Understanding the hospital system and mutuales
During my time at the workers’ hospitals, I was able to conduct other interviews with experts, chat with patients in the waiting rooms, attend public events on occupational health, and accompany the hospital’s qualification committee to assess the possible presence of ‘psychosocial risks factors’ in different workplaces.
After a few months of fieldwork, I began to understand the strong role that mutuales play in the country: for one, their modern services contrast sharply with the poorly funded public healthcare services. I was also stunned to see the power they have, through their qualification and metrics, to define who or what is deemed accountable for the disease: the worker or the workplace.
My experience in these institutions allowed me to see how local medical discourses and practices are intertwined with legal schemes and moral ideas on work and health. More importantly, I was able to perceive how tricky and conflictive the assessment of so-called ‘occupational mental disorders’ can be in Chile, given the high rates of job insecurity and the general environment of mutual distrust between workers, employers and institutions.
Why people take psychiatric sick leave?
Additionally, much of my time in Santiago was spent with fifteen workers who were on work-related psychiatric sick leave. With them, I experienced different parts of the city, going from hospitals to workplaces, to healthcare centres, and to their homes. I saw how they were confronted with pollution, long commutes, and social and urban segregation, all of which played part in the workers’ search for psychiatric healthcare, sick leave, compensation and 'a bit of justice' – as workers would often say.
I had the opportunity to talk with the workers about their difficult situations in the workplace, the reasons for their stress and mental anguish, and their need to be recognised as having an ’occupational disease’. We also touched on broader themes relating to social inequality, only a few months before Chile’s October 2019 protests movement took those same deep issues into the streets and public debate.
Overall, the time I spent in Santiago pushed me to expand my ethnography from the clinics to the streets, courtrooms and workplaces. Such a unique fieldwork experience enhanced and expanded my knowledge about mental health and work in Chile. Moreover, it also provided me with foundations to do a PhD research project that shows how workers’ and experts’ experiences are connected by the broader historical, political and social processes of Chile.