Mother’s Little Helper?

“Mother needs something today to calm her down
And though she’s not really ill
There’s a little yellow pill
She goes running for the shelter of a mother’s little helper
And it helps her on her way, gets her through her busy day”

Songwriters: JAGGER, MICK / RICHARDS, KEITH

Mother’s Little Helper lyrics © ABKCO Music Inc.

One of the things that I find fascinating about substance use is that the meanings attached to it can vary so widely, and with such far-reaching consequences. One example of this can be seen in the different policy, legal and social responses to alcohol and tobacco use, as compared to, for instance, LSD, heroin or cannabis. David Nutt, formerly a member of the Advisory Council on the Misuse of Drugs, for the UK Government, was famously sacked for challenging inconsistencies in legislation which did not, he argued, reflect the ‘objective’ harm caused by different substances. Social scientific work has a rich history of highlighting and challenging the variable ways in which substances are understood and given meaning both within and between different social and cultural contexts.

My own research draws on perspectives which address the diverse cultural meanings attached to substances, with a particular focus on opioids and opioid substitution – heroin, methadone, buprenorphine, subutex. An example I have used often in teaching is to encourage students to compare social responses to a morphine user who is in hospital, recovering from an operation, and one who is using heroin ‘recreationally’ at home. One is legitimate, the other illegitimate – but why? A more developed version of this is found in Helen Keane’s recent analysis of the stark differences in how medical literature approaches the same substance (methadone) when used in treating a) chronic pain and b) opioid dependence (Keane, 2013). Discourse addressing methadone use for chronic pain has to do a lot of work to try to avoid stigmatising patients, attesting to the highly negative meanings that methadone has come to imbue, associated as it is with: dependence, lack of control, lack of self-worth, epitomised in the cultural image of the underserving ‘junkie’.

Questions about the social construction of substance use often fade into the background in discussions about the impact of parental drug use on children. However, both parenting and substance use are clearly socially mediated, and given meaning in different ways according to a range of factors (social class, cultural background, religious belief etc.). Social scientific work on the dominance of middle-class models of ‘good’ parenting are one example of how this can play out in policy and practice (see e.g. Gillies, 2007).

In research completed in 2013 I was part of a team that explored accounts about parenting support among a group of opioid-dependent parents living in Scotland. A paper that has just been published in Drugs: education, prevention and policy, explores how parents accounted for their use of benzodiazepines compared to methadone. While policy often frames all drug-use as problematic among parents, in our research it became clear that some drugs were worse than others. In particular, while a range of problems can be associated with both methadone and benzodiazepine use; the latter was almost universally framed as unproblematic by parents who took part in the research. In particular, this applied to mothers – and several participants quoted the Rolling Stones song, Mother’s Little Helper (above), to support this view.

Benzodiazepine was described as helping parents to: sleep better, socialise, manage anxiety – so as not to impact negatively on children, and cope with traumatic histories. In contrast – methadone was associated with a range of difficulties, and almost all participants suggested they were committed to ‘coming off’ their methadone prescription. Though it was acknowledged that it was helpful in abstaining from illicit and/or injecting drug use – methadone was also framed as contributing to unpleasant physical symptoms, stigmatising identities (‘the junkie’), and the services connected with it (prescription pick-ups, monitored consumption) got in the way of ‘normal’ family life. Many of these constraining features were explored in more detail in an article published last year in the International Journal of Drug Policy (Chandler et al., 2013).

Different cultural images of drug-use and parenting (and especially mothering) highlight the importance of social context in shaping how we understand the impact of substance use on how we act, and who we are. For the parents we spoke to, these images had far-reaching impacts on their lives and on how they talked about parenting in the context of dependent drug-use. Those who continued to use methadone were tied in to services which monitored them and their children closely, as well as leaving them open to negative judgements from themselves and others. Benzodiazepine dependence was not seen as attracting the same level of scrutiny or stigma, and therefore stopping use seemed less pressing.

What I was left wondering when considering these findings, was whether methadone treatment could ever be viewed as benignly as benzodiazepine treatment seemed to be. I am far from an expert in the pharmacological make-up of these substances, but both can be ‘addictive’, both have psychoactive qualities, both have the potential (but not the promise) of impacting negatively on parenting. Yet one substance is imbued with (almost) positive qualities while the other has the opposite effect. Our research – and that of many others – has highlighted that these negative, stigmatising attitudes towards opioid treatment and dependence are ultimately damaging to both parents and their children: constraining help-seeking, leading to social isolation and lack of self-esteem. Can it ever be any different?

Chandler, A., Whittaker, A., Williams, N., McGorm, K. Cunningham-Burley, S. and Mathews, G. ‘Mother’s little helper? Contrasting accounts of benzodiazepine and methadone use among drug-dependent parents in the UK’ Drugs: Education Policy and Prevention

Chandler, A., Whittaker, A., Cunningham-Burley, S., Williams, N., McGorm, K. and Mathews, G. (2013), ‘Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods’, International Journal of Drug Policy, 24, 6, e35-e42.

Gillies, V. (2007), Marginalised mothers: exploring working-class experiences of parenting, London, Routledge.

Keane, H. (2013), ‘Categorising methadone: Addiction and analgesia’, Int J Drug Policy, 24, 6, 12.

 

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Narrating the self-injured body

Re-posted from the CRFR Blog

Recent media reports have highlighted an apparent rise in the numbers of young people reporting self-harm. These reports should be treated with caution: surveys may well have identified a rise in the number of people who are harming themselves, but findings might also reflect an increased awareness of what self-harm is; meaning that self-harm can be more easily identified and named.

Naming self-harm can be a tricky business, and the recent debates about including ‘non-suicidal self-injury’ in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (American Psychiatric Association, 2013) is just one example of this. My research, with people who have self-harmed, and General Practitioners, suggests that the type of practices self-harm is understood to involve, and the meanings they have, can vary widely. While for some people, ‘self-harm’ is taken to mean skin-cutting; for others it might refer to overdoses; misusing drugs and alcohol, attempting suicide, risk-taking, or maintaining an abusive relationship.

Surveys that collect data about rates of self-harm provide important information; but they do not tell us the whole story about how someone understands self-harm, what kind of practices self-harm involves, how self-harm affects and contributes to their day-to-day life. Even a particular type of self-harm, say, self-cutting, can be used and experienced in many different ways (Chandler, 2012; Chandler, 2013).

In a paper that was published recently (online first) in the BMJ journal Medical Humanities, I explore narratives about living with bodies scarred or marked by self-cutting. The paper uses Arthur Frank’s typology of illness narratives (Frank, 1995): restitution, chaos, and quest, to demonstrate the different ways in which people talked about the impact of scarring on their lives.

  • Restitution: For some participants, a focus of their story was to emphasise removal of scars, and attempts to ‘fix’ the problem of the scarred body.
  • Chaos: More rarely, people spoke of their scarred bodies as chaotic, indicating feeling out of control of their body and the scars.
  • Quest: A more optimistic account was given by others, who talked about the role of scars in ‘telling a story’ – to themselves and to others. Importantly, the story was one of hope, and of overcoming difficulties.

If rates of self-harm are increasing, there are likely to be more people living with scarred bodies in future. It is important to acknowledge that these scars may have very different meanings, and be experienced in different ways. Indeed, a common theme across the research I have done with people who have self-harmed highlights the pain caused by other people’s assumptions about what self-harm, or self-harm scars, might mean.

EDIT: The paper, Narrating the self-injured  body, is now open access in BMJ Medical Humanities.

American Psychiatric Association (2013), Diagnostic and statistical manual of mental disorders: DSM-5, Arlington, VA, American Psychiatric Association.

Chandler, A. (2012), ‘Self-injury as embodied emotion-work: Managing rationality, emotions and bodies’, Sociology, 46, 3, 442-457.

Chandler, A. (2013), ‘Inviting pain? Pain, dualism and embodiment in narratives of self-injury’, Sociology of Health & Illness, 35, 5, 716-730.

Frank, A. (1995), The Wounded Storyteller; Body, Illness, and Ethics Chicago, University of Chicago Press.

 

Ethics, Embodiment Re/Production and the Lifecourse

Written following a symposium I was involved in organising, held on June 6th 2014 at the University of Edinburgh.

“[B]ioethics is out of touch. It is out of touch with bodies themselves” (Shildrick 2005; p. 2)

Feminist theorists such as Margrit Shildrick have been prominent in critiquing bioethical discussions which take for granted bodies and embodiment. In Ethics of the Body: Postconventional Challenges, an edited collection by Shildrick and Mykitiuk, this is explored via papers addressing a range of topics which both invoke bioethical engagement, but also unsettle and question notions of embodiment and what bodies are. For me, the book has been a useful and enduring resource, since different chapters within it address areas of empirical research or teaching I’ve been involved in: addictions (Helen Keane), mental health (Nancy Potter), disability (Jackie Leach Scully), and sex/gender (Katrina Roen).

On 5th June 2014, a symposium, Ethics, Embodiment, Re/Production and the Lifecourse, at the University of Edinburgh, interrogated questions about the relationship, and potential for mutual collaboration between, theories of embodiment and bioethics. The symposium was part of a Wellcome Trust strategic award, The Human Body, its Scope, Limits and Future, on which Sarah Cunningham-Burley, my co-organiser, is co-investigator.

What can theoretical work on embodiment contribute to discussions about the ethical implications of biomedical innovations? What can bioethics contribute to theoretical work on embodiment?

The focus of the symposium on re/production and the lifecourse reflected an attempt to look at embodiment and ethics in terms of reproduction, and especially the challenges raised by new reproductive technologies, but also to consider how biomedicine increasingly works across the lifecourse to produce different types of bodies. Such biomedical innovations and interventions raise significant ethical questions. They also raise important questions about the nature of bodies and embodiment.

My own interest in embodiment and bioethics, and what the two might contribute to one another, led from work I undertook during a postdoctoral fellowship at IASH (Institute for Advanced Studies in the Humanities). While there I was working broadly on ethics and self-harm, but I focused especially on exploring the ways that academic discourse about the ethics of treating self-harm addressed embodiment. Perhaps unsurprisingly, most of what I found, which was itself limited, tended not to engage much with self-harm as an embodied practice. Indeed, this is reflective of the vast majority of academic work on self-harm – it tends to gloss over the messy, lived, corporeal aspects of being or caring for someone who self-harms.

The relative lack of engagement in (some) bioethical work with embodiment, and especially fleshy, lived bodies, was raised by many of the speakers who contributed to the symposium. I’ll be writing a more detailed blog and report of the day; but here is a brief overview of the speakers and their talks:

Session 1: Reproduction, ethics and embodiment

  • Elizabeth Ettorre, opened the day sketching out the need for an embodied ethics, which is open to and engages with bodily, embodied diversity; is empathic; and attends to embodied emotions as a part of ethical reflection.
  • Danielle Griffiths followed, taking an embodied perspective to ethical debates about new reproductive technologies; particularly those that have been proposed but not yet realised: male pregnancy and ectogenesis.

Session 2: Ethics, medicine and disabled bodies

  • The second session addressed disability and medical treatments or ‘fixes’. Fadhila Mazanderani discussed the role of patient’s embodied experiences in guiding their decision making regarding controversial treatments for MS; contrasting this type of evidence with, for example, Randomised Control Trials that are often prized in clinical decision making.
  • Jackie Leach Scully raised a series of provocative arguments regarding the development, use and representation of prosthetics. She suggested that the use of prosthetics contributes to the normalisation of certain types of disabled body; and the marginalisation of others.

Session 3: Biomedical innovations and enhancements

  • Next, Gill Haddow addressed a different type of assistive device (ICDs), though this one designed to prolong/extend/save life; discussing the embodied and relational consequences of being a ‘cyborg’.
  • Finally, Sarah Chan addressed bioethical debates about enhancement, using this discussion to problematize dominant bioethical discourse about normality, especially as applied to gender and disability.

The third session was also to have included a paper from Anne Kerr, discussing body work and emotional labour in biomedical innovation. Anne couldn’t present on the day unfortunately, but her paper would have been a great addition.

There were a number of common themes and threads running throughout the day, which I need more time to think about in order to do them justice. What was very clear was that there is a great deal of scope for further work which engages with bioethics and embodiment, especially when this explicitly includes attention to emotions.

References

Shildrick, M. (2005), ‘Beyond the Body of Bioethics: Challenging the Conventions’, in Shildrick, M. and Mykitiuk, R. (eds.), Ethics of the Body: Postconventional Challenges, London, MIT Press.