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.
Similar content being viewed by others
Notes
All names are pseudonyms.
I did not ask the explicit ages of the professionals, but they were between 30 and 60 years, with the majority between 35 and 45 years.
The research project has been reviewed and accepted by the Norwegian Committee of Medical Ethics.
Shortly afterwards, Billy was discharged. Six months later he phoned me. He was now admitted in an acute unit in another town. He was really sad, he told me, because he had got back his first diagnosis schizophrenia by the new therapists.
References
Agar, M.H. (1980) The Professional Stranger: An Informal Introduction to Ethnography. New York: Academic Press.
American Psychiatric Association (APA). (1995) Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), 4th edn. Washington DC: American Psychiatric Association (APA).
Barrett, R. (1996) The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. New York/Cambridge: University Press.
Bentall, R. (2003) Madness Explained. London: Allen Lane/Penguin.
Bentsen, H. (2003) Does psycho educational family intervention improve the outcome of schizophrenia? Tidsskrift Norsk Lægeforening 123 (18): 2571–2574.
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.
Blackman, L. (2001) Hearing Voices: Embodiment and Experience. London and New York: Free Association Books.
Blackman, L. (2007) Psychiatric culture and bodies of resistance. Body & Society 13 (2): 1–23.
Blackman, L., Cromby, J., Hook, D., Papadopoulos, D. and Walkerdine, V. (2008) Creating subjectivities (editorial). Subjectivity 22 (1): 1–27.
Boyle, M. (2002) Schizophrenia: A Scientific Delusion? 2nd edn. London: Routledge.
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.
Cohen, A.P. (1994) Self-consciousness. An Alternative Anthropology of Identity. London: Routledge.
Cooper, D. (1967) Psychiatry and Anti-psychiatry. London: Tavistock.
Crossley, N. (2004) Not being mentally ill. Social movements, system survivors and the oppositional habitus. Anthropology and Medicine 9 (2): 161–180.
Cruikshank, B. (1993) Revolutions within: Self-governance and self-esteem. Economy and Society 22 (3): 327–355.
Dean, M. (2007) Governing Societies: Political Perspectives on Domestic and International Rule. New York: Open University Press, Mc Graw Hill.
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.
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.
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.
Foucault, M. (1972) The Archaeology of Knowledge and the Discourse on Language. New York: Pantheon.
Foucault, M. (1977) Discipline and Punish: The Birth of the Prison. New York: Vintage, Books.
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.
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.
Foucault, M. (2001b) Governmentality. In: J.D Faubion (ed.) Power: Essential Works of Foucault 1954–1984, Vol. 3. London: Penguin Books, pp. 201–222.
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.
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.
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).
Greco, M. (1993) Psychosomatic subjects and the ‘duty to be well’: Personal agency within medical rationality. Economy and Society 22 (3): 357–373.
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.
Johnstone, L. (2001) Users and Abusers of Psychiatry, 2nd edn. Hove, UK: Brunner-Routledge.
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.
Laing, R. (1967) The Divided Self: An Existential Study in Sanity and Madness. London: Penguin Books.
Leudar, I. and Thomas, P. (2000) Voices of Reason, Voices of Insanity. Studies of Verbal Hallucinations. London: Routledge.
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.
Luhrmann, T.M. (2006) Subjectivity. Anthropological Theory 6 (3): 345–361.
Mad Pride. (2008) 2 December, http://madpride.org, accessed 5 February 2009.
Miles, M.B. and Huberman, A.M. (1994) Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage.
Mind Freedom. (2009) 2 February, http://www.mindfreedom.org, accessed 6 February 2009.
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.
Orem, D.E. (1971) Nursing: Concepts of Practice. New York: McGraw-Hill.
Pekkala, E. and Merinder, L. (2002) Psycho education for schizophrenia. The Cochrane Database of Systematic Reviews (2) CD002831.
Romme, M. and Escher, S. (eds.) (1993) Accepting Voices. London: Mind.
Rose, N. (1999) Powers of Freedom: Reframing Political Thought. Cambridge: University Press.
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.
Thomas, P. (1997) The Dialectics of Schizophrenia. London: Free Association Books.
Wikipedia. (2008) Mind freedom international. 14 Dec, http://en.wikipedia.org/wiki/MindFreedom_International, accessed 5 February 2009.
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).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Terkelsen, T. Transforming subjectivities in psychiatric care. Subjectivity 27, 195–216 (2009). https://doi.org/10.1057/sub.2009.6
Published:
Issue Date:
DOI: https://doi.org/10.1057/sub.2009.6