Culture, Medicine, and Psychiatry

, Volume 38, Issue 4, pp 527–549 | Cite as

The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry

Original Paper


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 with clients, and on-going workplace debates about allowable and forbidden uses of power. As people articulate their ethical sensibility toward constraint, they stumble over the enduring fault lines of community psychiatry, and they also develop an ethos of care tailored to the immediate circumstances, the implicit ideologies, and the broad social contexts of their work.


Psychiatry Ethics Coercion Constraint Ambivalence Care 



The author thank the National Science Foundation for funding this study and the clients and staff of the pseudonymous Eastside Services for their generosity. The author is also grateful for the perceptive comments of the peer reviewers as well as Janelle Taylor, Michele Rivkin-Fish, and their colleagues at the University of Washington-Seattle and the University of North Carolina-Chapel Hill where he presented early versions of this paper.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of Wisconsin-MilwaukeeMilwaukeeUSA

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