Negotiating boundaries: (A qualitative study of) mental health professionals’ demarcation of psychiatric diagnosis in everyday practice

The purpose of this article is to explore how mental health professionals make use of and negotiate the boundaries of psychiatric diagnosis in their everyday practice. The study is based on empirical material from four months of participant observation and interviews conducted in both inpatient and outpatient psychiatric clinics in Denmark. In this article, we demonstrate how diagnoses are not only used to describe the condition of a patient, but also to decide questions of agency, to render certain problems practicable, and to demarcate the boundaries of their practice. Finally, we show how these negotiations hold consequences for the trajectories of care offered to patients and propose the notions of situated rationality and psychiatry as a multiple institution as important terms to understand the everyday practice and negotiations of mental health professionals. • The boundaries of psychiatric diagnoses are negotiated in everyday practice • Negotiations of diagnostic boundaries have consequences for trajectories of care for patients • Diagnosis is used to determine questions of patients’ agency • Mental health professionals’ everyday use of diagnoses is inadequately understood as the application of scientific standards and methods.