The logics of self-responsibility and moral selection: Neoliberal (mis)framing as symbolic violence in Norwegian municipal mental healthcare

This article explores the interconnection between municipal mental healthcare provision for patients with co-occurring disorders and the overreaching discourse of individualization in healthcare governance. The central research question is: In which way do the (orthodox) neoliberal discourse of individualization manifest within the subfield of mental healthcare, and how does individualization crystallize in service delivery for patients with co-occurring disorders in Norway? The study is based on interviews with ten municipal healthcare providers in rehabilitation, residential and follow-up services. The logics of self-responsibility and moral selection are identified as key logics in service provision and delivery. These logics overlap with the orthodox neoliberal discourse of individualization in welfare state governance, emphasizing patients’ independence, empowerment and self-management. Individual-specific characteristics such as insight, motivation and substance use functions as selection criteria when patients seek help from municipal services. These logics reveal a paradox wherein patients are perceived as simultaneously capable and incapable of exercising rational control over their own action and yet are expected to take responsibility for their recovery. The article argues that the discourse of individualization, prominent in mental healthcare traditions like recovery and evidence-based practice, veils logics of self-responsibility and moral selection, placing more responsibility on patients to adapt to the healthcare system's framework. The symbolic power embedded in the ‘common sense’ discourse of individualization contributes to the (re)production of systemic marginalization, where structural barriers are obscured, and the patient's ability to adapt becomes essential in determining whether they are (mis)framed as "treatable," "treatment-resistant," or "too ill" to be helped. • The reengineering of the welfare state obscures structural barriers to healthcare • Increased individualization in healthcare contributes to systemic marginalization • The logics of self-responsibility and moral selection require patient adaption • Notions on patient's independence contributes to misframing and symbolic violence