Lydie Fialová
Current Project


Lydie Fialová

Curriculum Vitae

Current Project
Autonomy and agency of psychiatric patients from the perspective of psychiatrists in the context of post-socialist society (Czech Republic)

My project adresses the autonomy and agency of psychiatric patients. In contrast to earlier analysis of Erving Goffman and Michel Foucault who regarded Psychiatry as a form of social control over undesirable persons, my aim is to approach this issue from the perspective of professionals with experitse in this field, who, coming from medical tradition, understand their work as a way of relieving suffering. In their approach, agency of patients is compromised by the disease processes, revealed as the alteration of experience and behaviour, and the task of respective professionals therefore is to restore the agency of patients by available means. Following this, the distinction of "knowledge" and "care" in medical tradition shall be my analytical tools.

"Knowledge" is understood to be universal, transcending national and cultural boundaries, introducing globally unificated biomedical and clinical categories. With the rise of neuroscience psychiatry tends to conceptualize human being as biological organism and deals with mental illnes from the perspective of evolution biology, i.e. as maladaptation, thus neutralizing the moral space.

On the other hand, "care" is always embedded within local traditions and even within Europe and different aspects of care are emphasized. Western Europe, along with USA and other countrie have since 1960´ introduced deinstitualization and moved towards community based care that encouraged both increased autonomy of patients in "natural environment" and also "laicization", i.e. involving new professions in the care of people with mental illness. The year 1989 introduced new orientation of countries of Central and Eastern Europe and has been a new impulse for transformation of Psychiatry, that has been under direct control of the State. Introduction of new law governing involuntary treatment and hospitalization (and as a result new phenomenon of homelessness not known in socialist state) as well as initiatives from recently formed NGO advocating the rights of patients have significantly changed the practice of psychiatry.

Despite persistent endeavour of both psychiatrists and various NGO the proposed transformation of psychiatry towards differentiated community care has never really occurred and counts among the chronically most underresourced fields of medicine, where introduction of new psychopharmacs heavily marketed by competing pharma companies consuming most of the resources aimed for psychiatry: ideological restrains of the State have been replaced by economical ones.

Psychiatry is marginal field to society striving for economical success, and episodic interest in the situation of patients brought by critique of international institutions for using cage beds has not been sufficient force to awaken political engagement with this situation. New forms of stratification of post-socialist society lead to increased expectation of life chances, acceleration of life, as well as increased fragility of social cohesion are significant factors for increased risk for several forms of mental illness. Despite the ignorance of the State, new activities of civil engagement in the forms of art festivals in the grounds of large mental hospitals, build in late 19th century at the outskirts of towns, or establishment of cafés and shops to support resocialization, as well as private activities of psychiatrists introducing new forms of rehabilitation and prevention programs (psychoeducation programs, ITAREPS - information technology aided relapse prevention in schizophrenia, ).

My fieldwork is based in two different institutions, one devoted to research and education (Psychiatrické centrum Praha) and another devoted to long term care (Psychiatrická lécebna Kosmonosy). My aim is to analyze how various form of care are more or less appropriate for different populations suffering from various forms of mental illness, and from the perspective of psychiatrists, how the autonomy and agency of psychiatric patients is encouraged or inhibited.