"The Rowdy Ones:" Configurations of Difference in a Private Psychiatric Hospital

Drawing on participant-observation and semi-structured interviews, this paper examines the local forms of clinical practice in a 26-bed acute psychiatric inpatient unit located within a private psychiatric hospital in the Northeastern United States. It focuses on how clinicians, staff, and management understand and utilize the concepts of culture, race, and ethnicity in their daily work, finding that a humanistic approach to care that that treats patients as "individuals" was dominant. Clinicians and staff categorized patients using descriptive, behavior based categories including language, propensity for violence, and whether patients are "from the streets." They also used additional forms of difference such as the patient's pathway to care, their illness category or severity, and whether they use drugs. These forms of difference were shaped by the urgent needs of daily work. These local practices of categorization directly affected the quality of care when staff members assigned cultural characteristics to group members and treated them differently as a result. These findings suggest that anthropologists and clinicians should focus on the way new forms of cultural difference are constructed in small social settings in order to provide equitable treatment to all patients.