Tie a Knot and Hang On

Book excerpt: Tie a Knot and Hang On is an analysis of mental health care work that crosses the borders of diverse sociological traditions. The work seeks to understand the theoretical and empirical linkages between environmental pressures and activities and how these intersect with organizations and individuals. The work draws upon a research tradition that sees the issue of mental health care in terms of institutional pressures and normative values. The author provides a description and a sociological analysis of mental health care work, emphasizing the interaction of professionally generated norms that guide the "emotional labor" of mental health care workers, and the organizational contexts within which mental health care is provided. She concludes with a discussion of emerging institutional forces that will shape the mental health care system in the future. These forces are having greater impact than ever before as managed care comes to have a huge fiscal as well as institutional impact on the work of mental health professionals. Scheid's book is a brilliant, nuanced effort to explain the institutional demands for efficiency and cost containment with the professional ethics that emphasize quality care for the individual. The book is essential reading for those interested in mental health care organizations and the providers responding to these seemingly larger, abstract demands. The work offers a rich mixture not just of the problems faced by mental health care personnel, but the equilibrium currently in place û an equilibrium that shapes the theory of the field, no less than the activities of its practitioners. Teresa L. Scheid is associate professor of sociology, at the University of North Carolina at Charlotte. She has published widely in the area, including major essays in Sociology of Health and Illness, Sociological Quarterly, Perspectives on Social Problems, and The Journal of Applied Behavioral Science.