Interactions in psychiatric care consultation in Akan speaking communities

  • Nana Aba Appiah Amfo University of Ghana
  • Ekua Essumanma Houphouet University of Ghana
  • Eugene K. Dordoye University of Health and Allied Sciences
  • Rachel Thompson Griffith University
Keywords: Akan, code-mixing, cultural psychiatry, Ghana, mental illness, patient-centered care, proverbs, shared decision-making


The present paper examines interactions in psychiatric care consultation in selected hospital settings in three Akan-speaking communities in Ghana, based on 45 audio-recorded doctor/nurse-patient interactions. Using a discourse pragmatics approach, we note how language is used in the management of communication in psychiatric consultations, and how the dominance of healthcare practitioners is enacted. Specifically, we focus on some of the strategies used by the participants to manage the multilingual communicative settings, such as code-mixing. Our findings also suggest that the use of proverbs as a diagnostic tool in psychiatric consultations in Ghana needs to be reviewed. We propose that in order for patients to experience consultation sessions that are more interactive, with possible therapeutic benefits, health practitioners need to make considerable efforts to involve the patients in decisions regarding their health.

Author Biographies

Nana Aba Appiah Amfo, University of Ghana

Nana Aba Appiah Amfo is Professor of Linguistics at the University of Ghana. She has published in the areas of grammaticalization, information structure and (in)definiteness. Her recent research interests include language use in specific domains such as health and politics. She has recently published in Discourse & Society, International Journal of Language and Culture and Issues in Political Discourse Analysis.

Ekua Essumanma Houphouet, University of Ghana

Ekua Essumanma Houphouet is a medical officer at the University Hospital, Legon and a Member of the Ghana College of Physicians. She holds a Master’s of Public Health from the University of Ghana. She has worked as a co-investigator and a study physician on projects with the Noguchi Memorial Institute for Medical Research, University of Ghana.

Eugene K. Dordoye, University of Health and Allied Sciences

Eugene K. Dordoye is a senior lecturer in psychiatry at University of Health and Allied Sciences and a consultant psychiatrist for Ho Teaching Hospital, both in Ghana. He is a fellow of the Ghana College of Physicians and Surgeons and secretary to the faculty of psychiatry. He has a research interest in mental health at the workplace.

Rachel Thompson, Griffith University

Rachel Thompson is currently a PhD candidate at the Department of Languages and Linguistics, Griffith University, Australia. Her major research interest is the use of language in the electronic media. She is also interested in the study of culture and language use, (im)politeness, and discourse analysis across various domains such as politics and health.


Adegbite, W. and Odebunmi, A. (2006) Discourse tact in doctor-patient interactions in English: An analysis of diagnosis in medical communication in Nigeria. Nordic Journal of African Studies 15 (4): 499-519.

Alarcón, R. D. (2009) Culture, cultural factors and psychiatric diagnosis: Review and projections. World Psychiatry 8 (3): 131-139.

Amfo, N. A. A., Houphouet, E. E., Dordoye, E. and Thompson, R. (2018) ‘Insanity is from home’: The expression of mental health challenges in Akan. International Journal of Language and Culture 5 (1): 1-28.

Ansah, G. N. (2014) Re-examining the fluctuations in language in-education policies in post-independence Ghana. Multilingual Education 4 (1): 1-15.

Barron A. and Schneider K. (2014) Discourse pragmatics: Signposting a vast field. In K. P. Schneider and A. Barron (eds) Pragmatics of Discourse. Handbooks of Pragmatics 3: 1-33. Berlin: De Gruyter Mouton.

Brannon G. E. (2016) History and mental status examination. Medscape. Retrieved from:

Bhugra, D. and Osborne, T. (2006) Cultural assessment and management. Psychiatry 5 (11): 379-382.

Byrne, P. S. and Long, B. E. L. (1976) Doctors Talking to Patients. London: RCGP Publications.

Cohen, N. J., Farnia, F. and Im‐Bolter, N. (2013) Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry 54 (7): 733-744.

Cong Z. (2008) Application of proverbs in psychotherapy for the Chinese. World Cultural Psychiatry Research Review 3 (1): 16-19.

Cutting, J. (2002). Pragmatics and Discourse: A Resource Book for Students. London: Routledge.

Das, B. (2012) Code-switching as a communicative strategy in conversation. Global Media Journal - Indian Edition 3 (2): 1-20.

Delis, D. C., Kramer, J. H., Fridlund, A. J. and Kaplan, E. (2012) A cognitive science approach to neuropsychological assessment. In P. McReynolds, J. C. Rosen and G. J. Chelune (eds) Advances in Psychological Assessment, Volume 7, 101-132. New York: Springer.

Elmer, T., Rabenschlag, F., Schori, D., Zuaboni, G., Kozel, B., Jaeger, S., Mahlke, C., Heumann, K., Theodoridou, A. and Jaegar M. (2018) Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland. Psychiatry Research 262: 400-406.

Favazza A. R. and Oman, M. (1984) Foundations of cultural psychiatry. In J. E. Mezzich and C. E. Berganza (eds) Cultural Psychopathology, 15-35. New York: Columbia University Press.

Ghana Statistical Service (2012) 2010 Population and Housing Census Summary Report of Final Results. Accra: Ghana Statistical Service. Available online:

Giles, H., Coupland, N. and Coupland, J. (1991) Accommodation theory: Communication, context, and consequence. In H. Giles, J. Coupland and N. Coupland (eds) Contexts of Accommodation: Developments in Applied Sociolinguistics, 1-68. Cambridge: Cambridge University Press.

Hassan, G., Kirmayer, L. J., MekkiBerrada A., Quosh, C., Chammay, R., Deville-Stoetzel, J. B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. and Ventevogel, P. (2015) Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict. Geneva: UNHCR.

Jäger, M. (2017) Informeller Zwang in der therapeutischen Beziehung [Informal coercion within the therapeutic relationship]. Praxis: Schweizerische Rundschau für Medizin 106 (2): 91-96.

Jäger, M. and Rössler, W. 2009 Informeller Zwang zur Verbesserung der Behandlungsbereitschaft psychiatrischer Patienten [Informal coercion to enhance treatment adherence among psychiatric patients]. Neuropsychiatrie 23 (4): 206-215.

Jacobs, E. A., Lauderdale D. S., Meltzer, D., Shorey, J. M., Levinson, W. and Thisted, R. A. (2001) Impact of interpreter services on delivery of health care to limited English proficient patients. Journal of General Internal Medicine 16 (7): 468-474.

Koh, H. K. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Department of Health and Human Services.

Kramer, J. E., Wang, C. B., Kwong, K., Lee, E. and Chung, H. (2002) Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine 176 (4): 227-231.

Manley, M. R. S. (2000) Psychiatric interview, history and mental status exam. In H. I. Kaplan and B. J. Sadock (eds) Comprehensive Textbook of Psychiatry (7th edition), 652-677. Philadelphia, PA: Lippincott Williams & Wilkins.

Matras, Y. (2009) Language Contact. Cambridge: Cambridge University Press.

McCabe R., Heath C., Burns T. and Priebe S. (2002) Engagement of patients with psychosis in the consultation: Conversation analytic study. British Medical Journal 325: 1148-1151.

Nieva, V. F. and Sorra, J. (2003) Safety culture assessment: A tool for improving patient safety in healthcare organizations. Quality and Safety in Healthcare 12 (suppl. 2): 17-23.

Obeng, S. G. (2005) Akan and Nyo languages. In P. Strazny (ed.) Encyclopedia of Linguistics, 28-31. New York: Routledge.

Odebunmi, A. (2012) Code Selection at First Meetings: A Pragmatic Analysis of Doctor-Client Conversations in Nigeria. InLiSt: Interaction and Linguistic Structures 48. Available online:

Penn, N. E., Jacob, T. C. and Brown, M. (1988) Familiarity with proverbs and performance of a black population on Gorham’s proverbs test. Perceptual and Motor Skills 66 (3): 847-854.

Pestana-Santos, A., Loureiro, L., Santos, V. and Carvallio, I. P. (2018) Patients with schizophrenia assessing psychiatrists’ communication skills. Psychiatry Research 269: 13-20.

Rao, N. R. (2007) The influence of culture on learning of psychiatry: The case of Asian-Indian international medical graduates. International Journal Applied Psychoanalytic Studies 4 (2): 128-143.

Roberts, C. and Sarangi, S. (2005) Theme-oriented discourse analysis of medical encounters. Medical Education 39 (6): 632-640.

Romaine, S. (1995) Bilingualism. Oxford: Blackwell.

Sarangi, S. (2004) Towards a communicative mentality in medical and healthcare practice. Communication and Medicine 1 (1): 1-11.

Simons, G. F. and Fennig, C. D. (eds) (2017) Ethnologue: Languages of the world (20th edition). Dallas, TX: SIL International. Available online:

Spring, M. A., Ross, P. J., Etkin, N. L. and Deinard, A. S. (1995) Sociocultural factors to the use of prenatal care by Hmong women, Minneapolis. American Journal of Public Health 85: 1015-1017.

Themistocleous, M., McCabe, R., Rees, N., Hassan, I., Healey, P. G. T. and Priebe, S. (2009) Establishing mutual understanding in interaction: An analysis of conversational repair in psychiatric consultations. Communication & Medicine 6 (2): 165-176.

Tseng W. S. (2001) Handbook of Cultural Psychiatry. San Diego, CA: Academic Press.

US Department of Health and Human Services (2001) Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services.

Weiss, M. G. (ed.) (2001) Psychiatric diagnosis and illness experience. In A. T. Yilmaz, M. G. Weiss and A. Riecher-Rössler (eds) Cultural Psychiatry: Euro International Perspectives. Bibliotheca Psychiatrica 169: 21-34. Basel: Karger.

Zethsen, K. K. and Askehave, I. (2009) Medical communication: Professional-lay. In J. L. Mey (ed.) Concise Encyclopedia of Pragmatics (2nd edition), 592-597. Oxford: Elsevier.
How to Cite
Amfo, N. A. A., Houphouet, E. E., Dordoye, E. K., & Thompson, R. (2019). Interactions in psychiatric care consultation in Akan speaking communities. Communication & Medicine, 15(1), 40-52.