6 - Moral Trajectories: From Acute Psychosis to ‘Chronic Schizophrenic’

Summary

When a person was rendered into a written case format, there was little suggestion that he or she was capable of rational, consciously motivated action. Instead, behaviour was explained in terms of antecedent causes, or what Schutz (1972: 91-96) has called ‘because’ motives: the person acted in this way because of prior developmental influences or stressful life events. A case was a segmented version of a person in which behaviour was portrayed as the product of interactions between family dynamics, genetic predisposition, intrapsychic factors, and biological disturbances. Responsibility for behaviour was not attributed to the person because it was influenced by forces that lay beyond voluntary control. The schizophrenic illness was the most potent of these forces, either controlling the actions of a patient or pervading his or her entire personal identity. This was a deterministic construction that rendered the person a passive object.

When members of the Schizophrenia Team talked among themselves about a patient, however, they also drew on a voluntaristic construction that accorded volition to that person. In these accounts the person was perceived as unified rather than segmented—a single source of consciously motivated action. He or she was understood from within a subjective framework rather than treated as an object. Actions were understood in terms of the future outcome that this person sought to bring about, or what Schutz (1972:28-31, 86-90) called ‘inorder- to’ motives. For example, in Chapter 4 Miss Treloar was said to have pretended to forget her shoes in order to trick Margaret into driving her home again. She was regarded as capable of exerting control over her own behaviour, over her schizophrenic illness, and over other people. Endowed with the capacity for rational, purposive action, such patients were able to engage in strategic manipulation of others for selfinterest. Schizophrenia was no longer a causal force determining their behaviour; it was an instrument they employed to influence the staff or their relatives.

Within this voluntaristic construction, the person became a moral being who was deemed capable of deciding between right and wrong, acting on this choice, knowing what the consequences of that choice would be, and being held responsible for those consequences. Holding people to account in this way entailed subjecting them and their actions to moral evaluation. It created the possibility of ‘good’ and ‘bad’ people who behaved ‘appropriately’ or ‘inappropriately’.