Culture, Medicine, and Psychiatry

, Volume 37, Issue 1, pp 131–147 | Cite as

Opening the Gift: Social Inclusion, Professional Codes and Gift-Giving in Long-Term Mental Healthcare

  • S. T. C. Ootes
  • A. J. Pols
  • E. H. Tonkens
  • D. L. Willems


Deinstitutionalisation has not only made the social inclusion of clients a key objective in long-term mental healthcare, it may also affect the role of the care professional. This article investigates whether the social inclusion objective clashes with other long-standing professional values, specifically when clients give gifts to care professionals. In making a typology of gifts, we compare the literature on gift-giving with professional codes for gifts and relate both to the objective of social inclusion of clients. Our typology draws on an analysis of ethnographic fieldwork carried out in 2007/2008 at a Dutch mental healthcare centre. We identify four types of gifts for professionals in long-term mental healthcare, each relating individually to professional codes and the objective of social inclusion of clients. Only the ‘personal gift’ directly supports social inclusion, by fostering personal relationships between professionals and clients. Acceptance of this type of gift is advocated only for long-term care professionals. We suggest that professional codes need to consider this typology of gifts, and we advocate promoting reflexivity as a means of accounting for professional behaviour in deinstitutionalised care settings.


Mental healthcare Social inclusion Professional codes Gift-giving Ethnography 



This research was supported by Grants from the VSB fonds, the kfHein fonds, and Mondriaan Zorggroep. We are grateful for the cooperation of the staff and clients of the mental healthcare centre, where the fieldwork for this article was conducted. In earlier versions, this article has been presented at several conferences and workshops. We wish to thank attendees of the Rotterdam EASST 2008 conference, the Lancaster 2009 PhD summer conference, and members of the PhD seminar of the Centre de Sociologie de l’Innovation in Paris for their advice and comments. In addition, we thank Bianca Bruinsma, Tineke Broer, Eline van Haastrecht, Lineke van Hal, Jean Philippe de Jong, Samuel Lézé, Annemarie Mol, Vololona Rabeharisoa and Lineke van Hal for discussing this article with us and for their feedback and suggestions.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • S. T. C. Ootes
    • 1
  • A. J. Pols
    • 1
  • E. H. Tonkens
    • 2
  • D. L. Willems
    • 1
  1. 1.Department of General PracticeAcademic Medical Centre/University of Amsterdam, Medical Ethics SectionAmsterdamThe Netherlands
  2. 2.Department of Sociology and AnthropologyUniversity of AmsterdamAmsterdamThe Netherlands

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