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

Abstract

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.

References

Baddeley, J. L., Daniel, G. R. and Pennebaker, J. W. (2011) How Henry Hellyer’s use of language foretold his suicide. Crisis 32 (5): 288-292. doi:10.1027/0227-5910/a000092 https://doi.org/10.1027/0227-5910/a000092

Berrios, G. E. (1999) Classifications in psychiatry: A conceptual history. Australian and New Zealand Journal of Psychiatry 33 (2): 145-160. doi: 10.1046/j.1440-1614.1999.00555.x https://doi.org/10.1046/j.1440-1614.1999.00555.x

Brinck-Claussen, U. O., Curth, N. K., Davidsen, A. S., Mikkelsen, J. H., Lau, M. E., Lundsteen, M., Csillag, C., Christensen, K. S., Hjorthøj, C., Nordentoft, M. and Eplov, L. F. (2017) Collaborative care for depression in general practice: Study protocol for a randomised controlled trial. Trials 18 (1): 344. doi:10.1186/s13063-017-2064-7 https://doi.org/10.1186/s13063-017-2064-7

Burr, J. and Chapman, T. (2004) Contextualising experiences of depression in women from South Asian communities: A discursive approach. Sociology of Health & Illness 26 (4): 433-452. doi: 10.1111/j.0141-9889.2004.00398.x https://doi.org/10.1111/j.0141-9889.2004.00398.x

Charteris-Black, J. (2012) Shattering the bell jar: Metaphor, gender, and depression. Metaphor and Symbol 27 (3): 199-216. doi:10.1080/10926488.2012.665796 https://doi.org/10.1080/10926488.2012.665796

Davidsen, A. S. and Fosgerau, C. F. (2015) Grasping the process of implicit mentalization. Theory & Psychology 25 (4): 434-454. doi:10.1177/0959354315580605 https://doi.org/10.1177/0959354315580605

Demjén, Z. (2014) Drowning in negativism, self-hate, doubt, madness: Linguistic insights into Sylvia Plath’s experience of depression. Communication & Medicine 11 (1): 41-54.
https://doi.org/10.1558/cam.v11i1.18478

Donahue, A. B. (2000) Riding the mental health pendulum: Mixed messages in the era of neurobiology and self-help movements. Social Work 45 (5): 427-438. https://doi.org/10.1093/sw/45.5.427

Dura-Vila, G., Littlewood, R. and Leavey, G. (2011) Depression and the medicalization of sadness: Conceptualization and recommended help-seeking. International Journal of Social Psychiatry 59 (2): 165-175. doi: 10.1177/0020764011430037 https://doi.org/10.1177/0020764011430037

Fekete, S. (2002) The internet - A new source of data on suicide, depression and anxiety: A preliminary study. Archives of Suicide Research 6 (4): 351-361. https://doi.org/10.1080/13811110214533

Flynn, D. (2010) Narratives of melancholy: A humanities approach to depression. Medical Humanities 36 (1): 36-39. doi:10.1136/jmh.2009.002022 https://doi.org/10.1136/jmh.2009.002022

Fosgerau, C. F. (2013) The co-construction of understanding in Danish naturalization interviews. International Journal of Bilingualism 17 (2): 221-236. https://doi.org/10.1177/1367006912441421

Fosgerau, C. F. and Davidsen, A. S. (2014) Patients’ perspectives on antidepressant treatment in consultations with physicians. Qualitative Health Research 24 (5): 641-653.
https://doi.org/10.1177/1049732314528813

Fuchs, T. (2010) Subjectivity and intersubjectivity in psychiatric diagnosis. Psychopathology 43 (4): 268-274. https://doi.org/10.1159/000315126

Fuchs, T. (2013) Depression, intercorporeality, and interaffectivity. Journal of Consciousness Studies 20 (7-8): 219-238.

Fuchs, T. (2014) Psychopathology of depression and mania: Symptoms, phenomena and syndromes. Psychopathology of Mood Disorders 20: 404-413.

Fuchs, T. and Schlimme, J. E. (2009) Embodiment and psychopathology: A phenomenological perspective. Current Opinion in Psychiatry 22 (6): 570-575. https://doi.org/10.1097/YCO.0b013e3283318e5c

Galasiński, D. (2008) Men’s Discourses of Depression. New York: Palgrave Macmillan. https://doi.org/10.1057/9780230227620

Gardner, R. (2001) When Listeners Talk: Response Tokens and Listener Stance. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.92

Gask, L. (2015) The Other Side of Silence: A Psychiatrist’s Memoir of Depression. Chichester, UK: Summersdale Publishers.

Halliday, M. A. K. (1994) An Introduction to Functional Grammar. London: Hodder Arnold.

Halliday, M. A. K. and Matthiessen, C. (2014) Halliday’s Introduction to Functional Grammar (4th edition) London: Routeledge. https://doi.org/10.4324/9780203783771

Hansen, E. H. and Heltoft, L. (2011) Grammatik over det Danske Sprog, 3 vols. Copenhagen: Det Danske Sprog- og Litteraturselskab.

Heritage, J. (1984) Garfinkel and Ethnomethodology. Cambridge: Polity Press.

Hunt, D. and Carter, R. (2012) Seeing through The Bell Jar: Investigating linguistic patterns of psychological disorder. Journal of Medical Humanities 33 (1): 27-39. doi:10.1007/s10912-011-9163-3
https://doi.org/10.1007/s10912-011-9163-3

Haakana, M. (2008) Laughter as a patient’s resource: Dealing with delicate aspects of medical interaction. Interdisciplinary Journal for the Study of Discourse 21 (1-2): 187-219.
https://doi.org/10.1515/text.1.21.1-2.187

Karasz, A. (2008) The development of valid subtypes for depression in primary care settings - A preliminary study using an explanatory model approach. Journal of Nervous and Mental Disease 196 (4): 289-296. doi: 10.1097/NMD.0b013e31816a496e https://doi.org/10.1097/NMD.0b013e31816a496e

Kayali, T. and Iqbal, F. (2013) Depression as unhomelike being-in-the-world? Phenomenology’s challenge to our understanding of illness. Medicine Health Care and Philosophy 16 (1): 31-39. doi:10.1007/s11019-012-9409-5 https://doi.org/10.1007/s11019-012-9409-5

Kleinman, A. M. (1977) Depression, somatization and new cross-cultural psychiatry. Social Science & Medicine 11 (1): 3-10. https://doi.org/10.1016/0037-7856(77)90138-X

Kleinman, A. (1988) The Illness Narrative: Suffering, Healing, and the Human Condition. New York: Basic Books.

Marcus, M., Yasama, M. T., van Ommeren, M. and Chisholm, D. (2012) Depression: A global public health concern. In World Federation for Mental Health (ed.) Depression: A Global Crisis, 6-8. Occoquan, VA: World Federation for Mental Health. Available online: http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf https://doi.org/10.1037/e517532013-004

Mullen, P. E. (2007) A modest proposal for another phenomenological approach to psychopathology. Schizophrenia Bulletin 33 (1): 113-121. https://doi.org/10.1093/schbul/sbl043

Muntigl, P. and Ventola, E. (2010) Grammar, a neglected ressource in interaction analysis? In J. Streeck (ed.) New Adventures in Language and Interaction, 99-124. Amsterdam: John Benjamins
https://doi.org/10.1075/pbns.196.05mun

Ochs, E., Schegloff, E. A. and Thompson, S. A. (1996) Interaction and Grammar. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511620874

Ratcliffe, M. (2014) The phenomenology of depression and the nature of empathy. Medicine, Health Care and Philosophy 17 (2): 269-280. https://doi.org/10.1007/s11019-013-9499-8

Ratcliffe, M. (2015) Experiences of Depression: A Study in Phenomenology. Oxford: Oxford University Press.

Sacks, H., Schegloff. E. A. and Jefferson, G. (1974) Simplest systematics for organization of turn-taking for conversation. Language 50 (4): 696-735. https://doi.org/10.1353/lan.1974.0010

Schegloff, E. A. (1992) Repair after next turn - the last structurally provided defense of intersubjectivity in conversation. American Journal of Sociology 97 (5): 1295-1345.
https://doi.org/10.1086/229903

Schegloff.E. A. (1993) Reflections on quantification in the study of conversation. Research on Language and Social Interaction 26 (1): 99-128. https://doi.org/10.1207/s15327973rlsi2601_5

Stirman, S. W. and Pennebaker, J. W. (2001) Word use in the poetry of suicidal and nonsuicidal poets. Psychosomatic Medicine 63 (4): 517-522. https://doi.org/10.1097/00006842-200107000-00001

Stivers, T. (2008) Stance, alignment, and affiliation during storytelling: When nodding is a token of affiliation. Research on Language and Social Interaction 41 (1): 31-57.
https://doi.org/10.1080/08351810701691123

Styron, W. (1991) Darkness Visible: A Memoir of Madness. London: Jonathan Cape.

Svenaeus, F. (2000) The body uncanny - Further steps towards a phenomenology of illness. Medicine Health Care and Philosophy 3 (2): 125-137. https://doi.org/10.1023/A:1009920011164

Svenaeus, F. (2011) Illness as unhomelike being-in-the-world: Heidegger and the phenomenology of medicine. Medicine Health Care and Philosophy 14 (3): 333-343. doi:10.1007/s11019-010-9301-0
https://doi.org/10.1007/s11019-010-9301-0

Weich, S., Morgan, L., King, M. and Nazareth, I. (2007) Attitudes to depression and its treatment in primary care. Psychological Medicine 37 (9): 1239-1248. doi:10.1017/S0033291707000931
https://doi.org/10.1017/S0033291707000931

Ziolkowska, J. (2009) Positions in doctors’ questions during psychiatric interviews. Qualitative Health Research 19 (11): 1621-1631. doi:10.1177/1049732309350685 https://doi.org/10.1177/1049732309350685

Ziolkowska, J. (2011) The representation of illness manifestation during the first psychiatric interview with patients preliminarily diagnosed with depressive illness. Polish Phychological Bulleting 42 (3): 123-128. doi:10.2478/v10059-011-0017-7 https://doi.org/10.2478/v10059-011-0017-7

Ziolkowska, J. (2014) Time and the psychiatric interview: The negotiation of temporal criteria of the depressive disorder. Health 18 (2): 163-178. doi:10.1177/1363459313488005
https://doi.org/10.1177/1363459313488005
Published
2019-07-03
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. https://doi.org/10.1558/cam.32486
Section
Articles