This construction of depot as punishment is not the only representation of depot medication emerging from the interviews. In another form it exists as beneficial to treatment for medication to be administered via depot. Consider the following extract:
Ian: mm (2) so that’s better now you just have an injec.., well (.) that some of
that’s now (.) in form of (.) in in a form of an injection then
Beatrice: yeah it is (I: mm) (.) I quite like that yeah (.) I don’t like having the
it’s quite good (I: mm) (.) plus you don’t have to remember to take your tablets…..(lines 293-298)
In this extract Beatrice narrates a short account that serves to construct depot
administration as unpleasant, but not without its benefits. The beneficial element is that having one’s medication externally controlled reduces the chances – and lessens
personal responsibility – that users may forget to take tablets at times. This section works to normalise the account, in terms of framing it at a level of everyday
forgetfulness, a very normal occurrence as everybody can be expected to forget things from time to time. This extract, when related to Beatrice’s earlier one constructing depot medication as punishment, highlights some of the complexity of the use of this discursive formulation by users. To highlight the potential benefits of depot injection after representing it in a negative framework serves to perform a particular job of spinning a positive light on the ‘punishment’ of depot.
Additionally, this serves to separate ‘being compelled’ and ‘being adherent’ as two distinct, though closely related concepts. It has been demonstrated that adherence is seen as an overarching aim of both service providers and users. However, one of the numerous difficulties facing users is the sometimes undesired associated factors that come with the adherence. Adherence has meant fitting into a prescribed set of actions, such as necessity to keep appointments and medication routines that may reduce personal autonomy over bodies and time. However, service users still seek to construct adherence as good. Thus by separating adherence from compulsion, the reduced control can be represented as negative, whilst adherence is represented as positive.
By constructing depot injection as beneficial, a follow up positive light can be placed upon depot administration that serves to represent Beatrice’s current position – as receiving depot injections – as a more positive one than a framing of punishment at first allows. In the first instance, to state she was punished frames Beatrice’s current state, as someone receiving depot medication, as negative. If she had not misbehaved, a change in administration mechanism would not have occurred. However, Beatrice seeks to frame this as positive, not withstanding the negative process of punishment that occurred as part of the journey to the present. It is argued here that it is important for users to have a sense of positive thought regarding the present, as it is a key part of
their psychological make up in terms of their mental health difficulties. Recovery is seen as a progression, so it is not surprising that service users represent their current state as positive, as part of a process of recovery. This construction of depot
administration as beneficial can also be seen in the following extract:
Ian: mm (2) do you prefer injections or taking *
Peter: I prefer injections I don’t like taking tablets cos I think you can shy
away from them like you know
Ian: mm (2) where do (1.5) you (0.5) who do (.) where do you get the
injections done do you do them yourself?…..(lines 82-86)
Here Peter responds to my enquiry regarding his preferred medication administration mechanism by stating that he prefers injections as he does not like taking tablets since he believes that “you can shy away from them”. This statement is interesting in its ambiguity. To shy away from something can have a number of meanings: an
acknowledgement of personal weakness, lapses of control, or failure to be responsible. More broadly, it is a comment that suggests an awareness of potential personal ability to not take medication in tablet form. His response is salient in its immediacy in terms of constructing depot injection in this way. Indeed I had not actually finished my question as to whether he preferred injection or tablet administration before he interrupted so as to state he preferred injections. This construction of preference also serves to represent Peter as an adherent user as the desire and liking of injections is borne from his underlying drive to maintain and stick to the prescribed regimen. Indeed, his awareness that there is less chance of this happening if he is prescribed tablets rather than be given injections serves to strengthen this construction of
adherence. This claim is strengthened through the ‘shy away’ phrase, which constructs a sense of control. Peter was aware that he had the ability to not take medication if given them in tablet form, so was doubly keen to receive depot injections. Not only does he recognise the need to appear adherent, but is actively aware that it may not happen if receiving tablets, so affirms the presentation of depot as beneficial.
Additionally the ‘shy away’ formulation works to set up non-adherence as a routine, predictable act. We tend to shy away from things that we find unpleasant, and as such it becomes quite a ‘normal’ routine thing to do if faced with such events. The medication here is acting as the unpleasant factor, and through utilising terminology of shying
away, the potential of non-adherence is constructed as a normalised, common and routine thing to happen. It is not something specific to Peter, but rather a much more generalised activity, and given its prevalence, his construction of personal
responsibility over recognising its potential and avoiding it is strengthened.
The two analytic threads regarding depot medication position users as currently
adherent with their medication, which can then be associated with a current active state of moving forward to maintain progression towards good mental health. In this way users are positioned as clearly focused upon being seen to be mentally stable, a perception attained through alliance with the prescribed service provision practice. So far we have seen an overall production of service user knowledge that coheres closely to formal psychiatric knowledge of treatment as needing to be taken, and subsequently leading to improved mental health. Some of the issues associated with doing this have been identified, but within an overall framework of adherence to the system of thought, posited by mainstream psychiatric practice, that treatment is beneficial for service users.