Julia Brown (ANU): Temporality and self-as-being in the course of treatment of chronic schizophrenia
When most people think about what schizophrenia is, the ‘psychotic’ symptoms dominate the story. When thinking about why a majority of people being treated for schizophrenia carry extra body weight and smoke cigarettes, it is anti-psychotic side effects, cravings and lack of self-discipline that might come to mind (the latter two explanations more readily at hand due to wider population health models). However, my anthropological research into clozapine-treated schizophrenia suggests otherwise. In order to investigate experiences of ‘health’ in clozapine-treated chronic schizophrenia, I am conducting a qualitative, longitudinal, multi-sited ethnographic study in two clozapine clinics in Australia and England.
Basing myself in the space where clozapine patients are most immersed in the biomedical culture concerned has meant considerable input from clinical staff, both as participants and in the recruitment of patient participants. Critical insights emerged both inside of formal clinic time and outside of it, during consultations and informal meetings leading up to and between clinic time. My position as an independent researcher is necessarily compromised by inter-disciplinary collaborations, particularly in the UK where further supervision and legal sponsorship was required from the lead psychiatrist of the clozapine clinic involved. As a non-clinical medical anthropologist conducting research with medically vulnerable people, access to my field sites took over a year to obtain, and mandatory clinical staff training sessions. My formal fieldwork spans 18 months, consisting of 2 phases of interviews (audio-recorded and transcribed) and observations in each setting during clinical time (4 ‘blocks’ of fieldwork in total). It was not until I had completed my first block of fieldwork in the UK that final HREC approval could be granted in Australia.
The temporal-spatial underpinnings of my fieldwork have not only been necessary for ethical safeguarding, they have become instrumental to my personal and analytical boundary making in what is otherwise a pervasively confronting area of enquiry. As Dalsgaard and Nielsen (2013) assert in regards to ‘episodic fieldwork’, ethnographic insights evolve over periods of ‘being present’ (8) long enough to become part of the field, but also being absent in order to account for the ‘event’ of being inside or outside the formal field site (14). It is also through relationship building with clinical staff outside of clinical operations and clinical time that allowed me to think through my ideas in clinically relevant ways. Despite most of my time being spent outside the clinical setting, I have felt continually immersed in the field.
The analytical relevance of time and temporality did not emerge until the completion of my first two blocks of fieldwork. It has been challenging to compartmentalise my own time so that transcribing interviews and the process of analysis can also take place episodically; I needed to adopt clinical distancing (and sympathies) in order to work productively. Moreover, I have found that clozapine patients’ renewed ability to ‘focus’ and experience wellbeing during moments that suspend past or future point to notions of temporality. My AHRC DTP paper will discuss how Heidegger’s (1962) notion of ‘ecstatic temporality’, as standing free from clinical time and provisions, helps to elucidate why non-concordance to ‘health’ provisions in addition to clozapine so often occurs.