Resisting medications: moral discourses and performances in illness narratives

Abstract

Adherence research has been dominated by attitudinal approaches that isolate individual statements made in interviews and then assign a fixed attitude to the individual who made that statement. Despite much sociological research having raised questions about the notion of fixed attitudes, little research has theorised the process by which individual utterances about medicine-taking are produced as a form of resistance to medications within interviews. Using Goffman's concept of performance as a starting point, this article offers an alternative framework for conceptualising adherence presentations when provided in the form of a rhetorical narrative. Through the presentation of case material taken from interviews with participants who had not taken prophylactic asthma medications as prescribed, we develop Goffman's concept of performance to theorise the production of adherence talk in two important ways. First, individual performances can be seen to be shaped by how moral discourses of illness management transfer across contexts. Second, performances are subject to inequalities in the resources interactants have access to. An extended definition of Goffman's concept of performance is thus offered, arguing that the 'meaning' of individual performances is produced by a combination of which moral discourses interactants orientate to and which discourses are used to categorise individuals.