The fracturing of medical dominance in British psychiatry?

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power. Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services ‐ a medico‐eclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments—are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and para professionals. This paper draws primarily upon two sources of data; an ethnography and in‐depth interview study of 40 psychiatrists and managers in the Bristol area in 1989–90 and an analysis of the writings of psychiatrists in the professional press.