000. ix+295 pp.
Anthropological Approaches to the Study of Ethnomedicine, 2021
... Just as health care seekers routinely deal in many different" medical idioms" over ... more ... Just as health care seekers routinely deal in many different" medical idioms" over the course of a single illness episode, practi-Paul Brodwin is an Assistant Professor of Anthropology at the University of Wisconsin-Milwaukee, PO Box 433, Milwaukee, WI53201. ...
Philosophy, Psychiatry, & Psychology, 2019
Understanding Health Inequalities and Justice, 2017
This chapter raises a key question for the interdisciplinary study of health and justice: is dial... more This chapter raises a key question for the interdisciplinary study of health and justice: is dialogue possible between theoretical models and first-person testimony about the harms caused by injustice? To consider this question, the chapter examines the claim that disrespect—the systematic devaluation of others in a way that excludes them from reciprocal social relations—is a form of injustice. The philosopher Stephen Darwall and social theorist Axel Honneth conceptually elucidate the links between justice, respect, and recognition. Their normative arguments offer a high-order conceptual framework for recognizing people’s equal worth as human beings (and the harmful effects of denying such recognition). This chapter compares their abstract frameworks with a landmark autobiography by a founder of the psychiatric survivor movement. The search for commensurability between these texts exposes the precise difference between experience-far and experience-near genres of ethical expression....
Anthropological Quarterly, Jul 1, 2003
Encyclopedia of Ethical, Legal and Policy Issues in Biotechnology, 2002
Contemporary bioethics arose in the 1960s in the wake of innovations in dialysis, transplants, ar... more Contemporary bioethics arose in the 1960s in the wake of innovations in dialysis, transplants, artificial organs, and assisted reproduction. These biotechnologies sparked debates about the allocation of scarce resources and the quality and limits of life. In response, ...
Culture, medicine and psychiatry, 2014
This article investigates the ambivalence of front-line mental health clinicians toward their pow... more This article investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people's will. Ambivalence denotes both inward uncertainty and a collective process that emerges in the midst of everyday work. In their commentaries about ambivalence, providers struggle with the distance separating their preferred professional self-image as caring from the routine practices of constraint. A detailed case study, drawn from 2 years of qualitative research in a U.S. community psychiatry agency, traces providers' response to the major tools of constraint common in such settings: outpatient commitment and collusion between the mental health and criminal justice systems. The case features a near-breakdown of clinical work caused by sharp disagreements over the ethical legitimacy of constraint. The ethnography depicts clinicians' experience of ambivalence as the complex product of their professional socialization, their relationships...
Medicine and Morality in Haiti, 1996
The American Journal of Bioethics, 2008
Anthropology & Medicine, 2010
In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical com... more In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show how case managers use this assemblage in their everyday routines, but also how it undercuts key elements of the original ACT mission. Reflecting its roots in the deinstitutionalization movement, the ACT model gives case managers limitless responsibilities for clients' lives, but then narrowly defines their role as the prosthetic extension of psychiatric authority. To produce compliance, case managers depend on the medication cassette, analyzed here as a human/non-human hybrid woven into their ordinary work. The medication cassette has pre-scripted uses that enlist clinicians in biopsychiatric thinking and also silently impose compliant behavior on clients. The elements in the assemblage of compliance depend on each other, but they do not form a seamless whole, as evidenced by the dilemmas and micropolitics of the clinical front-line. Theoretical notions of assemblages and technologies of compliance, drawn from science and technology studies, illuminate a core conundrum of practice in psychiatric case management.
Anthropological Quarterly, 2003
Education, 2001
Page 1. Annals of Behavioral Science and Medical Education Vol. 7(2), Fall 2001, pp. 80-86 Annals... more Page 1. Annals of Behavioral Science and Medical Education Vol. 7(2), Fall 2001, pp. 80-86 Annals of Behavioral Science and Medical Education ©2001 by the Association for the Behavioral Sciences and Medical ZOOl, Vol. 7, No.2, XX(X=page numbers) ...
ABSTRACT. Recent disputes about human population genetics research have been pro-voked by the fie... more ABSTRACT. Recent disputes about human population genetics research have been pro-voked by the field’s political vulnerability (the historic imbalance of power between the geneticists and the people they study) and conceptual vulnerability (the mismatch be-tween scientific and popular understandings of the genetic basis of collective identity). The small, isolated groups often studied by this science are now mobilizing themselves as political subjects, pressing sovereignty claims, and demanding control over the direc-tion and interpretation of research. Negotiations between the geneticists and the people asked to donate DNA have resulted not only in explicit bioethics protocols but also in diffuse anxiety over the incommensurability between expert and non-expert views about genetic evidence for identity claims. This article compares two disputes over genetics A1 research: the Human Genome Diversity Project and the use of genetics to prove iden-tity claims among the Melungeons of Tenn...
Medical Anthropology Quarterly, 2011