Hablando y haciendo. El “modelo pólder” de la atención holandesa en salud mental

Abstract

In this article, the author shows how a cultural model of consultation and community thinking –the dutch “polder model”– together with specialization and separation of tasks can lead to fragmentation and paradoxes in mental health care that –in turn– result in dilemmas and costly negotiations between mental patients and therapists. The author discusses the development of the model in psychiatry since 1970 and shows by ethnographic data how therapists and patients are engaged in a struggle in which metaphors, counter transference and patients’ resistance and how they transform the “polder model” into a compromise and double therapeutic perspectives. The author argues that the democratic model only works by unequal power relationships, fragmentation of therapeutic work and ambiguity and results in a pragmatic attitude that denies the ontological status of the patients.