Chapter Two analysed various ways in which service users developed trust inspite of general public perceptions, not to mention significant personalexperiences, which might have warded against such positive expectations.Many of the social contexts and professional relations described byparticipants suggested positive grounds for trust, yet histories of negativeoutcomes combined with the multiple uncertainties described towards the endof Chapter One (regarding the possibility and durability of recovery, theeffectiveness of interventions, and the professionals’ embeddingwithin a risk-prioritised service) point towards an apparentunknowableness associated with mental healthcare or,indeed, healthcare in general (Titmuss, 2004). As a recent study makesclear, inherent to healthcare are uncertainties pertaining to the range ofpossible outcomes, more positive or negative in their nature: ‘At itsbest, healthcare will be a testimony to our capacity to be interdependent.At its worst, it will mistreat, maim and kill us’ (Pilgrim et al,2011: 59). Acting within positive expectations for the future amidst suchmanifold uncertainties – Titmuss (2004: 173) lists ‘thirteencharacteristics [which] are indicative of the many subtle aspects ofuncertainty and unpredictability which pervade modern medical caresystems’ – would appear to require a ‘suspension ofbelief ‘ or ‘leap of faith’ (Möllering, 2001),which transcends rational thought or consideration.

Preceding chapters have touched upon at least three features of trust thatwould prima facie seem to underline this‘less-than-rational’ status (Williamson, 1993) – orwhat Zinn (2008a) refers to as trust's position ‘inbetween’ the rational and non-rational. First, the way service users(and, indeed, professionals) focused particularly on the‘presentation of self ‘ – or facework – forappraising the trustworthiness of another would seem to be a highlytentative, subjectively constructed and far from robust means of buildingreliable knowledge about another. Recent debacles within the English NHSunderline the ‘dark side’ of trust (Davies and Mannion, 2000)– where a highly esteemed family doctor was able to kill hundreds ofpatients or where a prestigious regional centre for surgery had anabnormally high surgical mortality rate for infants (Pilgrim et al, 2011:131–45). Impressions, not least adeptly managed facework, can beutterly misleading, and, therefore, the gap between perceptions (trust) andsubstance (trustworthiness) becomes a problematic one (O’Neill,2002).