Managing Madness in the Community: The Challenge of Contemporary Mental Health Care by Kerry Michael Dobransky (review)

Increasingly, fields across disciplines are turning to the collection of interviews and stories as a methodology aimed at gathering firsthand information about human experiences. All interviews and stories, however, are not equal. It is important to frame the practice of interviewing or story collection within a particular methodology in order to understand the overall goals and limitations of the data/information gathered from individuals. Kerry Michael Dobransky's book Managing Madness in the Community: The Challenge of Contemporary Mental Health Care is an example of how interviews are utilized in mental health studies, and analyzing it provides an opportunity to consider the distinction between ethnographic research and oral history.

In his book, Dobransky examines the strategies organizations and their clients use to manage the fragmentation of mental health services for people with severe, persistent mental illness (SPMI) in the United States. For Dobransky, fragmentation refers to the often-conflicting demands of constituencies, laws, and regulations in any given case or situation that influence policies and treatment of people with SPMI. In order to better understand and analyze fragmentation and responses to it, Dobransky frames his analysis in the theoretical tradition of institutional logic, "a set of material practices and symbolic construction [that] constitutes the organizing principles" of the health care and social services fields (7). He argues that four logics exist in community health care: clinical-professional logic, community logic, empowerment logic, and the logic of bureaucratic accountability. In the book he examines the character of these logics and looks into how mental health professionals and their clients experience and deal with them in the actual service setting. Dobransky argues that logics penetrate an organization in different ways and to different degrees. Furthermore, the degree to which a given logic is institutionalized affects how it does or does not work in practice and how people deploy it with other logics. Through his analysis, he finds that workers and clients must navigate and adapt to the constraints and requirements the different logics bring.

Dobransky's analysis is based on data collected from two community organizations in the Midwest, "urban" and "suburban," which served as his field sites. The data includes observations from meetings, treatment groups, and counseling sessions he attended; policy and procedure materials that government entities and the organizations themselves gathered; clinical files of thirtynine out of forty-two clients he interviewed; and interviews from forty-two clients and forty-nine workers. According to Dobransky, he conducted semistructured interviews twenty minutes to two hours in length focused on statements and behaviors that he witnessed during his observations.

Dobransky's research methodology, including his approach to interviews, is best characterized as ethnography. Once primarily used by anthropologists, ethnography is a qualitative research strategy intended to allow a researcher to explore cultures and societies that are a fundamental part of human experience by providing in-depth examples of everyday life and practice (see, for example, Julian Murchison, Ethnography Essentials: Designing, Conducting, and Presenting Your Research [San Francisco, CA: John Wiley & Sons, 2010]; and Clifford Geertz, The Interpretation of Cultures [New York: Basic Books, 1973]). Indeed, the bulk of Dobransky's book focuses on interactions between workers and clients in order to examine everyday practices within mental health care communities. Dobransky shows how these interactions in the context of his two field sites result in workers socially constructing clients and their conditions. Ultimately, the everyday practices inform the treatment clients receive.

If Dobransky had taken an oral history approach, we might expect the goals of his research to be different. Ethnography and oral history both look to firsthand stories and observation as windows to the human experience. That said, even when employed within the same discipline, ethnography and oral history are different methodologies with distinct objectives. Two defining characteristics of oral history interviews are their content and purpose, both of which focus on the past. To clarify, even if the topic of...