"It wasn't written for me": Law, debt, and therapeutic contracts in Greek psychiatry

Since the international movement for patients' rights began, law has played an ambiguous role in mediating conflicts over responsibility for the mentally ill. In Greece, this contention has been shaped by reforms designed to shift psychiatric treatment from custodial hospitals to outpatient settings, challenging patients to help care for themselves. This article addresses one of the normative techniques deployed by Greek therapists to foster patients' responsibility in treatment: the therapeutic contract. By formalizing patients' and therapists' responsibilities to one other, contracts attach legalistic determinants to treatment that are said to have their own therapeutic efficacy. I examine the experiences of two patients in northeastern Greece who entered therapeutic contracts at moments of crisis in their treatment. Failures in these cases expose a conflict between the ethics of contract and the ethics of care. I argue that this conflict is intrinsic to the transactional model of public service relationships in liberal states.