Labor inclusion and medicalization: neuroleptics as actants in the experiences of workers diagnosed with schizophrenia in Chile

Ernesto Bouey Vargas PhD in Social Sciences. Professor, Faculty of Psychology, Universidad Diego Portales, Santiago, Chile. image/svg+xml , María José Reyes Andreani PhD in Social Psychology. Academic, Department of Psychology, Universidad de Chile, Santiago, Chile. image/svg+xml
Received: 21 August 2025, Accepted: 23 February 2026, Published: 10 March 2026 Open Access
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Abstract


People diagnosed with schizophrenia exhibit low rates of labor market participation, a phenomenon that has been predominantly addressed from biomedical approaches that associate work inclusion with pharmacological stabilization. However, there is limited research examining how the everyday use of neuroleptics shapes the work experiences of those employed with this diagnosis. The aim of this study was to understand the role of neuroleptics — conceived as actants — in the experiences of workers diagnosed with schizophrenia in Chile and their implications for labor inclusion. A qualitative ethnographic study was conducted between 2022 and 2024 in the Metropolitan Region of Chile, including participant observation across diverse everyday and workplace settings, as well as 86 interviews (53 with workers diagnosed with schizophrenia and 33 with individuals from their close environment). Drawing on actor-network theory and the notion of enactment, the analysis identified that the diagnosis and the neuroleptic become assembled as a lifelong practice, configuring an experience marked by tensions. Although medications are valued for alleviating distress, their assemblage with diagnosis and their side effects — sedation, motor disturbances, salivation, weight gain, and affective flattening — mediate the body, the psyche, and social life, hindering work performance and exposing individuals to stigma and discrimination.

Full-text of the article is available for this language: Español.


References


1. Bouwmans C, De Sonneville C, Mulder CL, Hakkaart-van Roijen L. Employment and the associated impact on quality of life in people diagnosed with schizophrenia. Neuropsychiatric Disease and Treatment. 2015;11:2125-2142.
Crossref | Google Scholar

2. Marwaha S, Johnson S, Bebbington P, Stafford M, Angermeyer MC, Brugha T, et al. Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. British Journal of Psychiatry. 2007;191:30-37.
Crossref | Google Scholar

3. Ministerio de Desarrollo Social. Encuesta de Discapacidad y Dependencia (Base de datos) [Internet]. 2023 [citado 10 jul 2025]. Disponible en: https://tinyurl.com/47c47czk

4. Ministerio de Desarrollo Social y Familia. Encuesta de caracterización socioeconómica nacional (CASEN) [Internet]. 2020 [citado 10 jul 2025]. Disponible en: https://tinyurl.com/3s4w3tmm

5. Charzyńska K, Kucharska K, Mortimer A. Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. International Journal of Occupational Medicine and Environmental Health. 2015;28(3):407-418.
Crossref | Google Scholar

6. Christensen TN, Wallstrøm IG, Eplov LF, Laursen TM, Nordentoft M. Incidence rates and employment trends in schizophrenia spectrum disorders, bipolar affective disorders and recurrent depression in the years 2000–2013: a Danish nationwide register-based study. Nordic Journal of Psychiatry. 2022;76(3):225-232.
Crossref | Google Scholar

7. Ottewell N. Working in disability employment: An interpretative phenomenological study of experiences of people with a diagnosis of schizophrenia. British Journal of Occupational Therapy. 2022;85(7):541-548.
Crossref | Google Scholar

8. Kobayashi H, Yamaoka T, Toma T, Imai K, Wakamatsu A, Noguchi K. The Effects of Paliperidone Palmitate 1 Month on the Employment Status and Social Functioning of Patients with Schizophrenia. Innovations in Clinical Neuroscience. 2020;17(1):36-44.

9. Mihaljevic-peles A, Sagud M, Filipcic IS, Grosic V, Pedisic I, Emsley R. Remission and employment status in schizophrenia and other psychoses: one-year prospective study in croatian patients treated with risperidone long acting injection. Psychiatria Danubina. 2016;28(3):263-272.

10. Noordsy DL, Glynn SM, Sugar CA, Keefe CDO, Marder SR. Risperidone versus olanzapine among patients with schizophrenia participating in supported employment : Eighteen-month outcomes. Journal of Psychiatric Research. 2017;95:299-307.
Crossref | Google Scholar

11. Matsuzaki H, Hatano M, Iwata M, Saito T, Yamada S. Effectiveness of Clozapine on Employment Outcomes in Treatment-Resistant Schizophrenia: A Retrospective Bidirectional Mirror-Image Study. Neuropsychiatric Disease and Treatment. 2023;19:615-622.
Crossref | Google Scholar

12. Abidin MZRZ, Yunus FW, Rasdi HFM, Kadar M. Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review. British Journal of Occupational Therapy. 2021;84(10):605-619.
Crossref | Google Scholar

13. Kinoshita Y, Furukawa TA, Omori IM, Watanabe N, Marshall M, Bond GR, et al. Supported employment for adults with severe mental illness. Cochrane Database of Systematic Reviews. 2013;(9).
Crossref | Google Scholar

14. Marwaha S, Johnson S. Schizophrenia and employment: A review. Social Psychiatry and Psychiatric Epidemiology. 2004;39(5):337-349.
Crossref | Google Scholar

15. Chang Paredes N, Ribot Reyes V de la C, Pérez Fernández V. Influencia del estigma social en la rehabilitación y reinserción social de personas esquizofrénicas. Revista Habanera de Ciencias Medicas. 2018;6(5):1-15.

16. González-Pablos E, Martin-Lorenzo C. Estigma y esquizofrenia. Informaciones Psiquiátricas. 2021;243:65-75.

17. Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet. 2016;387(10023):1123-1132.
Crossref | Google Scholar

18. Caponi S. Sobre la llamada revolución psicofarmacológica: el descubrimiento de la clorpromazina y la gestión de la locura. História, Ciências, Saúde - Manguinhos. 2021;28(3):661-683.
Crossref | Google Scholar

19. Moncrieff J. The Bitterest Pills: The troubling Story of Antipsychotic Drugs. New York: Palgrave Macmillan; 2013.
Crossref | Google Scholar

20. Barberá M, Sanjuán J, Munárriz M, Novella E, Santiago C, Simó M. La experiencia subjetiva con antipsicóticos: Evaluación cuantitativa. Actas Españoles de Psiquiatría. 2006;34(5):287-294.

21. Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment–a systematic literature review and meta-analysis of qualitative studies. Journal of Mental Health. 2020;29(5):513-523.
Crossref | Google Scholar

22. Doane MJ, Sajatovic M, Weiden PJ, O’sullivan AK, Maher S, Bjorner JB, et al. Antipsychotic treatment experiences of people with schizophrenia: Patient perspectives from an online survey. Patient Preference and Adherence. 2020;14:2043-2054.
Crossref | Google Scholar

23. Townsend M, Pareja K, Buchanan-Hughes A, Worthington E, Pritchett D, Brubaker M, et al. Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis. Patient Preference and Adherence. 2022;16:373-401.
Crossref | Google Scholar

24. Bernal O, Latorre ML, García-Ubaque JC, Zamora D, Otero-Wandurraga JA, Palencia-Sánchez F, et al. Vigilancia y análisis de zonas de frontera, puertos de entrada y de población inmigrante. Revista de Salud Pública. 2017;19(2):258-266.
Crossref | Google Scholar

25. Castro MA. Experiencias y transformaciones subjetivas: sufrimiento y coerción en el uso de psicofármacos en el tratamiento psiquiátrico en Chile. Salud Colectiva. 2024;20:e5388.
Crossref | Google Scholar

26. Read J, Sacia A. Using open questions to understand 650 people’s experiences with antipsychotic drugs. Schizophrenia Bulletin. 2020;46(4):896-904.
Crossref | Google Scholar

27. Moncrieff J, Gupta S, Horowitz MA. Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder. Therapeutic Advances in Psychopharmacology. 2020;10:1-10.
Crossref | Google Scholar

28. Harrow M, Jobe TH, Tong L. Twenty-year effects of antipsychotics in schizophrenia and affective psychotic disorders. Psychological Medicine. 2022;52(13):2681-2691.
Crossref | Google Scholar

29. MacKenzie NE, Kowalchuk C, Agarwal SM, Costa-Dookhan KA, Caravaggio F, Gerretsen P, et al. Antipsychotics, Metabolic Adverse Effects, and Cognitive Function in Schizophrenia. Frontiers in Psychiatry. 2018;9:622.
Crossref | Google Scholar

30. Rada P, Ferreira V, Valverde ÁM. Fármacos antipsicóticos de segunda generación y su impacto en el tejido adiposo. Anales de la Real Academia Nacional de Farmacia. 2024;90(1):21-44.
Crossref | Google Scholar

31. Holt RIG. Association Between Antipsychotic Medication Use and Diabetes. Current Diabetes Reports. 2019;19(10):96.
Crossref | Google Scholar

32. Estroff SE. Making It Crazy: An ethnography of psychiatric clients in an american community. London: University of California Press; 1985.
Crossref | Google Scholar

33. Barberá Fons MA. Investigación cualitativa con grupos focales, sobre la experienca subjetiva de los pacientes psicóticos con tratamiento neuroléptico. Valencia: Universitat de Valencia; 2008.

34. Moncrieff J, Crellin N, Stansfeld J, Cooper R, Marston L, Freemantle N, et al. Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial. The Lancet Psychiatry. 2023;10(11):848-859.
Crossref | Google Scholar

35. King SR, Allan M, Lindsey L. “I found hundreds of other people…but I still wasn’t believed”–An exploratory study on lived experiences of antipsychotic withdrawal. Psychosis. 2024;16(1):15-27.
Crossref | Google Scholar

36. Lewins A, Morant N, Akther-Robertson J, Crellin NE, Stansfeld JL, Smith R, et al. A qualitative exploration of family members’ perspectives on reducing and discontinuing antipsychotic medication. Journal of Mental Health. 2024;33(3):333-340.
Crossref | Google Scholar

37. Hellewell JSE. Patients’ subjective experiences of antipsychotics: Clinical relevance. CNS Drugs. 2002;16(7):457-471.
Crossref | Google Scholar

38. Martínez-granados F, Briones-Vozmediano E, Ronda E. Vivir con psicofármacos: un estudio fotovoz comunitario en personas con alta adherencia al tratamiento en el sureste de España. Salud Colectiva. 2024;20:e5090. 10.18294/sc.2024.5090
Crossref | Google Scholar

39. Latour B. Reensamblar lo social. Una introducción a la teoria del actor-red. Buenos Aires: Manantial; 2008.

40. Mol A. The body multiple : ontology in medical practice annemarie mol the body multiple. Durham: Duke University Press; 2002.
Crossref | Google Scholar

41. Mol A, Law J. Acción encarnada, cuerpos actuados: El ejemplo de la hipoglucemia. En: Ibáñez Martín R, Pérez Sedeño E, (eds). Cuerpos y diferencias. Madrid: Plaza y Valdes; 2012. p. 153-177.

42. Mol A. Ontological politics. A word and some questions. Sociological Review. 1999;47(1):75-89.
Crossref | Google Scholar

43. Mascayano F, Lips W, Mena C, Manchego C. Estigma hacia los trastornos mentales: características e intervenciones. Salud Mental. 2015;38(1):53-58.
Crossref | Google Scholar

44. Sanhueza G, Galaz Saravia G. Inserción laboral y esquizofrenia: una revisión de literatura desde el Trabajo Social. Revista de investigacion del Departamento de Humanidades y Ciencias Sociales. 2023;24:183-206.
Crossref | Google Scholar

45. Castro Gatica MA. El estigma y el sufrimiento de ser “loco” en Chile: otro efecto performativo de la psiquiatría. Intervención. 2023;13(1):51-66.
Crossref | Google Scholar

46. Khalid A, Syed J. A relational perspective of schizophrenia at work. Equality, Diversity and Inclusion: An International Journal. 2023;42(3):321-345.
Crossref | Google Scholar

47. Goffman E. Estigma: La identidad deteriorada. Buenos Aires: Amorrortu; 2006.

48. Anglin DM, Greenspoon MI, Lighty Q, Corcoran CM, Yang LH. Spontaneous labelling and stigma associated with clinical characteristics of peers ‘at-risk’ for psychosis. Early Intervention in Psychiatry. 2014;8:247-252.
Crossref | Google Scholar

49. Loubat O. M, Lobos R, Carrasco N. Estigmatización de la persona con esquizofrenia y consecuencias para el proceso de rehabilitación: un estudio en profesionales de la salud mental. Límite. 2017;12(39):15-25.

50. Gibbs G. El análisis de datos cualitativos en investigación cualitativa. Madrid: Ediciones Morata; 2012.

51. Guber R. La Etnografía: Método, campo y reflexibidad. Buenos Aires: Siglo XXI Editores; 2011.

52. Strauss A, Corbin J. Bases de la investigación cualitativa: Técnicas y procedimientos para desarrollar la teoría fundamentada. Medellín: Editorial Universidad de Antioquia; 2002.

53. Hammersley M, Atkinson P. Ethnography: Principles in Practice. 3ra ed. Vol. 15, Contemporary Sociology. New York: Routledge; 2007.

54. Taylor SJ, Bogdan R. Introducción a los métodos cualitativos de investigación. Barcelona: Ediciones Paidós Ibérica; 1992.

55. Glasser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967.

56. Flick U. An Introduction To Qualitative Research Fourth Edition. London: SAGE Publications; 2009.

57. Marcus GE. Etnografía en/del sistema mundo. El surgimiento de la etnografía multilocal. Alteridades. 2001;11(22):111-127.

58. Guasch Ó. Observación participante. Madrid: Centro de Investigaciones Sociológicas; 2002.

59. Geertz C. La interpretación de las culturas. Barcelona: Gedisa; 2003.

60. Devereux G. De la ansiedad al método en las ciencias del comportamiento. Mexico: Siglo XXI Editores; 2012.

61. Díaz-Bravo L, Torruco-García U, Martínez-Hernández M, Varela- Ruiz M. La entrevista, recurso flexible y dinámico. Investigación en Educación Médica. 2013;2(7):162-167.
Crossref | Google Scholar

62. Charmaz K. La teoría fundamentada en el siglo XXI. En: Denzin NK, Lincoln YS, editores. Las estrategias de investigación cualitativa. Barcelona: Gedisa; 2013. p. 271–325.

63. Hogar de Cristo. Del dicho al derecho: Trayectorias de inclusión social de personas con discapacidad mental en contextos de pobreza y vulnerabilidad. Santiago de Chile: Dirección Social Nacional; 2023.

64. Lettieri A, Villoria ED. A systematization of the international evidence related to labor inclusion barriers and facilitators for people with mental illness. Sociologica. 2017;11(3).

65. Leigh Star S, Griesemer JR. Institutional Ecology , “Translations” and Boundary Objects : Amateurs and Professionals in Berkeley’s Museum of Vertebrate Zoology, 1907-39. Social Studies of Science. 1989;19(3):387-420.
Crossref | Google Scholar

66. Chile, Ministerio de Salud. Ley 21331 Del reconocimiento y protección de los derechos de las personas en la atención de salud mental [Internet]. 2021 [citado 20 jul 2025]. Disponible en: https://tinyurl.com/52525sdr

67. Chile, Ministerio de Desarrollo Social. Ley 21015: Incentiva la inclusión de personas con discapacidad al mundo laboral [Internet]. 2017 [citado 20 jul 2025]. Disponible en: https://tinyurl.com/skxk4fxb

68. Chile, Ministerio de Salud. Guías Clínicas AUGE: Tratamiento de personas desde el primer episodio de Esquizofrenia [Internet]. 2017 [citado 20 jul 2025]. Disponible en: https://tinyurl.com/mwxw3tk7

69. Loonen AJM, Ivanova SA. Neurobiological mechanisms associated with antipsychotic drug-induced dystonia. Journal of Psychopharmacology. 2021;35(1):3-14.
Crossref | Google Scholar

70. Mascayano F, Montenegro C. El “modelo de la recuperación” y la reforma de la atención en salud mental: evidencias, diferencias y elementos para una agenda latinoamericana. Vertex Revista Argentina de Psiquiatría. 2017;28(136):460-467.

71. Buus N, Ong B, Einboden R, Lennon E, Mikes-Liu K, Mayers S, et al. Implementing Open Dialogue approaches: A scoping review. Family Process. 2021;60(4):1117-1133.
Crossref | Google Scholar

72. Lincoln IS, Guba EG. Establishing Trustworthiness. En: Naturalistic Inquiri. California: SAGE Publications; 1985. p. 289-327.