Patients’ representations of depressive symptoms and physicians’ responses in clinical encounters

  • Christina Fogtmann Fosgerau University of Copenhagen
  • Annette Sofie Davidsen University of Copenhagen,
Keywords: conversation analysis, clinical encounter, depression, head/brain symptoms, patients’ representations, systemic functional linguistics


Depression is defined by a list of symptoms. However, patients' experiences of these symptoms and the ways they are represented in medical consultations are not well described. Applying the methods of systemic functional linguistics and conversation analysis, we aim to explore how patients diagnosed with depression represent their depressive symptoms in medical consultations, and how physicians respond to patients' representations.We analyzed 30 video-recorded consultations between general practitioners or psychiatrists and patients with moderate depression, and found that one third of the patients represented experiences of activity located in the head or brain. The patients' representations of such head/brain symptoms were instantiated through a delimited set of transitivity patterns - material Processes and relational Processes - without any specification of agency. The transitivity patterns reflected experiences of head/brain symptoms taking place outside the patients' control. When physicians engaged with patients' head/brain experiences, they tried to make them fit into their own understanding of depression, which did not include head/brain symptoms detached from the patients' agency.

Linguistic and interactional methods could promote insights into patients' experiences of depressive illness and we suggest that more focus should be placed on understanding patients' experiences, and that the intersubjective understanding of the patient could be further studied using linguistic methods.

Author Biographies

Christina Fogtmann Fosgerau, University of Copenhagen

Christina Fogtmann Fosgerau, PhD, is Associate Professor at the Department of Scandinavian Studies and Linguistics at the University of Copenhagen, Denmark. She has studied processes of intersubjectivity from a linguistic and interaction analytical perspective for a number of years, especially as they unfold in interactions between patients and physicians.

Annette Sofie Davidsen, University of Copenhagen,

Annette Sofie Davidsen, MD, PhD, DMSc, is Associate Professor at the Research Unit for General Practice and Section of General Practice, Department of Public Health at the University of Copenhagen, Denmark. Her main research areas include the treatment of common mental disorders in general practice, the gap between general practice and psychiatry and collaborative care between the two sectors. Her research is mainly qualitative, using phenomenological and lingusticmethods.


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How to Cite
Fosgerau, C. F., & Davidsen, A. S. (2019). Patients’ representations of depressive symptoms and physicians’ responses in clinical encounters. Communication & Medicine, 15(1), 28-39.