Making Sense of Nonadherence to Psychiatric Treatments

People often do not follow psychiatric treatments as prescribed. This phenomenon is well known and has been investigated across thousands of population-level studies. The original work of this thesis involves adapting resources from population-level studies, and from other social scientific and philosophical theories, for the purpose of making sense of individual cases of nonadherence. The thesis examines the different concepts that are explicitly used or that are implicitly at work in these studies and theories, and it appropriates them for use in frameworks which can be used to make sense of the nonadherence of individual patients. The thesis employs a rich array of interdisciplinary resources for this purpose, appropriating resources from medicine, psychiatry, social science, philosophy, economics, and law. It begins by examining the ways in which nonadherence is understood in empirical population-level research, supplemented by resources from the philosophy of social science and theories of causation. Later, it examines the ways in which nonadherence may be understood to be rational under different theories of rationality, and the ways in which nonadherence may be understood to shape subjectivity under Foucauldian theories of the subject and subjectivation. In total, four meta-frameworks are articulated that can be employed for the purpose of making sense of individual cases of nonadherence. Under these meta-frameworks, sense can be made of nonadherence as a problem to be solved; as an effect; as an expression of rational agency; and as a practice of subjectivation. Each chapter focuses on one meta-framework and articulates a set of hermeneutic questions that can be used in making sense of individual cases of nonadherence. Although the meta-frameworks are intended to have use for making sense of nonadherence to treatments for a range of psychiatric disorders, the applied analysis in the thesis focuses on a particularly troubling case-study: nonadherence to treatment for anorexia nervosa.