The Moral Life of Doors in an Open Psychiatric Center

ABSTRACT

Doors are infamous in psychiatry for being used as instruments of constraint. Yet, while taking a close look at the doors of an open psychiatric center for teenagers in Brussels, I discover that doors play much more ambivalent roles beyond the issue of access and that their normativity shifts in the ongoing practice of care. While examining the moral life of these doors, I describe four modes of reflexivity that unfold with them. These reflexive modes are central to care work, since they put fraught issues on the table and enable a more livable everyday togetherness in institutional care.

RÉSUMÉ

En psychiatrie, les portes sont tristement célèbres pour leur utilisation comme instruments de contrainte. Pourtant, par une observation minutieuse des portes d’un centre psychiatrique ouvert pour adolescents à Bruxelles, je découvre que celles-ci jouent un rôle beaucoup plus ambivalent au-delà du problème de l’accès et, de plus, que leur normativité se modifie au cours de la pratique de soin. Mon enquête sur la « vie morale » de ces portes met en évidence quatre modes de réflexivité que celles-ci provoquent. Ces modes réflexifs sont cruciaux pour le travail du soin, car ils mettent sur la table des questions embarrassantes et permettent une meilleure vie commune dans une institution de soin.

KEYWORDS:

• Belgium
• doors
• empirical ethics
• morality
• reflexivity
• psychiatry

Acknowledgments

I am grateful to the employees and teenagers of the care facility where I conducted research. I thank Jeannette Pols, Annekatrin Skeide, and the anonymous reviewers for their comments on previous versions, and Stephen Creek who assisted with editing. This article is based on a chapter of my PhD thesis, titled, Modest Attachments: An Inquiry into the Potentialities of Material Spaces in a Psychiatric Day Care Centre (University of Amsterdam and Université Libre de Bruxelles, 2018). The revision was possible thanks to unemployment benefits in Belgium.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

1. On their request, all the names of my interlocutors are pseudonyms. The names of all facilities are real.

2. The distinction between “morality” and “normativity” may be confusing. Here, the former refers to interactions with the object seen as good or bad, and the latter to the social standards seen as appropriate in the center. Whereas moral issues are hard to disconnect from normativity, norms may not always involve moral obligations or dilemmas.

^3. In Belgium, teams of psychiatric settings often combine several therapeutic orientations. Here, therapeutic community life blended with a biomedical practice and with analytical work, inspired by psychoanalytic and systemic approaches.

^4. The detail of door equipment is quite fascinating for its potential to discreetly afford (or fail to afford) ease to users, such as when inducing them to push or pull. See Norman (1998: 10).

^5. Hennion associates reflexivity with the French grammatical form “reflexive.” This form uses the word “se” to express that events arrive without active or passive actors at all, leaving the subject impersonal (for instance, “cela se passe”).

^6. In psychiatry, doors that exclude patients from the team’s secrets easily provoke lots of anger among patients (Estroff 1981: 61). More broadly, one may remember that doors are conducive to arousing curiosity, for example while eavesdropping or spying through a keyhole.

^7. Foucault (2003: 103) detected “supportive points” [points d’appuis] of power in the disciplining spaces of hospitals, as they distributed individuals and organized circulations and gazes.

^8. As Pols (2012: 115–131) showed with the implementation of a telecare device, when certain changes gradually translate into routines, the innovative care practice can be experimented with more creatively than with normal application.

Additional information

Funding

The research was funded by a scholarship from the Fonds de la Recherche Scientifique (F.R.S.-FNRS).

Notes on contributors

Ariane d’Hoop

First trained as a stage designer, Ariane d’Hoop conducted her PhD research in Medical Anthropology at the University of Amsterdam and in Architecture at the Université Libre de Bruxelles. She studied how spatial arrangements in non-hospital psychiatric settings contribute to the everyday care practice. She is currently working on two projects that extend her thinking on care and space. One investigates the contributions of art in health and social care, while the other explores environmental care for animals facing extinction in cities.