Indiana Consortium For Mental Health
Services Research
Indiana University, Bloomington, Indiana

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Abstract

Reprint # 9: PROFESSIONAL WORK IN PUBLIC AND PRIVATE SETTINGS:

According to theories of the professions, the formal and informal socialization that occurs during training represents the most salient influence on the content and conduct of professional work. A long tradition of research in medical sociology and the sociology of organizations suggests that the constraints and opportunities imposed by the workplace shape what people do as well. In this paper we examine how occupational background and organizational context influence the use, importance and evaluation of a professionally-based system of expert knowledge. Specifically, we explore the response of a variety of individuals who work in general hospital psychiatric units to the American Psychiatric Association's manual of mental health problems, the Diagnostic and Statistical Manual of Mental Disorders. Using data from the Indianapolis Network Mental Health Study (INMHS 1991-1993; see Pescosolido 1989a), we examine whether organizational setting affects mental health work and if professional differences override organizational context. In the two largest general hospitals (one public and one private) that serve a majority of a large city's population with serious mental illness, we find a much higher global approval for the DSM and willingness to continue its use than reported in previous studies. However, occupational background and organizational settings do shape the use and perceived importance of the DSM. While there is no difference in DSM training across sites, more individuals in the public sector use the DSM during their workday and rate it significantly more important for a wide range of purposes. Only professional background shapes evaluation, with psychiatrists, social workers, nurses, and general mental health workers forming a hierarchy of decreasing approval of the DSM's formal, medical model approach to mental illness. While the difference between psychiatrists and social workers is not statistically significant, the nurses and mental health workers that comprise the bulk of the workforce on psychiatric units do report significantly lower evaluations of the DSM.