Resisting medications: moral discourses and performances in illness narratives

Abstract

Adherence research has been dominated by attitudinal approaches that isolate individual statements made in interviews and then assign a fixed attitude to the individual who made that statement. Despite much sociological research having raised questions about the notion of fixed attitudes, little research has theorised the process by which individual utterances about medicine-taking are produced as a form of resistance to medications within interviews. Using Goffman's concept of performance as a starting point, this article offers an alternative framework for conceptualising adherence presentations when provided in the form of a rhetorical narrative. Through the presentation of case material taken from interviews with participants who had not taken prophylactic asthma medications as prescribed, we develop Goffman's concept of performance to theorise the production of adherence talk in two important ways. First, individual performances can be seen to be shaped by how moral discourses of illness management transfer across contexts. Second, performances are subject to inequalities in the resources interactants have access to. An extended definition of Goffman's concept of performance is thus offered, arguing that the 'meaning' of individual performances is produced by a combination of which moral discourses interactants orientate to and which discourses are used to categorise individuals.

Abandoned Acid? Understanding Adherence to Bisphosphonate Medications for the Prevention of Osteoporosis among Older Women: A Qualitative Longitudinal Study

“…In depth sociolinguistic research has highlighted that patients talk and deploy different discourses and narratives depending on both the context and on the interactional resources available to them [23], [24], [25], [26]. Although most patients and their health care providers are likely to be keen to ensure that they utilise the outputs of modern medical advances, this is in the context of the increasing biomedicalisation of life, especially as people in developed countries are living longer [27].…”

The Role of Distributed Health Literacy in Asthma Integrated Care: A Public Medical Context from Portugal

“…That is typically the case of those with a disruptive narrative. In fact, transgenerational paths of chronic illness minimize the negative impacts that psychosocial difficulties might have on self-management strategies [4546]. Additionally, through the analysis of the coping strategies and resilience patterns of each patient, a collective understanding of illness susceptibility and its effects in lessening the disruptive potential towards one’s biography might be achieved [4748].…”

‘Everybody has to think – do I have any peanuts and nuts in my lunch?’ School nurses, collective adherence, and children's food allergies

“…By examining food allergy management from the perspective of school nurses, this paper also contributes to the call by Murdoch et al . () for a more nuanced examination of patients’ talk about adherence and its meaning.…”

“…That parents in the study were unaware of this work suggests that the work that others do to assist with adherence may not be accessible through patient narratives. By examining food allergy management from the perspective of school nurses, this paper also contributes to the call by Murdoch et al (2013) for a more nuanced examination of patients' talk about adherence and its meaning.…”

“…, Conrad , Murdoch et al . ). As chronic illness becomes increasingly about managing risk, rather than managing symptoms (Aronowitz ), the multitude of actors and settings involved in managing health will likely become more relevant to studies of adherence.…”