ABSTRACT
This chapter examines the implications of a fragmentation of shared cultural plots and symbols, and its substitution by a Western psychiatric nosology for the possibilities of articulating personal distress. It argues the development through a dialogue between the theoretical literature and an ethnography based on observing and listening to psychiatric consultations. The chapter explores the significance of a somatic versus psychological language of distress and considers the implications of such languages for the possibility of dialogue and the affirmation of subjectivity. It focuses on the transcriptions of four psychiatric consultations and to look at how, within these consultations, the shifting interrelationships of narrative and voice reveal not only the structures of subjectivities and intersubjectivities, but also the impact of power structures within the public domain where the Latvian psychiatric consultations are frequently disrupted and fragmented. In seeking to understand the psychiatric consultations the idea of voice directs towards the very real presence of the patient in the consulting room.
