The lithium battlefield: Subjective meanings and intersubjective contexts of 'noncompliance

Despite the crucial significance of understanding the subjective meanings of "noncompliance" in patients diagnosed with manic depression, the issue is barely addressed in the vast literature on lithium---the medication most prescribed by doctors for both acute affective episodes and long-term maintenance of the illness. This study, divided into two parts, explores these meanings: Part I is a theoretical exploration of lithium noncompliance conceptualized as a meaningful and co-constructed sign of intersubjective disjunction---a lithium battlefield---that is situated in the reciprocal interplay between doctors' and patients' differently organized subjective worlds. These differing subjective worlds are understood in the context of the developmental history of both the medical profession---that is, doctors as a group---and the individual patient. Exploring noncompliance as an intersubjective disjunction between doctor and patient included investigating how the doctor's act of interpreting a patient's taking or not taking medication in terms of "compliance"---a medical concept that assumes the doctor's dominant, authoritarian posture to be in complementary relation to the patient's submissive, passive posture---is itself a problematic aspect of the relational context within which the patient decides not to take lithium. In particular, this study explores the impact of the doctor's expectation of compliance on the self-experience of patients diagnosed with manic depression. Part II is an intersubjective exploration of lithium noncompliance in psychobiographical case studies of Kay Jamison and Kate Millett, two women diagnosed with manic depression who have a history of going on and off lithium. In these case studies, Jamison's and Millett's battles over lithium compliance are understood in the context of their subjective worlds and in relation to others. In particular, Jamison's and Millett's battles are viewed as an expression of enduring themes in their lives concerning loss of agency in relation to feeling invalidated and usurped by the authority of others. Findings from the case studies offer an intersubjective conceptualization of the phenomenon of manic depressives' refusal to take lithium and suggests a general critique of the medical concept of compliance.