Overview

How do states decide who is or is not mentally ill? Alex V. Barnard shows that, beneath the chaotic trajectories of people with mental illness and the fragmented agencies and professionals serving them, there is an underlying order to the ways societies classify, treat, and control madness. Based on more than a year of in-depth fieldwork in France, Mental States takes readers to a public mental health clinic charged with providing care despite diminishing resources, a social service office dispensing benefits intended to help chronically ill people recover their autonomy, and a court where judges must decide the delicate balance between rights and control for people subjected to involuntary psychiatric hospitalization. Drawing on these observations, as well as hundreds of interviews with French professionals and decades of archival materials, Barnard demonstrates that these disparate sites are linked by a shared conception of what makes someone a malade-a real mentally ill person. This medical and bureaucratic identity keeps the mad in the grips of a paternalist, protective psychiatric system-in sharp contrast to the United States, where this population careens among jails, shelters, and hospitals. This book reveals the power of states to create mentally ill populations and shows how these populations can in turn remake states. The way states have crafted madness in the past weighs on the present, explaining why countries can maintain distinct approaches even in an era when psychiatric knowledge and medical treatment are converging across borders.

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Reviews

Mental States skillfully analyzes France’s approach to deinstitutionalization. Rather than abandoning those with severe mental illness, the French state and psychiatric experts have created a unique bureaucratic classification: malades. With clarity and innovation, Alex V. Barnard theorizes the looping effects of this classification, illustrating how the actions (even if uncoordinated or unintended) of people so labeled impact state policy in often contradictory ways. This is a must-read for theorists of classification, the welfare state, mental health, and expertise. -- Claire Decoteau, author of <i>Emergency: COVID-19 and the Uneven Valuation of Life</i> Mental States is an extraordinary study of the practical ways in which people with mental disorders are put into diverse sets of public-policy categories. While highlighting the complexity of the French mental health system, it raises fundamental questions about the ambivalent status of mental disorders in contemporary societies and the various professional and bureaucratic forces that influence it. An important read for anyone with a serious interest in mental health policies and care. -- Nicolas Henckes, author of <i>Maladies mentales et sociétés: XIXe–XXIe siècles</i> Barnard’s ambitious analysis of the rights, care, and control of the malades in France greatly advances our understanding of the cultural contexts that define the complexities of psychiatric classification, professional and legal jurisdictional domains, and the role of the state. Mental States will certainly become a classic that will be enjoyed by readers from a wide range of disciplines for years to come. -- Teresa L. Scheid, coeditor of <i>The Sociology of Mental Health</i>, fourth edition The treatment of psychiatric disorders varies enormously between countries, and it’s still a mystery why. Barnard goes a long way toward providing an explanation, doing so with flair, insight, and sympathy. And as much as Barnard describes the process of how patients and clients are sorted into bureaucratic categories, he never loses sight of the people involved. Mental States is an excellent book. -- Jason Schnittker, coauthor of <i>Side Effects: The Social Ecology of Adverse Drug Reactions</i>

Author Information

Alex V. Barnard is an assistant professor of sociology at New York University. He is the author of Freegans: Diving Into the Wealth of Food Waste in America (2016) and Conservatorship: Inside California’s System of Coercion and Care for Mental Illness (Columbia, 2023).

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