Subjectivity

, Volume 27, Issue 1, pp 195–216

Transforming subjectivities in psychiatric care

Original Article

Abstract

This paper is based upon ethnographic fieldwork in a Norwegian psychiatric unit practicing a psycho-educational treatment of young adults diagnosed with schizophrenia. An aim of the programme is that patients learn to detect and monitor their ‘symptoms’ in order to obtain ‘insight into their own illness’, thus transforming themselves into self-governed and self-responsible subjects who are able to cope with life outside institutions. The programme is constituted within a medical framework with a strong emphasis on medicine compliance. I explore the dynamics of power relations inherent in the programme, referring to Foucault's descriptions of discipline and normalization through pedagogy and examinations. His concepts of governmentality and self-technologies have proved useful as a frame for a critical evaluation of such programmes. However, subjectivities cannot be read off directly from educational technology, and my data from everyday, mundane settings in the institution reveal paradoxes and contradictions, which are accounted for in this study.

Keywords

schizophrenia psycho-education foucault power-knowledge governmentality subjectivity 

References

  1. Agar, M.H. (1980) The Professional Stranger: An Informal Introduction to Ethnography. New York: Academic Press.Google Scholar
  2. American Psychiatric Association (APA). (1995) Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), 4th edn. Washington DC: American Psychiatric Association (APA).Google Scholar
  3. Barrett, R. (1996) The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. New York/Cambridge: University Press.CrossRefGoogle Scholar
  4. Bentall, R. (2003) Madness Explained. London: Allen Lane/Penguin.Google Scholar
  5. Bentsen, H. (2003) Does psycho educational family intervention improve the outcome of schizophrenia? Tidsskrift Norsk Lægeforening 123 (18): 2571–2574.Google Scholar
  6. Biehl, J., Good, B. and Kleinman, A. (2007) Introduction. Rethinking subjectivity. In: J. Biehl, B. Good and A. Kleinman (eds.) Subjectivity. Los Angeles, CA: University of California Press, pp. 1–23.Google Scholar
  7. Blackman, L. (2001) Hearing Voices: Embodiment and Experience. London and New York: Free Association Books.Google Scholar
  8. Blackman, L. (2007) Psychiatric culture and bodies of resistance. Body & Society 13 (2): 1–23.CrossRefGoogle Scholar
  9. Blackman, L., Cromby, J., Hook, D., Papadopoulos, D. and Walkerdine, V. (2008) Creating subjectivities (editorial). Subjectivity 22 (1): 1–27.CrossRefGoogle Scholar
  10. Boyle, M. (2002) Schizophrenia: A Scientific Delusion? 2nd edn. London: Routledge.Google Scholar
  11. Breggin, P.R. and Cohen, D. (1999) Your Drug May be Your Problem: How and Why to Stop Taking Psychiatric Drugs. Reading, MA: Perseus books.Google Scholar
  12. Cohen, A.P. (1994) Self-consciousness. An Alternative Anthropology of Identity. London: Routledge.CrossRefGoogle Scholar
  13. Cooper, D. (1967) Psychiatry and Anti-psychiatry. London: Tavistock.Google Scholar
  14. Crossley, N. (2004) Not being mentally ill. Social movements, system survivors and the oppositional habitus. Anthropology and Medicine 9 (2): 161–180.CrossRefGoogle Scholar
  15. Cruikshank, B. (1993) Revolutions within: Self-governance and self-esteem. Economy and Society 22 (3): 327–355.CrossRefGoogle Scholar
  16. Dean, M. (2007) Governing Societies: Political Perspectives on Domestic and International Rule. New York: Open University Press, Mc Graw Hill.Google Scholar
  17. Estroff, S. (1993) Identity, disability and schizophrenia. The problem of chronicity. In: S. Lindenbaum and M. Lock (eds.) Knowledge, Power & Practice, the Anthropology of Medicine and Everyday Life. Los Angeles, CA: University of California Press, pp. 247–287.Google Scholar
  18. Falloon, I.R., Kydd, R.R., Coverdale, J.H. and Laidlaw, T.M. (1996) Early detection and intervention for initial episodes of schizophrenia. Schizophrenia Bulletin 22 (2): 191–401.CrossRefGoogle Scholar
  19. Flyckt, L., Taube, A., Edman, G., Jedenius, E. and Bjerkenstedt, L. (1999) Clinical characteristics and insight in a group of severely ill schizophrenics. Nordic Journal of Psychiatry 53 (5): 377–382.CrossRefGoogle Scholar
  20. Foucault, M. (1972) The Archaeology of Knowledge and the Discourse on Language. New York: Pantheon.Google Scholar
  21. Foucault, M. (1977) Discipline and Punish: The Birth of the Prison. New York: Vintage, Books.Google Scholar
  22. Foucault, M. (1997) Technologies of the self: A seminar with Michel Foucault. In: P. Rabinow (ed.) Ethics: Subjectivity and Truth: Essential Works of Foucault 1954–1984, Vol. 1. London: Penguin Books, pp. 223–251.Google Scholar
  23. Foucault, M. (2001a) The subject and power. In: J.D. Faubion (ed.) Power: Essential Works of Foucault 1954–1984, Vol. 3. London: Penguin Books, pp. 326–348.Google Scholar
  24. Foucault, M. (2001b) Governmentality. In: J.D Faubion (ed.) Power: Essential Works of Foucault 1954–1984, Vol. 3. London: Penguin Books, pp. 201–222.Google Scholar
  25. Goldstein, M.J. and Milkowitz, D.J. (1995) The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. Journal of Marital and Family Therapy 21 (4): 361–376.CrossRefGoogle Scholar
  26. Gordon, C. (1991) Governmental rationality: An introduction. In: G. Burchell, C. Gordon and P. Miller (eds.) The Foucault Effect: Studies in Governmentality, with Two Lectures by and an Interview with Michel Foucault. London: Harvester Wheatsheaf.Google Scholar
  27. Gråwe, R. (1991) Et selvstendig liv. På vei til å bli bedre: Mestring av symptomer, arbeidshefte, Intern publikasjon, Psykiatrisk Institutt, Østmarka, Psykologisk Institutt, Lade, NTNU, Norge. (An independent life. Getting better: Coping with symptoms, Work Book, Internal publication, Department of Psychiatry, Ostmarka, Department of Psychology, Lade, NTNU, Norwegian University of Science and Technology, Norway, my translation).Google Scholar
  28. Greco, M. (1993) Psychosomatic subjects and the ‘duty to be well’: Personal agency within medical rationality. Economy and Society 22 (3): 357–373.CrossRefGoogle Scholar
  29. Hogarty, G.E. et al (1991) Family psychoeducation, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two year effects of a controlled study on relapse and adjustment. Archives in General Psychiatry 48: 340–347.CrossRefGoogle Scholar
  30. Johnstone, L. (2001) Users and Abusers of Psychiatry, 2nd edn. Hove, UK: Brunner-Routledge.Google Scholar
  31. Kleinman, A. and Fitz-Henry, E. (2007) The experiential basis of subjectivity: How individuals change in the context of societal transformation. In: J. Biehl, B. Good and A. Kleinman (eds.) Subjectivity. Los Angeles, CA: University of California Press, pp. 52–66.Google Scholar
  32. Laing, R. (1967) The Divided Self: An Existential Study in Sanity and Madness. London: Penguin Books.Google Scholar
  33. Leudar, I. and Thomas, P. (2000) Voices of Reason, Voices of Insanity. Studies of Verbal Hallucinations. London: Routledge.Google Scholar
  34. Liberman, R.P. (1985) Psychosocial therapies for schizophrenia. In: H.I. Kaplan and B.J. Sadock (eds.) Comprehensive Textbook of Psychiatry, 4th edn. Baltimore, MD: Williams and Wikens.Google Scholar
  35. Luhrmann, T.M. (2006) Subjectivity. Anthropological Theory 6 (3): 345–361.CrossRefGoogle Scholar
  36. Mad Pride. (2008) 2 December, http://madpride.org, accessed 5 February 2009.
  37. Miles, M.B. and Huberman, A.M. (1994) Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage.Google Scholar
  38. Mind Freedom. (2009) 2 February, http://www.mindfreedom.org, accessed 6 February 2009.
  39. Mosher, L.R. (1999) Soteria and other alternatives to acute psychiatric hospitalization. A personal and professional review. The Journal of Nervous and Mental Disease 187: 142–149.CrossRefGoogle Scholar
  40. Orem, D.E. (1971) Nursing: Concepts of Practice. New York: McGraw-Hill.Google Scholar
  41. Pekkala, E. and Merinder, L. (2002) Psycho education for schizophrenia. The Cochrane Database of Systematic Reviews (2) CD002831.Google Scholar
  42. Romme, M. and Escher, S. (eds.) (1993) Accepting Voices. London: Mind.Google Scholar
  43. Rose, N. (1999) Powers of Freedom: Reframing Political Thought. Cambridge: University Press.CrossRefGoogle Scholar
  44. Terkelsen, T., Blystad, A. and Hydle, I. (2005) Transforming extraordinary experiences into the concept of schizophrenia: A case study of a Norwegian psychiatric unit. Ethical Human Psychology and Psychiatry 7 (3): 229–252.Google Scholar
  45. Thomas, P. (1997) The Dialectics of Schizophrenia. London: Free Association Books.Google Scholar
  46. Wikipedia. (2008) Mind freedom international. 14 Dec, http://en.wikipedia.org/wiki/MindFreedom_International, accessed 5 February 2009.
  47. World Health Organisation (WHO). (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland: World Health Organisation (WHO).Google Scholar

Copyright information

© Palgrave Macmillan 2009

Authors and Affiliations

  1. 1.Universitetet i AgderNorway

Personalised recommendations