- Bad Souls: Madness and Responsibility in Modern Greece by Elizabeth Anne Davis
In 1983, a clarion call for psychiatric reform in Greece was issued when the Greek Ministry of Health reported, “It is broadly accepted that psychiatric care [in Greece] is totally inadequate. The manner of dealing with psychiatric patients often comes close to denying the most basic notions of human dignity. Radical reform is needed to change this intolerable situation.” At the time, persons with mental illness were often relegated to one of ten state hospitals, kept under the watch of the state and out of the public eye. But beyond a concern for human rights, reform was necessary to meet the country’s goals. In order to accede to the European Union, Greece would have to move from a reliance on these “custodial hospitals” to community-based care and outpatient services. How this reform impacted and shifted relationships of responsibility “among psychiatric patients and their caregivers” is the topic of Elizabeth Anne Davis’s first book, Bad Souls: Madness and Responsibility in Modern Greece.
Using ethnographic study and research conducted between 2001 and 2004 in the northern borderland of Thrace, Davis brilliantly illuminates international and national policy impacts at the local level. Bad Souls is split into three parts and telescopes outward from the “suspicions of deceptions shared by patients and therapists,” to cultural influences impacting relationships between patients and the state as well as their therapists, to the “challenging presumptions of personal freedom written into the legislation of reform” that the “ ‘inhuman’ face of severe pathology” presents. Interludes dispersed throughout the book deepen the reader’s understanding without diverging from the main themes of the book. Switching freely between prosaic, ethnographic accounts and [End Page 152] interviews with patients and therapists to heavy analysis of psychiatric reform and its philosophical underpinnings, Davis’s style of writing mirrors the experience of therapists, administrators, patients, and policymakers who regularly face the same strange dichotomy between life in practice and life in theory. The haunting accounts of the individuals, from suicides to reflections on living with mental illness, make the subject relatable to the reader and stir compassion for the suffering of those with mental illness and the failure of the system to meet their needs. At the same time, the ethnographies expose the messy boundaries between need and abuse of psychiatric drugs and care in northern Greece and the ethical and moral quandaries they pose to therapists. It is clear that the reform demanded for accession to the European Union was, at the time of writing, still stuck in limbo, with policymakers, doctors, and patients alike still searching for an appropriate twenty-first-century, Greek expression of psychiatric care amidst a diverse population.
In part 1, Davis uses the framework of truth games to examine power in therapeutic settings. “Clinical diagnosis,” she writes, “is the key to the problematic status of truth in contemporary psychiatry.” She further contends that “diagnosis is a fundamentally moral activity . . . not only because it transpires in relations of care between people unequal in power . . . but also because it proceeds according to the rules of a game played for truth.” It is this diagnosis that determines the level of care—as well as other forms of welfare—that patients receive from the state. Patients and therapists are constantly engaged in this game of truth and deception to meet their own objectives, while the new focus on outpatient care puts a greater burden on clear patient communication in determining a diagnosis. Davis goes into detail to provide examples and her analysis of both the lies and truths spoken between doctors and patients. These “suspicions,” she argues, go against reformist goals and “help to secure mutual therapeutic dependencies.”
In part 2, Davis moves into the question of culture—particularly of Muslim, Gypsy, and Pontian minorities in Greece as they interact with the psychiatric system in Thrace. Here, the ideals of neoliberal reform and patient responsibility butt up against culture and tradition. One doctor of Turkish descent on...