The extracts covered in this chapter highlight the kind of mainstream psychiatric discourses that users in this study have drawn upon in constructing their medication regimens. It can be seen that the dominant mainstream discourse relating to treatment is one of psychiatric medication as the most widely used and appropriate treatment for mental illness. Users did not construct versions of treatment, such as Cognitive
Behavioural Therapy or any other kind of treatment. Indeed the use of medication was drawn upon in stark exclusion of other treatments, and alternatives were not involved
even as part of a wider regimen incorporating medication. More explicit evidence of this can be seen in the interviews where the notion of alternative treatments was mentioned. Consider the following extract:
Ian: mm (2) mm (1) has any (1) has anything else ever helped?
(6)
Rob: in what respect?
Ian: well just made you feel better (.) anything else you know (.) the
medication you say has helped, is there anything else you’ve found that’s (.) helped you
Rob: er ..hh I used to take a lot of amphetamine (I: mm) and I mean everyone
used to say to me (.) all the doctors (.) they knew I was taking it and saying (.) oh you’ll make yourself really ill (I: mm) you’ll ruin your life but (I: mm) I thought it were great at the time, I….(lines 171-180)
In this extract I ask Rob whether anything else – other than medication – has ever helped him. This question was followed by a six-second pause, before Rob asks in what respect is the question framed. Clearly, the notion of anything other than
medication helping is one that is not immediate to conscious experience. It could have been that Rob had received other forms of treatment that he felt were beneficial and this would be an appropriate time to talk about them. Instead, Rob was quite unsure as to the whole notion of other things helping. I respond by directly mentioning his construction of medication as beneficial and relating my question to this.
Consequently, Rob states that he used to find taking amphetamine helped, but that he was told it would not be beneficial in the long run, and as such, constructs it as something that he knows he should not have done. The further statement that he “thought it were great at the time” constructs it as something that he does not do anymore. Consider this further example:
Ian: yeah [S: yeah] (.) has it (.) have they have they changed your medication
at all have they or have they?
Ian: um (.) what sort of different things have you had then?
Sarah: Librium (1) um (1) Largactil (1) Lithium (2) Pipothiazine (1) um
(DRUG NAME) (1) and (.) quite a few
Ian: yeah (2) yeah (1) what reasons do they give from changing them do they
just suggest it’s not working very well or something do they?
Sarah: yeah they just suggest it’s not working very well and change it [I: mm]
(1) if I’m depressed or if I’m (1) not well you know then they change (1) just lately they’ve not changed it they’ve they’ve upped the dosage you know and [I: ok] yeah
Ian: so what (.) what are you on at the moment?
Sarah: I’m on (DRUG NAME) Lithium (1) and Clopixidol
Ian: ok (2) and they are (1) you’re diagnosed them (.) for different (.)
difficulties are you?
Sarah: yeah (.) yeah….(lines 99-115)
This extract is from a section of an interview with Sarah in which we are discussing her medication and the nature of her prescribed regimens over time. On being asked
whether her medication has been changed over the years since she started taking it she states that it has “been changed a lot (.) yeah”, and then she goes on in the next line to list some of the medications she has taken. Of interest is the way medication is
constructed to a certain extent as an exploratory journey. It may be that the medication users are first prescribed do not work, and if that is the case then different types of medication are tried. In response to my question Sarah states that medication is changed if it is not working, and that changes are not exclusive to actual types of medication, but prescribed dosages as well. Sarah constructs a version of medication taking as one that may involve a continued changing of medication type if previous ones are not proving effective, along with potential changes in dosage if type changes are not deemed effective enough. It can be seen that Sarah is drawing on mainstream discourse of medication as the dominant most appropriate treatment for mental health difficulties. The ways in which this is done further strengthen this discourse, as highlighted in the earlier extract with Rob. Namely, that even if medication is not effective, the alternative treatment is to try a different medication rather than an alternative treatment. Indeed Sarah’s account demonstrates that even if a change in medication is not effective, then dosage altering is performed rather than treatment type
alteration. This is further strengthened through the way that Sarah lists all the names of her medication over time. She has paid close attention to her prescribed regimens and the changes that have occurred with it over time, further demonstrating how cemented in psychiatric knowledge medication is as the primary treatment for mental health difficulties. In addition, placing dominance on medication helps to reinforce the notion that mental health comes from outside in the sense that the treatment is externally provided. One could construct treatment as something that one does, for instance in the case of Cognitive Behavioural Therapy. This poses the danger that continued ill health becomes the result of personal responsibility; medication allows for responsibility to be externally located.
5.8 Discussion
The construction of treatment being predominantly in the domain of medication was one that existed across the users in this study. Drawing upon this kind of psychiatric discourse is indicative of the kind of information and practices that users are prescribed and provided with, both historically and in current practice. Namely, that medication is the single most effective and appropriate treatment for their mental health difficulties. In addition to this users have drawn upon mainstream knowledge in constructing medication regimens as needing to be adhered to, and, as has been seen from the users extracts covered so far, any departure from prescribed practices was something that occurs as a one-off and as such prescribed regimens are adhered to in the most part. The ‘problem’ facing service users in accounting for their experiences in relation to mainstream psychiatric forms of expression operates around the focal point of agency, namely how any sense of control is constructed with regard to decisions for which control is predominantly in the hands of service providers. We saw a couple of discursive strategies utilised as attempts to overcome this, or at least lessen it, which were the various ‘claims to expertise’ made and representing changes to depot medication administration, at least in part, as actively sought by service users
themselves, rather than as entirely the result of a lack of responsibility of users when self-managing their regimens.
In this chapter the positioning of service users as subject to a variety of forms of knowledge has grounded the analysis. As we have seen, service users’ ability to construct accounts of their engagements with forms of formal knowledge practices are
very limited. In terms of illuminating as closely as possible, their underlying experiences however, an approach was utilised that recognises the potential of ‘re- workability’ of accounts. That is, to produce a space in which multiple forms of subjectivity can be constructed, which although limited by the social forces of positioning, still retains the facility to re-work according to self-devised discursive activity. Additionally, this production is performed through the flow of subjectivities into one another, rather than operating as distinct stable points. This web of
subjectivities is produced through the relation between discursive and non-discursive (expression and content), that is constantly in a state of flux and change. In this chapter, it is a sense of how users’ capture this in multiple forms of subjectivity through the way they talk about their experiences. This was important for understanding how users attained forms of agency in areas in which control appeared a very difficult factor to grasp.
In this and the previous chapter we have seen a range of discursive strategies utilised in regard to issues of diagnosis and formal knowledge practices, which has involved focusing very much on the forms of discursive expression of service users, in talking about their experiences. In the next two chapters we will shift the focus on to the forms of content that inter-relate with discursive strategies, but which operate as part of a series of non-discursive concerns, whose production is distinct from the forms of expression that they interconnect with. The following two chapters set out to analyse how the forms of expression in the last two chapters relate to forms of content with regard to how relations of force become driven into the production of non-discursive experience. In doing this, some of the ways relations of power impact upon and shape the content of service users’ lives, along with how such relations are taken on and re- worked by users themselves. Utilising a Deleuzian Discourse Analysis enables an approach that involves describing the organisational forms of content, and how they are captured, based on the interview transcripts collected for this thesis. I will use specific concepts in order to restore the movement in experience, that is, to deduce something of the experience of being a service user through using particular concepts, drawn from Deleuze, and Deleuze and Guattari.