Prawdziwa depresja i paternalizm kliniczny: etnografia realności diagnostycznej depresji w publicznej służbie zdrowia w Polsce
Real depression and clinical paternalism: an ethnography of the realness of depression diagnostics in Polish public health care

Summary/Abstract: The article explores the cultural and economic dimensions in diagnosing depression in Polish psychiatric practice since the systemic transformation with a particular focus on strategies used by physicians. Based on ethnographic research in clinical settings, it discusses this issue in terms of realness and “realification” (urealnienie)– concepts referring to the relation-ship between categories of description and their objects. While the changes of diagnostic classifications since the 1990s had the explicit goal of tightening that relationship, in clinical practice it remains somewhat lose and unclear. What contributes to it is not just the specific ontology of mental disorders which is hard to reduce fully to objectively measurable symptoms, but several other factors: specific changes in the philosophy of diagnostic classifications and their complex nature as clinical, administrative and financial tools, as well as their referential nature, which connotes optimal, though unattainable, standards of care. It is also shaped by the pragmatics of clinical work and the patients’ limited resources, which render the diagnostics a tool of physicians’ “medical paternalism” – their informal, instrumental attempts to respond to the deficiencies of the system of care.

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