Introduction

Summary

On a typical morning in a modern psychiatric hospital, patients receive a variety of treatments, ranging from pharmacological, psychodynamic, and behavioral therapies to electroconvulsive therapy, occupational therapy, and music therapy. The results of these therapeutic interventions are interpreted by both members of the treatment team and by the patients, their families, and their friends. Some patients will be seen as improved. Others will be seen as needing additional therapy or a different therapeutic approach. Medical students learn to look at patients, interpret the entirety of their situation, and sum it up succinctly: Is he good? Is she better? To claim that these clinical “realities” are socially constructed would be to state the obvious. Examining the workings of this construction, however, is revealing of what is valued by both the medical profession and by society at large. Some judgments in medicine are self-evident. It would be hard to argue with the perception of clear lungs as preferable to the crepitations of pulmonary edema, or that a stable mood is better than crippling depression. Other judgments are less straightforward. Why did patients seem better after lobotomy? How did both physicians and the public look at these patients and judge them to be good?