Medical guidelines define asthma as a chronic lung disease usually treated with daily, preventative medication. A significant proportion of asthma sufferers, however, reject understandings of asthma as chronic, based on their experiences of bouts of breathlessness that are frightening but often episodic and short-lived. This paper considers the experiential aspects of asthma among New Zealanders and explores the interplays between pharmaceutical temporalities and the temporalities of respiratory distress. Focusing on asthma sufferers who eschew preventative medication, I argue that while standardized treatment programs assume a particular mode of reckoning time, sufferers can engage in radically different ways of temporalizing the symptom and the subject, indicating the need for a new conceptualization of what “non-compliance” may entail.
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With the assistance of five graduate students, semi-structured interviews were conducted with 40 adult sufferers and parents of children with asthma; 36 respiratory specialists, general practitioners, nurses, and other medical professionals; and six alternative health providers. Ethics approval was granted by the University of Auckland. Some of the examples of asthma sufferers’ and medical professionals’ perspectives discussed here appear in Trnka (2017) but were not analyzed in relation to temporality in that text.
In highlighting asthma sufferers’ own positioning of themselves vis-à-vis pharmaceutical temporalities, I am developing my examination of subjectivity in light of three different theoretical strands: processual and experiential views of the subject as in a state of becoming (as, for example, articulated by Biehl and Locke), Gramsci’s discussion of “good sense” critiques developed out of experiences that run against the grain of hegemonic forms, and Foucault and Rose’s insights into governmentality, in particular the crafting of the “responsible patient” as part of contemporary medicine.
Due to the international stature of his work, I have not used a pseudonym for Julian Crane. Otherwise, all of the names of the medical professionals, asthma sufferers, and parents are pseudonyms.
Others, however, particularly when discussing children’s health, described longer-term interactions resulting in diagnosis. International diagnosis guidelines state that asthma is “defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation” (Global Initiative for Asthma 2015, p. 2) but do not specify the time period over which this history is to be taken, much less when lack of symptoms indicates asthma’s cessation.
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Trnka, S. Diagnostic refusals, temporality, and subjectivity among “non-compliant” sufferers of asthma. Subjectivity 11, 1–20 (2018). https://doi.org/10.1057/s41286-017-0039-5
- Patient subjectivity