This paper presents and interprets a qualitative interview with a Paxil user who was prescribed the antidepressant following a major depressive episode. Through the interview narrative, the paper traces how the subject's initial confusion and noncompliance gave way to a deep reliance on the medication over three months. Drawing on Howard S. Becker's framework for how new behaviors toward unfamiliar objects emerge — originally developed in the context of marijuana use — and Ian Hacking's concept of "making up people," the paper argues that the subject underwent a meaningful transformation in his conception of Paxil, shifting from reluctant patient to someone who viewed the drug as essential to normal life.
There are a variety of ways in which an individual can respond to a new object or substance. For an individual to develop a new behavior toward something, he or she first undergoes a transformation of sorts in which new conceptions are formed regarding that substance and its nature. This paper presents a narration drawn from an interview with a Paxil user, followed by a theoretical interpretation of what the interviewee shared.
The interview subject has been using Paxil (paroxetine) for the last three months. The drug was prescribed to him after he suffered a major depressive episode. Paxil has been in use for quite some time and, though it is considered relatively effective in the treatment of anxiety disorders and depression, it does occasion some significant side effects. To minimize the risk of adverse effects, users should inform their doctor of any pre-existing medical conditions, including a history of epilepsy, kidney disease, and bipolar disorder. Documented side effects include headaches, loss of coordination, high fever, unusual bleeding (via the rectum or mouth), hallucinations, and uneven heartbeats. Less serious side effects include a ringing sensation in the ears and mild nausea. It should also be noted that while Paxil interacts well with some drugs, it does not work well with others.
Given the complexity of the drug, it follows that a user should be well briefed on every relevant aspect of it. During the interview, I asked the subject a number of questions about his interaction with Paxil. To gauge his understanding of the drug and its workings, I sought to find out whether he had researched its side effects after it was prescribed. According to the subject, he did not conduct formal research about the drug; instead, he asked an old friend, Jonathan, who had previously used the drug, how it worked and whether it was effective in treating depression. Jonathan was, in fact, the person who had earlier encouraged the subject to seek medical attention for his depression and anxiety. It was only after the subject began experiencing strange bodily reactions — including a mild headache and a feeling of nervousness — that he consulted Jonathan.
I also sought to know how carefully the subject was consuming Paxil. Though he admitted he was not as careful when he first started, he agreed that he had gradually come to take the drug more seriously. In his words: "I did experience difficulties when I first started taking the drug. I wasn't as committed at first as I am currently." When pressed further, he added: "I am not certain I was using the drug as the doctor had prescribed. For instance, there were times I completely forgot to take it during the recommended time." Jonathan also played an important role in helping the subject adapt and develop the understanding that the drug was necessary for managing his depression.
Given the subject's initial reaction to Paxil, I was also interested in whether he had taken another drug previously to treat depression or anxiety. I gathered that he had sought professional help before, but this was the first time an antidepressant had been prescribed. When I asked how often his doctor recommended that he take the drug, and whether usage was ongoing, I was impressed that he had listened carefully to his doctor's instructions — he was well briefed on how the medication was to be taken and the expected duration of use (though he was initially evasive when I asked about when he might stop). According to the subject, his doctor had instructed him to take one tablet per day, which he preferred to take in the morning. He also noted that he regularly consulted his doctor whenever he needed to take other prescription medications, in order to avoid adverse interactions with Paxil. I later verified that this was indeed the correct protocol for the drug.
On whether Paxil use was to be ongoing, the subject was, as noted, noncommittal. However, when pressed, he shared that his doctor had warned him against stopping the drug without first consulting him, as suddenly discontinuing Paxil could result in serious side effects. The subject was quick to add that he was in no hurry to stop, as he was certain the drug had benefited him greatly.
When I asked whether the subject had spoken with anyone besides his doctor and Jonathan about his use of Paxil, he was again noncommittal. I later gathered that he had not discussed it with anyone else. Though it was clear from our conversation that he had come to learn a great deal about the drug — including why he was taking it, the recommended dosage, and what to avoid while on medication — he remained reluctant to discuss the drug and his experiences with others. As the interview progressed, I had to use a number of probing techniques to get him to open up. His reluctance was also evident in his refusal to speak with others beyond Jonathan about the matter.
It is also worth noting that he only consulted Jonathan after experiencing side effects that he suspected were caused by the drug. He sought Jonathan's perspective in part because Jonathan had previously disclosed to him that he had used Paxil as an adolescent, at a time when he was being treated for panic disorder.
"Subject's unexpected resolve to continue using Paxil"
"Becker and Hacking frameworks applied to interview findings"
Becker, Howard S. "Becoming a Marihuana User." American Journal of Sociology, vol. 59, no. 3, Nov. 1953, pp. 235–242.
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