Actively Negotiating the Mind–Body Divide: How Clozapine-Treated Schizophrenia Patients Make Health for Themselves
- 345 Downloads
It is well recognised that antipsychotic treatments impact the whole body, not just the target area of the brain. For people with refractory schizophrenia on clozapine, the gold standard antipsychotic treatment in England and Australia, the separation of mental and physical regimes of health is particularly pronounced, resulting in multiple, compartmentalised treatment registers. Clinicians often focus on the mental health aspects of clozapine use, using physical indicators to determine whether treatment can continue. Our observations of 59 participants in England and Australia over 18 months revealed that patients did not observe this hierarchisation of mental treatments and physical outcomes. Patients often actively engaged in the management of their bodily symptoms, leading us to advance the figure of the active, rather than passive, patient. In our paper, we do not take the position that the facility for active management is a special one utilised only by these patients. We seek instead to draw attention to what is currently overlooked as an ordinary capacity to enact some sort of control over life, even under ostensibly confined and confining circumstances. We argue that clozapine-treated schizophrenia patients utilise the clinical dichotomy between mental and physical domains of health to rework what health means to them. This permits patients to actively manage their own phenomenological ‘life projects’ (Rapport, I am Dynamite: an Alternative Anthropology of Power, Routledge, London 2003), and forces us to reconsider the notion of clinical giveness of what health means. This making of one’s own meanings of health may be critical to the maintenance of a sense of self.
KeywordsThe ‘active patient’ Clozapine Health Schizophrenia Medical ethnography
The first author thanks her research participants and Dr Emilio Fernandez-Egea (University of Cambridge) for providing additional supervisory support.
Compliance with Ethical Standards
Conflict of interest
While not directly funding this study, Ms. Brown is supported by the Australian Postgraduate Award (J.B., APA 1183a/2010). However, Ms. Brown and A/Professor Dennis declare no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Australian Commission on Safety and Quality in Health Care (ACSQHC). 2012. National Adult Clozapine Titration Chart User Guide. ACSQHC. Sydney.Google Scholar
- Biehl, João. 2005. Vita: Life in a Zone of Social Abandonment. Berkeley: University of California Press.Google Scholar
- Csordas, Thomas 1994 Embodiment and Experience: the Existential Ground of Culture and Self. Cambridge University Press.Google Scholar
- Delueze, Gilles. 2006. Two regimes of madness: texts and interviews 1975-1995, Los Angeles: Semiotext(e).Google Scholar
- Fuchs, Thomas. 2010. Phenonmeonolgy and Psychopathology. In: D Schmicksing and S. Gallagher (eds) Handbook of Phenomenology and Cognitive Science, Springer: Dordrecht, pp. 547-573.Google Scholar
- Fuchs, Thomas. 2015. Pathologies of Intersubjectivity in Autism and Schizophrenia. Journal of Consciousness Studies 22 (1-2): 191-214.Google Scholar
- Heidegger, Martin 1962  Being and Time. Blackwell Publishing.Google Scholar
- Jenkins, Janis. 2004. Schizophrenia as a Paradigm Case for Understanding Fundamental Human Processes. In J. Jenkins and R. Barrett (Eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press.Google Scholar
- Jenkins, Janis. 2010. Psychopharmaceutical Self and Imaginary in the Social Field of Pschiatric Treatment. In J. Jenkins (Ed.) Pharmaceutical Self: the global shaping of experience in an age of psychopharmacology. New Mexico: School for Advanced Research Press. Pp. 17-40.Google Scholar
- Jenkins, Janis. 2015. Extraordinary Conditions: culture and experience in mental illness. University of California Press: CaliforniaGoogle Scholar
- Jenkins, Janis and Barrett, Robert. 2004. Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press.Google Scholar
- Kapferer, Bruce. 2003. Beyond Rationalism: Rethinking Magic, Witchcraft and Sorcery. New York: Berghahn Books.Google Scholar
- Kleinman, Arthur. 2012. Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years. In: Marcia Inhorn and Emily Wentzel (eds) Medical Anthropology at the Intersections: Histories, Activisms, and Futures, Duke University Press: Durham, pp.178-196.Google Scholar
- Laing, Ronald. 1960. The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth: Penguin.Google Scholar
- Lambert, Timothy [Representing Members of the Australian Consensus Panel for Treatment-Refractory Schizophrenia] 2010 Targeting Treatment-Refractory Schizophrenia: a multidimensional outcomes approach to the diagnosis and management of incomplete recovery. Consensus statement 2010. [Accessed in pre-publication form from Timothy Lambert, University of Sydney]Google Scholar
- Leucht, Stefan; Cipriani, Andrea; Spineli, Loukia; Mavridis, Dimitris; Orey, Deniz; Richter, Franziska; Samara, Myrto; Barbui, Corrado; Engel, Rolf; Geddes, John; Kissling, Werner; Stapf, Marko; Lässig, Bettina; Salanti, Georgia and John Davis. 2013. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382, 951–962. 10.1016/S0140-6736(13)60733-3.CrossRefGoogle Scholar
- Lucas, Rodney. 2004. In and Out of Culture: Ethnographic Means to Interpreting Schizophrenia. In J. Jenkins and R. Barrett (Eds.) Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press. Pp. 146-163.Google Scholar
- Merleau-Ponty, Maurice 1962  Phenomenology of Perception. Routledge.Google Scholar
- Morgan, Vera; Waterreus, Anna; Jablensky, Assen; Mackinnon, Andrew; McGrath, John; Carr, Vaughan; Bush, Robert; Castle, David; Cohen, Martin; Harvey, Carol; Galletly, Cherrie; Stain, Helen, Neil, Amanda; McGorry, Patrick; Hocking, Barbara; Shah, Sonal and Saw, Suzy. 2011. People living with psychotic mental illness: report on the second Australian national survey. Canberra: Commonwealth of Australia.Google Scholar
- Prior, Trevor and Baker, Glen. 2003. Interactions between the cytochrome P450 system and the second-generation antipsychotics. Journal of Psychiatry and Neuroscience 28: 99.Google Scholar
- Rapport Nigel. 2003. I am Dynamite: an Alternative Anthropology of Power. Routledge, London.Google Scholar
- Salzberg, Michael and Castle, David (ed.) 2010. Physical and Mental Health: the Interface. Australian Postgraduate Medicine, Victoria.Google Scholar
- Sartre, Jean-Paul 1969 Being and Nothingness: an Essay on Phenomenological Ontology. Routledge.Google Scholar
- Sass, Louis. 1992. Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. New York: Basic Books (Harvard University Press paperback 1994).Google Scholar
- The Royal Australian and New Zealand College of Psychiatrists (RANZCP) 2015 Keeping Body and Mind Together: Improving the physical health and life expectancy of people with serious mental illness. Available at www.ranzcp.org/strategicplan
- World Health Organisation (WHO) 1948 Constitution of the World Health Organisation. Available from: http://www.who.int/governance/eb/who_constitution_en.pdf,
- World Health Organisation (WHO) 1993 The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research.Google Scholar