Questioning the right dosage of care: patterns of communication about psyche in Latvia

Abstract

This paper explores the attitudes that stakeholders in mental health in Latvia espouse towards policy-making process. It notes Latvian service users’ absence from mental health policy fora and argues that such aloofness stems from ambivalence around thresholds of under-treatment and over-treatment. Firstly, being aware of over-treatment in institutionalized care potential patients may avoid psychiatric services, remaining however subject to marketing of psychoactive substances. Secondly, the image of psychiatry as once collaborating with the KGB has strengthened the stigma around seeking psychiatric care. Finally, there are a number of pre-requisites for a community of communication on patients’ needs, rights and interests. Drawing on ethnographic data and historical records the paper identifies hierarchies of knowledge among mental health stakeholders. The mode of mental health care is often determined along divergent criteria within different communities. Moral consequences of this knowledge politics are discussed in the light of Seyla Benhabib’s theory of interactive universalism.