Alex Barnard


Public mental healthcare systems in the developed world face three interlinked challenges, but their responses to them—and the consequences of those responses for people living with severe mental illnesses like schizophrenia—vary enormously. First, as emphasis shifts from the relatively narrow category of “mental illness” to the much broader one of “mental health,” growing demand for services is increasingly in tension with welfare-state retrenchment. Second, as long-term “institutionalization” in custodial hospitals has become fiscally and ethically indefensible, there is a widening fissure between a social mandate to promote “autonomy” or “recovery” and the reality of chronic illnesses. Third, the rising proportion of the mentally ill in prison is emblematic of the growing interpenetration of law and psychiatry. My dissertation examines how frontline professionals in France are responding to these challenges, drawing on a multi-sited ethnography of psychiatric clinics, disability offices, emergency rooms, and courts, as well as on archival materials and over two-hundred qualitative interviews. Deciding who goes where between fragmented health, social, and criminal justice agencies is rarely a matter of diagnosis. Instead, professionals push people with severe mental disorders between different institutions of care and control by drawing on culturally-specific understandings of who is mentally “diseased” versus those who are instead “disabled” “dangerous” or “deviant.” My research thus shows how reforms to social policy must contend with often unspoken schemes of classification that are embedded in the very structure of states and the everyday practices of bureaucrats.