Psychiatric Medication and Meaning-Making

Background and Purpose: Researchers in social work and beyond have urged those in mental health to more fully embrace research into the subjective experience of pharmacotherapy among people with serious mental illness (Floersch et al., 2007, Jenkins et al, 2005; Mintz, 2001). Often using symbolic interactionism as a theoretical frame, previous studies have examined, for example, patient-staff communication (Rhodes, 1984), the use of metaphors (Helman, 1981), issues of self-identity (Carder et al, 2003), medication as a symbol of hope, struggle, and control (Usher's 2001), and, importantly, as an avenue to normality (Knudsen, Hansen, Traulsen, & Eskildsen, 2003). This study attempts to build on that body research with a specific client group served in a local community program, and then immediately transform the findings into program enhancement.

This community-based qualitative inquiry asks: what is the meaning and impact of taking psychiatric medications in the lives of people with severe mental illness living in a residential program. The specific study objectives are (1) to create a “typology of meaning” and (2) use the findings to enhance specific programming to better reflect the role and importance of medication issues in the everyday lives of residents.

Method: Consistent with related inquiries, the research derives from an interpretive paradigm and relies on a thematic analysis of semi-structured interview data. A staff-resident Advisory Panel guided the research. Participants were 21 adults with extensive histories of mental illness, numerous hospitalizations, currently taking multiple medications. In addition to the interviews, participants each created a color drawing related to their experience with medication, which they titled and “interpreted” themselves. In addition to a member check, a peer consultant supervised the audit trail of data reduction to support rigor.

Findings: The main results are the distillation of themes into a typology of meaning with 7 dimensions:

Psychiatric medication as

1. …a positive force across several dimensions of experience.

2. …as tolerated fact of life.

3. …as primarily an internal and individual experience.

4. …as a prominent part of the story and evolution of one's mental illness.

5. …as basis of gratitude and source of victory over past struggles.

6. …as necessary for prevention of relapse and protection of humanness.

7. …as a symbol of differentness and dependency.

Conclusions & Implications: Among this group of residents, it is clear that taking medication is not a benign act. Rather, taking psychiatric medication is something that incites meaning, influences identity, and impacts life. There is also conundrum: medication can be an avenue to full humanness and a more positive life experience, but also can be the source of felt differentness, resignation and melancholy. The Advisory Panel generated 12 different initiatives for program change, currently being implemented. These include sponsoring a Summer Book club for staff and residents, publishing a collections of life stories, conducting skills training sessions on “how to talk with your prescriber” about psychiatric medication, and changing intake assessment forms to allow new residents to talk more about their experience with medications and the evolution of their mental illness.