From ‘High Achievers’ to 'Hopeless Cases': Class Dynamics in the Psychotherapy of Work-Related Suffering

• In Event: 20420 - Section on Sociology of Culture Roundtables
  In Refereed Roundtable (90 minute): Table 7: Culture, Labor, and Meaning Making at Work

Abstract

Throughout this paper I analyze how mental health clinics treat work-related sufferings of their patients and, subsequently, how they reproduce class inequalities on a micro level while doing so. I draw on ethnographic observations and interview data from research in eight psychosomatic clinics in Germany, where a broad, socially diverse range of patients suffering from depression and other conditions seek treatment. I examine the treatment process from the perspective of the practitioners by looking at the symbolic boundaries they draw. How do they make sense of the diversity of problems with work and employment their patients report? What kind of normative and practical orientations do they follow during treatment of work-related sufferings? What different kinds of strategies do they use in treatment to help their patients deal with their problems?
By making use of analytic tools in cultural sociology, I look at practitioners’ interpretations of their patients’ stories and behaviors. The study reconstructs two exemplary patient archetypes that lie on opposing sides of a social class divide: High achievers and patients with a demand for retirement. I argue that patients labeled as high achievers are met in a mode of validation, whereas practitioners see patients with a demand for retirement more often in need of activation. To high achievers, treatment is offered as an extension of their already existing lifestyle orientations and self-conceptions. Patients with a demand for retirement, on the other hand, are met with a more confrontational style. They are often treated as lacking emotional competence and personal accountability. I argue that this approach establishes a class-blind standard of a balanced lifestyle, which integrates career orientation and private life, that it limits their opportunities to appropriate psychotherapeutic help on their own terms and that it risks stigmatizing low-income, unemployed and working-class patients even further.

Author

• Alexander Herold, Institute for Social Research / Univ of Education