The theme of mental health has gained growing attention within the field of sociolinguistics, broadly conceived, especially in relation to the subfield of medical discourse studies. Juan Eduardo Bonnin's contribution is timely and demonstrates Latin American discourse analysis as an alternative to the structural approaches to medical discourse studies. The book aims at providing a new sociolinguistic approach to (linguistic) inequality. As its general theoretical standpoint, the study is formulated at the intersection, as the Bonnin puts it, of ‘three areas of interests’: singularity and difference, voice, and emergent discourse (7). Based on a five-year ethnographic research at a public hospital located in Argentina, Bonnin examines the sociocultural specific factors affecting the psychologist-patient interactions and sheds light on the political tensions entangled within mental health practices.
Chapter 1 elaborates on the conceptual architecture of the study. The three areas of interest combine in highlighting the uniqueness, individuality, and fluidity in everyday discourse. Singularity refers to the conception of everyday discursive events as ‘always hav[ing] the potential to be exceptional’ (18) rather than banal episodes. Voice is directed at the need to consider the ‘individual biography’ (22) of social members in their engagement with social practices. Emergent discourse draws attention to the dynamic nature of discourse in which ‘every early choice and social response narrows future ones’ (25). Chapter 2 outlines the contextual uniqueness of psychoanalysis in public hospitals. Gaze direction and the processes of agenda setting in professional-patient meeting sessions are analysed in the construction of three levels of spatio-interactional construction: the public, the private, and the intimate, in each of which the patient takes up a different subjectivity. Expectations and roles between psychologists and patients, however, are not determined by an established structure but often have to be negotiated under instances of maladjustments. Through the analysis of the hospital landscape and interaction sequencing in diagnosis/treatment, chapters 3 and 4 combine in presenting the institutional practices in constructing the discourse of mental healthcare. Strategies of resistance employed by patients and collaborative psychologist-patient efforts in closing the institutional gap are addressed next, analysing the patients’ technical exploitation of the institutional practices in meeting their individual goals in the consultations and the professional-patient mutual alignment in register and voice (chapters 5 and 6). The book is concluded in chapter 7 by a discussion on discourse in relation to three modes of contestation in contexts of inequality: dissent, protest, and resistance.
Positioned in the nexus of ‘interactional negotiation, misunderstandings and maladjustments’ (172), medical contexts are rich points providing insights into (linguistic) inequality and resisting strategies. Neither professionals nor patients are passively subjugated by the bureaucratic institution. Instead, with their strategic maneuver within the institutional practices, ‘[a]gency and voice are not… exceptional features, but a systematic property of interaction in medical settings’ (172). One fundamental implication of this study lies in its reminder that medical discourse is intertwined with the complex political dynamics in society. As Bonnin suggests in the epilogue, new approaches to discourse may be required ‘to understand new realities’ (173).
