Writing is central to psychiatric work. A common sight on the wards of the Schizophrenia Team was that of the staff hard at work, writing in the case records. So fundamental was writing to the interaction between clinicians and patients that if the case records were misplaced work ground to a halt until they were recovered or a temporary file established. This chapter examines the clinical staff as they interviewed their patients and made entries in the case records. It analyses the processes through which these clinicians constructed written definitions of cases, processes that were so fundamental to clinical practice that they applied to all patients, irrespective of diagnosis. Because the material is drawn from observations of work on the Schizophrenia Team it focuses on the written definition of schizophrenia. The chapter aims to show that as much as psychiatry was a ‘talking cure’ it was also a ‘writing cure’. Clinical writing did not merely describe the treatment of patients, it also constituted the treatment (c.f. Silverman 1975:287).

Cycle of interpretation

At the heart of clinical work was a cycle of talking and writing, of face-to-face interaction and documentation or, to use hospital argot, ‘seeing patients’ and ‘writing them up’. The common-sense view held that ‘seeing’ was primary and ‘writing up’ was a derivative record of that interaction. Raffel (1979:19) describes this assumption as follows: ‘Events are not seen as produced by the records but the record is seen as produced by the events…. The events can occur and remain unrecorded, but the record cannot occur without the events’. This view fails to take account of underlying interpretive processes that occur at each phase of the cycle of talking and writing. The work of Ricouer (1976:1-44; 1979:73-80; 1981: 145-9), especially his distinction between the interpretation of speech and the interpretation of writing, provides a useful framework for understanding how this cycle operates in a clinical context.3 An interview was a dialogue in which meanings were negotiated between a clinician and a patient. The clinician then interpreted these meanings in order to make notes on the interview. Because the notes now formed part of a permanent record, they were distanced from that immediate context in which they were produced, and their subsequent interpretation was influenced by other factors.