Filling scripts: A multi-sited ethnography of pharmaceutical sales practices, psychiatric prescribing, and phamily life in North America

Michael James Oldani
Dept. of Anthropology, Princeton University
July, 2006


This dissertation is an ethnographic examination of the standard pharmaceutical prescription narrative (the standard pharmaceutical script). It focuses on the double meaning of scripts---pharmaceutical and cultural---that have combined to create both imagined and real pharmaceutical families, or 'phamilies.' Methodologically, each scene of the standard pharmaceutical script is tested against ethnographic reality---following the plot. Psychotropic scripts are also followed across borders (between the United States and Canada) and from the clinic to the home of patients. Part I examines how the Aboriginal community in postcolonial Manitoba has come to resist phamily life by opposing the prescribing of psychoactive medication for their children diagnosed with fetal alcohol spectrum disorder (FASD). Through detailed interviews and participant observation, I document how medicating children has become a reminder of past injustices of the residential school era. Specifically, I describe how First Nation people have withstood pathologizing themselves (through state-governed scripts) and have embraced specific Aboriginal prescriptive healing practices.
Part II explores the logic of phamily acceptance by focusing on a key site in generating scripts: the clinical encounter. Within this site, the hidden transcripts of pharmaceutical industry sales practices are examined at both the corporate and local sales levels. I give special (auto)ethnographic attention to the methods and tactics drug reps use to generate prescriptions. I examine and critique psychiatry's evolving clinical role as a script writer through interviews with psychiatrists during and after their residencies. A final ethnographic case documents the process of patient self-prescribing and the implications of a scripted pharmaceutical personhood.