Choreographing care and restraint: Managing acute distress in recovery-oriented psychiatric inpatient wards

In contemporary Western psychiatry, the paradigm of recovery has become a dominant framework, shaping both therapeutic practice and the architectural design of inpatient facilities. Recovery-oriented approaches emphasize hope, autonomy, and individualized pathways to wellbeing. However, translating these ideals into acute psychiatric settings remains challenging, as coercion, containment, and crisis management continue to structure everyday life on inpatient wards. This paper examines how acute distress is managed within a psychiatric hospital in Denmark designed to support recovery. Drawing on 200 hours of ethnographic fieldwork (June 2016-August 2017) observing interactions between staff and patients in inpatient spaces, we show how episodes of acute distress become critical moments in which care practices, spatial arrangements, and clinical understandings are reconfigured. Drawing on Science and Technology Studies, we analyze how responses to acute distress unfold through coordinated movements of bodies, objects and spaces. We identify three forms of movement: (i) calibrated circulation, (ii) reactive reconfiguration, and (iii) recursive reorientation. We conceptualize these movements as enacting choreographies of care and restraint through which seemingly incompatible logics of care and coercion are enacted and held together in the situated management of acute distress. Extending existing discussions of choreographies of care, the paper contributes to debates on the possibilities and limits of recovery in inpatient psychiatry by demonstrating how such tensions are managed rather than resolved, as recovery ideals are continuously negotiated, displaced, or sidelined in everyday institutional practice.