The Psychotropic Self/Imaginary: Subjectivity and Psychopharmaceutical Use Among Heroin Users with Co-Occurring Mental Illness

Abstract

Many people diagnosed with mental illnesses struggle with illicit drug addiction. These individuals are often treated with psychiatric medications, yet little is known about how they experience this treatment. Research on the subjective experience of psychiatric medication use highlights the complex, contradictory, and ambiguous feelings often associated with this treatment. However, for those with mental illness and addiction, this experience is complicated by the need to manage both psychiatric medication and illicit drug use. Using ethnographic data from a study of heroin use in Northeast Ohio, we explore this experience by expanding the pharmaceutical self/imaginary (Jenkins, Pharmaceutical Self: The Global Shaping of Experience in an Age of Psychopharmacology, School for Advanced Research Press, Santa Fe, NM, 2010b) to include psychopharmaceuticals and illicit drugs, what we call the psychotropic self/imaginary. Through this lens we explore the ways participants interpret and manage their psychotropic drug use in relation to sociocultural, institutional, and political-economic contexts. This analysis reveals how participants seek desired effects of legally prescribed and illicit drugs to treat mental illness, manage heroin addiction, and maintain a perceived "normal" self. Participants manage their drug use using active strategies, such as selective use of psychiatric medications, in the context of structural constraints, such as restricted access to mental health care, and cultural contexts that blur distinctions between "good" medicines and "bad" drugs.

Drugs in Context

“…Social scientists in the field of ethnopsychopharmacology argue that the effects of drugs are not a one-dimensional phenomenon involving endogenous biological factors but are based on ''multilevel, interwoven dimensions ranging from individual biology to sociocultural dynamics'' (Lin et al, 2008;Ma, 2012;Ninnemann, 2012;Schlosser and Ninnemann, 2012, p. 3). By attending to patients' lived experience of pharmaceuticals, anthropologists demonstrate that pharmaceutical effectiveness is dependent on structural and sociocultural factors, involving diverse understandings of disease etiology and process, treatment modalities, and expected outcomes, as well as biological processes (Ma, 2012;Petryna and Kleinman, 2006;Schlosser and Hoffer, 2012).…”

Recovery in the US ‘Opioid Crisis’

“…They reflect the fluid and fraught distinction between 'bad' drugs and 'good' medicines, which scholars have long critiqued as socially-mediated categories defined in particular social, cultural, and political-economic contexts (Montagne 1996;Singer 2008). The dynamics the body of ethnographic research highlighting how lived experiences of (il)legal drug use defies the social categorization of these substances (Bourgois 2000;Fraser and Valentine 2008;Luhrmann 2010;Schlosser and Hoffer 2012). This knowledge is critical and is enabled by time for deliberation and careful consideration that 'crisis' may preclude.…”

Care for Psychiatric Patients that Use Drugs: Management and Perceptions of Professionals

“…Even considering that abstinence would be more appropriate, the professional sought to investigate the habits of the patient and took them into account when providing the guidelines. Schlosser and Hoffer (2012) emphasize the importance of the team being aware that often the patient of mental health services who uses drugs will continue to consume them during psychiatric treatment, not basing their practices on the illusion of complete abstinence.…”