Skip to main content
SpringerLink
Log in

Diagnostic refusals, temporality, and subjectivity among “non-compliant” sufferers of asthma

  • Original Article
  • Published:
Subjectivity Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

References

  • Adams, V., M. Murphy, and A. Clarke. 2009. Anticipation: technoscience, life, affect, temporality. Subjectivity 28: 246–265.

    Article  Google Scholar 

  • Allen-Collinson, J., and H. Owton. 2014. Take a deep breath. International Review for the Sociology of Sport 49 (5): 592–608.

    Article  Google Scholar 

  • Applbaum, K. 2006. Educating for global mental health. In Global pharmaceuticals: ethics, markets, practices, ed. A. Petryna, A. Lakoff, and A. Kleinman, 85–110. Durham: Duke University Press.

    Google Scholar 

  • Applbaum, K., and M. Oldani. 2010. Towards an era of bureaucratically controlled medical compliance? Anthropology & Medicine 17 (2): 113–127.

    Article  Google Scholar 

  • Aroni, R., et al. 2003. Asthma self-management: what do we really mean? Australian Journal of Primary Health 9 (2&3): 10–17.

    Google Scholar 

  • Barnes, P., and S. Pedersen. 1993. Efficacy and safety of inhaled corticosteroids in asthma. American Review of Respiratory Disease 148: S1–S26.

    Article  Google Scholar 

  • Beauchesne, M., et al. 2006. Action plans in asthma. Canadian Respiratory Journal 13 (6): 306–310.

    Article  Google Scholar 

  • Becker, G. 1997. Disrupted lives. Berkeley: University of California Press.

    Google Scholar 

  • Biehl, J. 2011. Homo economicus and life markets. Medical Anthropology Quarterly 25 (2): 278–284.

    Article  Google Scholar 

  • Biehl, J. 2013[2005]. Vita: life in a zone of social abandonment. Berkeley: University of California Press.

  • Biehl, J., and P. Locke (eds.). 2017. Unfinished: the anthropology of becoming. Durham and London: Duke University Press.

    Google Scholar 

  • Blackman, L., J. Cromby, D. Hook, D. Papadopoulos, and V. Walkerdine. 2008. Creating subjectivities. Subjectivity 22: 1–27.

    Article  Google Scholar 

  • Bodenheimer, T., et al. 2002. Patient self-management of chronic disease in primary care. JAMA 288 (19): 2469–2475.

    Article  Google Scholar 

  • Canguilhem, G. 1989[1978]. The normal and the pathological. New York: Zone Books.

  • Charles, T., et al. 2007. An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma. Journal of Allergy & Clinical Immunology 119 (4): 811–816.

    Article  Google Scholar 

  • Conrad, P. 1985. The meaning of medications. Social Science and Medicine 20 (1): 29–37.

    Article  Google Scholar 

  • Conrad, P. 2007. The medicalization of society. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Csordas, T. 1993. Somatic modes of attention. Cultural Anthropology 8 (2): 135–156.

    Article  Google Scholar 

  • Dahl, R. 2006. Systemic side effects of inhaled corticosteroids in patients with asthma. Respiratory Medicine 100 (8): 1307–1317.

    Article  Google Scholar 

  • Das, V. 2006. Life and words. Berkeley: University of California Press.

    Google Scholar 

  • Das, V., and R. Das. 2007. How the body speaks. In Subjectivity: ethnographic investigations, ed. J. Biehl, B.J. Good, and A. Kleinman, 66–97. Berkeley: University of California Press.

    Chapter  Google Scholar 

  • DelVecchio Good, M. 2001. The biotechnical embrace. Culture, Medicine and Psychiatry 25 (4): 395–410.

    Article  Google Scholar 

  • Derrida, J. 1981. Dissemination. Chicago: University of Chicago Press.

    Google Scholar 

  • Dumit, J. 2012. Drugs for life. Durham: Duke University Press.

    Book  Google Scholar 

  • Durkheim, E. 2001[1912]. Elementary forms of religious life. Oxford: Oxford University Press.

  • Estroff, S. 1993. Identity, disability, and schizophrenia. In Knowledge, power and practice, ed. S. Lindenbaum, and M. Lock, 247–286. Berkeley: University of California Press.

    Google Scholar 

  • Feldman, C., et al. 1962. Establishment and evaluation of an asthma self-management program. Journal of Allergy and Clinical Immunology 69 (1): 144.

    Article  Google Scholar 

  • Ferzacca, S. 2000. ‘Actually, I don’t feel that bad’: managing diabetes and the clinical encounter. Medical Anthropology Quarterly 14 (1): 28–50.

    Article  Google Scholar 

  • Ferzacca, S. 2010. Chronic illness and the assemblages of time in multisited encounters. In Chronic conditions, fluid states, ed. L. Manderson, and C. Smith-Morris, 157–174. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Fortun, M., et al. 2014. Asthma, culture, and cultural analysis. In Heterogeneity in asthma, ed. A. Brasier, 321–332. New York: Springer.

    Chapter  Google Scholar 

  • Funk, L. 2013. Home healthcare and family responsibility. Healthcare Policy 9: 86–97.

    Google Scholar 

  • Global Initiative for Asthma. 2015. The global strategy for asthma management and prevention. http://www.ginasthma.org/. Accessed 23 November 2015.

  • Gramsci, A. 1971. Selections from the prison notebooks. London: Lawrence and Wishart.

    Google Scholar 

  • Greene, J., and D. Herzberg. 2010. Hidden in plain sight: marketing prescription drugs to consumers in the twentieth century. American Journal of Public Health 100 (5): 793–803.

    Article  Google Scholar 

  • Guyer, J. 2007. Prophecy and the near future. American Ethnologist 34 (3): 409–421.

    Article  Google Scholar 

  • Harper, J. 2004. Breathless in Houston. Medical Anthropology 23 (4): 295–326.

    Article  Google Scholar 

  • Holt, S., and R. Beasley. 2001. The burden of asthma in New Zealand. Wellington: Asthma and Respiratory Foundation.

    Google Scholar 

  • Horne, R. 2006. Compliance, adherence, and concordance. Chest 130 (1 suppl): 65S–72S.

    Article  Google Scholar 

  • Jackson, M. 2009. Asthma: the biography. Oxford: Oxford University Press.

    Google Scholar 

  • Kaufman, S. 2005. And a time to die: how American hospitals shape the end of life. Chicago: University of Chicago Press.

    Google Scholar 

  • Lakoff, A. 2005. The private life of numbers. In Global assemblages: technology, politics, and ethics as anthropological problems, ed. A. Ong, and S.J. Collier, 194–213. Malden, MA: Blackwell.

    Google Scholar 

  • Lerner, B. 1997. From careless consumptives to recalcitrant patients. Social Science and Medicine 45 (9): 1423–1431.

    Article  Google Scholar 

  • Martin, E. 2007. Bipolar expeditions: mania and depression in American culture. Princeton: Princeton University Press.

    Google Scholar 

  • Mattingly, C. 1998. Healing dramas and clinical plots. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Mattingly, C. 2010. The paradox of hope: journeys through a clinical borderland. Berkeley: University of California Press.

    Google Scholar 

  • McNally, A., et al. 2004. Application of asthma action plans to childhood asthma. New Zealand Medical Journal 18: 117.

    Google Scholar 

  • Messinger, S. 2010. Rehabilitating time. Medical Anthropology 29 (2): 150–169.

    Article  Google Scholar 

  • Miller, P., and N. Rose. 2008. Governing the present. Malden: Polity Press.

    Google Scholar 

  • Minh-ha, T. 1989. Woman, native, other. Bloomington: Indiana University Press.

    Google Scholar 

  • Mol, A. 2003. The body multiple: ontology in medical practice. Durham: Duke University Press.

    Google Scholar 

  • Mol, A., I. Moser, and J. Pols. 2010. Care: putting practice into theory. In Care in practice, ed. A. Mol, I. Moser, and J. Pols, 7–26. Bielefeld: Transcript Verlag.

    Google Scholar 

  • Munn, N. 1992. The cultural anthropology of time. Annual Review of Anthropology 21: 93–123.

    Article  Google Scholar 

  • Murphy, K., et al. 2012. Asthma management and control in the United States. Allergy and Asthma Proceedings 33 (1): 54–64.

    Article  Google Scholar 

  • Pearce, N. 2007. Adverse reactions: the fenoterol story. Auckland: Auckland University Press.

    Google Scholar 

  • Peck, J., and N. Theodore. 2012. Reanimating neoliberalism: Process geographies of neoliberalisation. Social Anthropology 20 (2): 177–185.

    Article  Google Scholar 

  • Prout, A., L. Hayes, and L. Gelder. 1999. Medicines and the maintenance of ordinariness in the household management of childhood asthma. Sociology of Health & Illness 21 (2): 137–162.

    Article  Google Scholar 

  • Rose, N. 2006. The politics of life itself. Princeton: Princeton University Press.

    Google Scholar 

  • Rouse, C. 2010. Patient and practitioner noncompliance. Anthropology & Medicine 17 (2): 187–200.

    Article  Google Scholar 

  • Royal College of Physicians. 2014. Why asthma still kills. London: RCP.

    Google Scholar 

  • Sharp, L.A. 2014. The transplant imaginary. Berkeley, CA: University of California Press.

    Google Scholar 

  • Shubin, S., F. Rapport, and A. Seagrove. 2015. Complex and dynamic times of being chronically ill. Social Science and Medicine 147: 105–112.

    Article  Google Scholar 

  • Smith-Morris, C. 2010. The chronicity of life, the acuteness of diagnosis. In Chronic conditions, fluid states, ed. L. Manderson, and C. Smith-Morris, 21–37. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Sunder Rajan, K. 2012. Pharmaceutical crises and questions of value. The South Atlantic Quarterly 111 (2): 321–346.

    Article  Google Scholar 

  • Trnka, S. 2011. Specters of uncertainty: violence, humor, and the uncanny in Indo-Fijian communities after the May 2000 Fiji coup. Ethos 39 (3): 331–348.

    Article  Google Scholar 

  • Trnka, S. 2017. One blue child: asthma, responsibility and the politics of global health. Palo Alto: Stanford University Press.

    Google Scholar 

  • Trostle, J. 1988. Medical compliance as an ideology. Social Science and Medicine 27 (12): 1299–1308.

    Article  Google Scholar 

  • van der Geest, S., and S.R. Whyte. 1989. The charm of medicines. Medical Anthropology Quarterly 3 (4): 345–367.

    Article  Google Scholar 

  • Verdery, K. 1996. What was socialism and what comes next?. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Vuckovic, N. 1999. Fast relief: buying time with medications. Medical Anthropology Quarterly 13 (1): 51–68.

    Article  Google Scholar 

  • Whitmarsh, I. 2008. Biomedical ambivalence: asthma diagnosis, the pharmaceutical, and other contradictions. Ithaca: Cornell University Press.

    Google Scholar 

  • Whitmarsh, I. 2010. The ascetic subject of compliance. In When people come first: critical studies in global health, ed. J. Biehl, and A. Petryna, 302–324. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Willems, D. 2000. Managing one’s body using self-management techniques: practicing autonomy. Theoretical Medicine and Bioethics 21: 23–38.

    Article  Google Scholar 

  • World Health Organization. 2003. Adherence to long-term therapies. Geneva: World Health Organization.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anthropology Programme, Faculty of Arts, School of Social Science, University of Auckland, P.B. 92019, Auckland, 1142, New Zealand

    Susanna Trnka

Authors
  1. Susanna Trnka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susanna Trnka.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41286-017-0039-5

Keywords

Search

Navigation