A Foucauldian-inspired ethnographic investigation: The emergence of the everyday social practice of ADHD

Abstract

The project utilised an ethnographic approach, and the scholarship of Michel Foucault and Joao Biehl, to reconnect the wider social, political and institutional factors that were influential in the formation of a particular form of ADHD related health care. By utilising various strands of theoretical and empirical material from both authors, the study aimed to reconnect the nexus of elements that conditioned the possibility for the everyday social practice of ADHD to be in place within an NHS region in Scotland. An overarching aim was to consider ADHD from outside its dominant biomedical explanation by examining the wider context and processes that conditioned the possibility for the emergence of a local social practice of ADHD inscription and treatment. The investigation made use of the ethnographic approach of Vita: Life in a Zone of Social Abandonment as a methodological guide. Vita reconnects the nexus of elements – the ‘invisible machinery’ – that allowed for the subject of the project to be represented as mentally defective in the present. This project attempts a similar methodological reconnection of the invisible machinery that conditioned the present, but with the social practice of ADHD as the focus. The analytic approach made use of the concept of ‘problematisation’, which captures a two-stage process – the questioning of how and why certain ‘things’ become a problem, but also how these ‘things’ are shaped as the objects that they become. Objects are not considered as things that previously did not exist being created by discourse, but as things that become what they are because of their interconnected ‘apparatus’ – the totality of discursive and non-discursive elements that introduce them into the play of true and false. The object of interest for this project was ‘young people’ and how they were problematised and shaped as the target of certain knowledges. It was through this process, the how of their construction as a problem, that the project made the connections thatprovided the authority for particular problem explanations to be installed as ‘real’ over other possibilities.The fieldwork was conducted in a small geographical region in Scotland and consisted of several periods in health and education services. Along with extended periods in these domains, further ethnographic tools utilised includedobservation of clinical appointments, document analysis, interviews and archival research. Multiple sources of informationformed the qualitative data for the investigation, including audio recordings/transcription of clinical appointments, clinical case notes, health service management team meetings, and health and education policies and guidelines. The different layers of qualitative material – from individual appointment to national policy – allowed for reconnection of the discursive field in which the current practice of ADHD emerged. The material was engaged with horizontally and vertically within and across the different layers of material, allowing for the examination of the changing discursive background and the problematisation of young people within education and health domains. The analysis revealed discontinuity in how the ‘problem’ of young people was constructed across time, what was legitimated as solution to these problems, what effects were created, and what followed from these effects. The study is considered a Foucauldian-inspired ethnographic ‘case study’. The thesis uses the various chapters to construct a genealogical account of the emergence of the local social practice of ADHD, one that maps and makes visible the multiplicity of events implicated in the construction of young people as particular types of problems and which conditioned the possibility for the social practice of ADHD to become the current means by which young people become known as problems. The genealogy is considered a theoretical redescription of the rise of ADHD inscription and treatment locally, one that aims to trouble accepted explanations by revealing the wider complex network from which the social practice emerged.