Advertisement

Theory and Society

, Volume 48, Issue 5, pp 753–784 | Cite as

Bureaucratically split personalities: (re)ordering the mentally disordered in the French state

  • Alex V. BarnardEmail author
Article

Abstract

The ability to (re)classify populations is a key component of state power, but not all new state classifications actually succeed in changing how people are categorized and governed. This article examines the French state’s partly unsuccessful project in 2005 to use a new classification—“psychic handicap”—to ensure that people with severe mental disorders received services and benefits from separate agencies based on a designation of being both “mentally ill” and “disabled.” Previous research has identified how new classifications can be impeded by cultural and cognitive barriers to their adoption and struggles between professionals or administrators over their implementation. Drawing on 186 interviews, archival sources, and 13 months of observations across different French bureaucracies, I expand on this literature in two ways. First, I use the case of psychic handicap to argue that a new classification can also fail to achieve its intended effect when it constitutes a bureaucratically split personality—a combination of classifications that imply that individuals belong to two, mutually exclusive kinds of people. I show how psychic handicap embodied contradictory expectations about the behavior, characteristics, and institutional trajectory of people with mental disorders. Second, I identify how bureaucrats resolved these contradictions through mechanisms of refractory looping, outsourcing expertise, and classification by default, which in this case led to the reclassification of this population as simply “mentally ill.” This framework calls attention to how practical inconsistencies can limit the impact of new classifications, even absent overt resistance to their elaboration or implementation.

Keywords

Boundary objects Bureaucratically split personalities Classification struggles The French state Psychiatric diagnosis Psychic handicap 

Notes

Acknowledgements

The author gratefully acknowledges the assistance of Martin Eiermann, Gil Eyal, Neil Fligstein, Marion Fourcade, Matty Lichtenstein, Michael Long, Mara Loveman, Marie Mourad, Isabel Perera, Gisele Sapiro, Tonya Tartour, two anonymous reviewers, and the Theory and Society Editors, as well as the Culture Organizations and Politics Workshop, Berkeley Medical Sociology Working Group, the Berkeley-SciencesPo Collaboration Conference, the Columbia Science Knowledge and Technology Working Group, and the Center for European Sociology. A version of this article was presented at the 2017 ASA Annual Meeting in the Regular Session on Health Policy. Research was made possible with the generous support of the Chateaubriand and Georges Lurcy Fellowships and the Institute for International Studies and Center for European Studies at Berkeley.

References

  1. Abbott, A. (1988). The system of professions: An essay on the division of expert labor. Chicago: University of Chicago Press.Google Scholar
  2. Alexis, S. (2008). Accueillir ou reconduire. Enquête sur les guichets de l’immigration. 7Paris: Éditions Raisons d’Agir.Google Scholar
  3. Ayme, J. (2002). La loi de 1975 et les réactions syndicales. In J. P. Arveiller (Ed.), Pour une psychiatrie sociale. 50 ans d’action de la Croix Marine (pp. 181–186). Erès: Ramonville-Sainte-Agne, Paris.Google Scholar
  4. Bagnall, A., & Eyal, G. (2016). Forever children? and autonomous citizens: Comparing the deinstitutionalizations of psychiatric patients and developmentally disabled individuals in the United States. In B. Perry (Ed.), 50 years after deinstitutionalization: Mental illness in contemporary communities (pp. 27–61). Bingley: Emerald.Google Scholar
  5. Bailey, S. R. (2008). Unmixing for race making in Brazil. American Journal of Sociology, 114(3), 577–614.  https://doi.org/10.1086/592859.Google Scholar
  6. Barman, E. (2013). Classificatory struggles in the nonprofit sector: the formation of the national taxonomy of exempt entities, 1969–1987. Social Science History, 37(1), 103–141.  https://doi.org/10.1017/S0145553200010580.Google Scholar
  7. Barral, C. (2007). Disabled persons’ associations in France. Scandinavian Journal of Disability Research, 9(3–4), 214–236.  https://doi.org/10.1080/15017410701680506.Google Scholar
  8. Baudot, P.-Y., & Revillard, A. (2015). L’autonomie de l’équilibriste. Gouvernement et action publique, 4(4), 83–113.Google Scholar
  9. Bauduret, J.-F., & Jaeger, M. (2005). Rénover l’action sociale et médico-sociale: histores d’une refondation (2nd ed.). Paris: Dunod.Google Scholar
  10. Berg, M., & Bowker, G. (1997). The multiple bodies of the medical record: toward a sociology of the artifact. The Sociological Quarterly, 38(3), 513–537.  https://doi.org/10.1111/j.1533-8525.1997.tb00490.x.Google Scholar
  11. Berkowitz, E. D., & DeWitt, L. (2013). The other welfare: Supplemental security income and U.S. social policy. Ithaca: Cornell University Press.Google Scholar
  12. Bertrand, L., Caradec, V., & Eideliman, J.-S. (2014). Situating disability: the recognition of “disabled workers” in France. ALTER-European Journal of Disability Research, 8(4), 269–281.  https://doi.org/10.1016/j.alter.2014.09.006.Google Scholar
  13. Bosk, E. A. (2013). Between badness and sickness: reconsidering medicalization for high risk children and youth. Children and Youth Services Review, 35(8), 1212–1218.  https://doi.org/10.1016/j.childyouth.2013.04.007.Google Scholar
  14. Bourdieu, P. (2015). On the state. Cambridge, UK: Polity.Google Scholar
  15. Bowker, G. C., & Star, S. L. (1999). Sorting things out: Classification and its consequences. Cambridge, MA: MIT Press.Google Scholar
  16. Bracci, E., & Llewellyn, S. (2012). Accounting and accountability in an Italian social care provider: contrasting people-changing with people-processing approaches. Accounting, Auditing & Accountability Journal, 25(5), 806–834.Google Scholar
  17. Brubaker, R., & Cooper, F. (2000). Beyond “identity.”. Theory and Society, 29(1), 1–47.Google Scholar
  18. Burawoy, M. (1998). The extended case method. Sociological Theory, 16(1), 4–33.Google Scholar
  19. Bureau, M.-C., Rist, B., Lima, L., & Trombert, C. (2013). La traduction de la demande d’aide sociale: les cas du handicap et de l’insertion des jeunes. Revue française d’administration publique, 145(1), 175–188.Google Scholar
  20. Carson, J. (2007). The measure of merit: Talents, intelligence, and inequality in the French and American republics, 1750-1940. Princeton: Princeton University Press.Google Scholar
  21. Chamak, B. (2010). Autisme, handicap et mouvements sociaux. ALTER-European Journal of Disability Research, 4(2), 103–115.  https://doi.org/10.1016/j.alter.2010.02.001.Google Scholar
  22. Chapireau, F. (2016). Le handicap psychique. In L’Encyclopédie médico-chirurgicale. http://www.em-consulte.com/article/1068052/handicap-psychique. Accessed 19 June 2016.
  23. Chauvière, M. (1980). Enfance inadaptée: l’héritage de Vichy. Paris: Les Editions Ouvrières.Google Scholar
  24. Conrad, P. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.Google Scholar
  25. Craciun, M. (2016). The cultural work of office charisma: maintaining professional power in psychotherapy. Theory and Society, 45(4), 361–383.  https://doi.org/10.1007/s11186-016-9273-z.Google Scholar
  26. Davis, L., Fulginiti, A., Kriegel, L., & Brekke, J. S. (2012). Deinstitutionalization? Where have all the people gone? Current Psychiatry Reports, 14(3), 259–269.  https://doi.org/10.1007/s11920-012-0271-1.Google Scholar
  27. Dubois, V. (2003). La vie au guichet: relation administrative et traitement de la misère (2nd ed.). Paris: Economica.Google Scholar
  28. Espeland, W. N., & Stevens, M. L. (1998). Commensuration as a social process. Annual Review of Sociology, 24(1), 313–343.  https://doi.org/10.1146/annurev.soc.24.1.313.Google Scholar
  29. Eyal, G. (2013). For a sociology of expertise: the social origins of the autism epidemic. American Journal of Sociology, 118(4), 863–907.  https://doi.org/10.1086/668448.Google Scholar
  30. Foucault, M. (1991). Governmentality. In G. Burchell, C. Gordon, P. Miller (Eds.), The Foucault effect (pp. 87–104). Chicago: University of Chicago Press.Google Scholar
  31. Fourcade, M. (2009). Economists and societies: Discipline and profession in the United States, Britain, and France, 1890s to 1990s. Princeton: Princeton University Press.Google Scholar
  32. Friese, C. (2010). Classification conundrums: categorizing chimeras and enacting species preservation. Theory and Society, 39(2), 145–172.  https://doi.org/10.1007/s11186-009-9103-7.Google Scholar
  33. Goldberg, C. A. (2005). Contesting the status of relief workers during the new Deal. Social Science History, 29(3), 337–371.Google Scholar
  34. Goldstein, J. (1987). Console and classify: The French psychiatric profession in the nineteenth century. Cambridge: Cambridge University Press.Google Scholar
  35. Gong, N. (2017). “That proves you mad, because you know it not”: Impaired insight and the dilemma of governing psychiatric patients as legal subjects. Theory and Society, 46(3), 201–228.  https://doi.org/10.1007/s11186-017-9288-0.Google Scholar
  36. Hacking, I. (1995). The looping effects of human kinds. In D. Sperber, D. Premack, & A. J. Premack (Eds.), Causal cognition: A multidisciplinary approach (pp. 351–383). Oxford, UK: Oxford University Press.Google Scholar
  37. Hacking, I. (1998). Rewriting the soul: Multiple personality and the sciences of memory. Princeton: Princeton University Press.Google Scholar
  38. Hansen, H., Bourgois, P., & Drucker, E. (2014). Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform. Social Science & Medicine, 103, 76–83.  https://doi.org/10.1016/j.socscimed.2013.06.033.Google Scholar
  39. Hasenfeld, Y., Rafferty, J. A., & Zald, M. N. (1987). The welfare state, citizenship, and bureaucratic encounters. Annual Review of Sociology, 13(1), 387–415.Google Scholar
  40. Henckes, N. (2011). La politique du handicap psychique. DREES/MiRe–Convention de Recherche n° 08-2547. https://hal.archives-ouvertes.fr/file/index/docid/769756/filename/Henckes_2011_Rapport_MiRe.pdf. Accessed 1 Oct 2015.
  41. Hirschman, D., Berrey, E., & Rose-Greenland, F. (2016). Dequantifying diversity: affirmative action and admissions at the University of Michigan. Theory and Society, 45(3), 265–301.  https://doi.org/10.1007/s11186-016-9270-2.Google Scholar
  42. Horwitz, A. V. (2001). Creating mental illness. Chicago: University of Chicago Press.Google Scholar
  43. Joyce, P., & Mukerji, C. (2017). The state of things: state history and theory reconfigured. Theory and Society, 46(1), 1–19.  https://doi.org/10.1007/s11186-017-9282-6.Google Scholar
  44. Kellogg, K. C. (2011). Challenging operations: Medical reform and resistance in surgery. Chicago: University of Chicago Press.Google Scholar
  45. Kellogg, K. C. (2014). Brokerage professions and implementing reform in an age of experts. American Sociological Review, 79(5), 912–941.  https://doi.org/10.1177/0003122414544734.Google Scholar
  46. Lakoff, A. (2005). Diagnostic liquidity: mental illness and the global trade in DNA. Theory and Society, 34(1), 63–92.  https://doi.org/10.1007/s11186-005-6233-4.Google Scholar
  47. Lamont, M., & Molnár, V. (2002). The study of boundaries in the social sciences. Annual Review of Sociology, 28, 167–195.Google Scholar
  48. Lanteri-Laura, G. (1972). La chronicité dans la psychiatrie moderne française. Note d’histoire théorique et sociale. Annales. Histoire, Sciences Sociales, 27(3), 548–568.  https://doi.org/10.3406/ahess.1972.422522.
  49. Lara-Millán, A. (2014). Public emergency room overcrowding in the era of mass imprisonment. American Sociological Review, 79(5), 866–887.  https://doi.org/10.1177/0003122414549552.Google Scholar
  50. Lipsky, M. (2010). Street-level bureaucracy: dilemmas of the individual in public service (30th anniversary.). New York: Russell Sage Foundation.Google Scholar
  51. Liu, K., King, M., & Bearman, P. S. (2010). Social influence and the autism epidemic. American Journal of Sociology, 115(5), 1387–1434.  https://doi.org/10.1086/651462.Google Scholar
  52. Loveman, M. (2007). The U.S. Census and the contested rules of racial classification in early twentieth-century Puerto Rico. Caribbean Studies, 35(2), 79–113.Google Scholar
  53. Loveman, M. (2014). National colors: Racial classification and the state in Latin America. Oxford, UK: Oxford University Press.Google Scholar
  54. Loyal, S., & Quilley, S. (2017). The particularity of the universal: critical reflections on Bourdieu’s theory of symbolic power and the state. Theory and Society, 46(5), 429–462.  https://doi.org/10.1007/s11186-017-9298-y.Google Scholar
  55. Mayrl, D., & Quinn, S. (2016). Defining the state from within: boundaries, schemas, and associational policymaking. Sociological Theory, 34(1), 1–26.  https://doi.org/10.1177/0735275116632557.Google Scholar
  56. Mohr, J. W., & Duquenne, V. (1997). The duality of culture and practice: poverty relief in New York City, 1888-1917. Theory and Society, 26(2–3), 305–356.  https://doi.org/10.1023/A:1006896022092.Google Scholar
  57. Mol, A. (2002). The body multiple: Ontology in medical practice. Durham: Duke University Press.Google Scholar
  58. Mora, G. C. (2014). Cross-field effects and ethnic classification. American Sociological Review, 79(2), 183–210.  https://doi.org/10.1177/0003122413509813.Google Scholar
  59. Morgan, K. J., & Orloff, A. S. (Eds.). (2017). Introduction. In The many hands of the state: Theorizing political authority and social control (pp. 1–32). Cambridge, UK: Cambridge University Press.Google Scholar
  60. Navon, D., & Eyal, G. (2016). Looping genomes: diagnostic change and the genetic makeup of the autism population. American Journal of Sociology, 121(5), 1416–1471.  https://doi.org/10.1086/684201.Google Scholar
  61. Norton, M. (2014). Classification and coercion: the destruction of piracy in the English maritime system. American Journal of Sociology, 119(6), 1537–1575.  https://doi.org/10.1086/676041.Google Scholar
  62. Pinell, P. (2004). La normalisation de la psychiatrie française. Regards sociologiques, 29, 3–21.Google Scholar
  63. Porter, T. M. (1996). Trust in numbers: The pursuit of objectivity in science and public life. Princeton, NJ: Princeton University Press.Google Scholar
  64. Powell, J. J. W. (2010). Change in disability classification: redrawing categorical boundaries in special education in the United States and Germany, 1920–2005. Comparative Sociology, 9(2), 241–267.Google Scholar
  65. Power, A., Lord, J. E., & DeFranco, A. S. (2014). Active citizenship and disability: Implementing the personalisation of support. Cambridge, UK: Cambridge University Press.Google Scholar
  66. Prottas, J. (1979). People processing: The street-level bureaucrat in public-service bureaucracies. Lexington: Lexington Books.Google Scholar
  67. Romien, P. (2005). À l’origine de la réinsertion professionnelle des personnes handicapées : la prise en charge des invalides de guerre. Revue française des affaires sociales, 2, 229–247.Google Scholar
  68. Rose, N. (2006). Disorders without borders? The expanding scope of psychiatric practice. BioSocieties, 1(04), 465–484.  https://doi.org/10.1017/S1745855206004078.Google Scholar
  69. Sandfort, J. R. (2000). Moving beyond discretion and outcomes: examining public management from the front lines of the welfare system. Journal of Public Administration Research and Theory, 10(4), 729–756.  https://doi.org/10.1093/oxfordjournals.jpart.a024289.Google Scholar
  70. Seim, J. (2017). The ambulance: toward a labor theory of poverty governance. American Sociological Review, 82(3), 451–475.  https://doi.org/10.1177/0003122417702367.Google Scholar
  71. Showalter, D. (2019). Misdiagnosing medicalization: penal psychopathy and psychiatric practice. Theory and Society, 48(1), 67–94.  https://doi.org/10.1007/s11186-018-09336-y.Google Scholar
  72. Soss, J. (2000). Unwanted claims: the politics of participation in the U.S. welfare system. Ann Arbor: University of Michigan Press.Google Scholar
  73. Star, S. L., & Griesemer, J. R. (1989). Institutional ccology, translations and boundary objects: amateurs and professionals in Berkeley’s Museum of Vertebrate Zoology, 1907-39. Social Studies of Science, 19(3), 387–420.  https://doi.org/10.1177/030631289019003001.Google Scholar
  74. Starr, P. (1992). Social categories and claims in the liberal state. Social Research, 59(2), 263–295.Google Scholar
  75. Steensland, B. (2006). Cultural categories and the American welfare state: the case of guaranteed income policy. American Journal of Sociology, 111(5), 1273–1326.  https://doi.org/10.1086/ajs.2006.111.issue-5.Google Scholar
  76. Stone, D. A. (1984). The disabled state. Philadelphia: Temple University Press.Google Scholar
  77. Strand, M. (2011). Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge. Theory and Society, 40(3), 273–313.  https://doi.org/10.1007/s11186-011-9142-8.Google Scholar
  78. Waldschmidt, A. (2009). Disability policy of the European Union: the supranational level. ALTER-European Journal of Disability Research, 3(1), 8–23.  https://doi.org/10.1016/j.alter.2008.12.002.Google Scholar
  79. Watkins-Hayes, C. (2009). The new welfare bureaucrats: Entanglements of race, class, and policy reform. Chicago: University of Chicago Press.Google Scholar
  80. Whooley, O. (2016). Measuring mental disorders: the failed commensuration project of DSM-5. Social Science & Medicine, 166, 33–40.  https://doi.org/10.1016/j.socscimed.2016.08.006.Google Scholar
  81. Winance, M., Ville, I., & Ravaud, J.-F. (2007). Disability policies in France: changes and tensions between the category-based, universalist and personalized approaches. Scandinavian Journal of Disability Research, 9(3–4), 160–181.  https://doi.org/10.1080/15017410701680795.Google Scholar
  82. Zerubavel, E. (1996). Lumping and splitting: notes on social classification. Sociological Forum, 11(3), 421–433.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of SociologyNew York UniversityNew YorkUSA

Personalised recommendations