Gendering and schizophrenia: Negotiating power relations, gender understandings and experience in psychiatric/patient interactions

Abstract

This thesis uses a discursive approach to examine psychiatric understandings of gender and schizophrenia in clinical encounters between professionals and patients. Chief reasons for undertaking the research were an unease about the concept of schizophrenia and a lack of attention to interactive psychiatric contexts in feminist work on gender and madness. This study attempts to move beyond explanations of schizophrenia as a label or social product to analyse the intersections between femininity, masculinity, and schizophrenia accomplished within psychiatric/patient interactions. Drawing on case conference discussions in a British psychiatric unit, I argue that the interplay between locally accomplished power and the broader mandate of community care produces co-existing relations of benevolent psychiatry/responsible patient, and supervisory psychiatry/ untrustworthy patient, and considerable professional persuasion and patient resistance at this local level. Within these relations, understandings of femininity and (masculine) personhood produce a plurality of meanings of emotion, activity, and (in)dependence. The experiences of patients and their significant others are fluid and complex resources (re)configured in gendered relational terms to inform the restoration of lives and definitions of trouble. The central argument is that schizophrenia is not applied as a label but operates largely as a background understanding. Professional assumptions about schizophrenia, not gender, inform discourses of responsibility, consumerism and supervision, whereas professional discourses of femininity and (masculine) personhood intersect with understandings of schizophrenia to differentiate and delimit restoration to purpose and autonomy. But professionals' understandings of femininity and masculinity, not schizophrenia, inform definitions of trouble: negative understandings of femininity are associated with blame and change; those of masculinity with excusing and unchangeability. Contemporary psychiatry is more concerned with encouraging self-regulation and restoring lives than straightforward social control and gender conformity. But gender understandings remain salient to contemporary psychiatry and, in relation to schizophrenia, gender differentiations in local interactions run counter to schizophrenia's distributional gloss of gender neutrality.