ABSTRACT
This chapter explores the interactions between contexts, conceptions of professionalism, and the object of psychiatry. Contexts co-constitute what professionals and professional groups are doing, i.e., what they see as the proper object of their care and how they define themselves. This co-constituting can be split into the three levels of interaction: micro, meso, and macro. On each of these levels of interaction, the normative practice approach can be applied and leads to different definitions of the object of psychiatry.
Contextual factors at a micro-level have an immediate impact on the genesis and manifestation of disease and, thereby, on the object of mental healthcare. They also codetermine how individual professionals develop, define themselves, and are perceived by others. Changing conceptions about the professional role influence the way patients communicate about their symptoms and signs.
At the meso-level, institutional factors impact on conceptions of psychopathology and on professionalism. The object of psychiatry shifts towards meeting the healthcare needs of patients and sustaining and improving of the capabilities of patients in a certain region, rather than serving the well-being of individual patients.
At the macro-level, the focus is on societal issues with an impact on how mental illness is expressed and on how professions are defined. Changing conceptions of professionalism influence how patients tell about their complaints. The emphasis now shifts from capacities and needs to distributive justice, i.e., to society’s responsibility to provide access to care that meets standards that are sufficiently high—standards that evolve from a discussion between all relevant stakeholders.
At the end of the chapter, it is concluded that civic partnership will increasingly be part of tomorrow’s definition of professionalism.
