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“Let's Speak in Order”: Diagnostic Interview in a Psychiatric Ward as a Performance
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Original Article|Sociology of Medicine and Health
AbstractFull textReferencesFilesAuthorsAltmetrics
David V. Oganyan
Medical doctors arrive at a diagnosis after considering various types of evidence, including the patient's complaints, their outer appearance, talk, and non-verbal behavior. In psychiatry, the role of conversation is more important than in somatic medicine, because it is in the patient's talk that the disease can express itself. Some elements of the conversational machinery have been studied in diagnostic interviews in a psychiatric ward. In the interviews, a recurrent pattern of the doctor’s questions and the patient’s answers was found. Schegloff (2007) showed that “known answer” questions form a distinctive three-part sequence type: question-response-evaluation. In diagnostic interviews in psychiatry, the questions don't address knowledge but the capacity to perform the task. Not all the test questions have a correct answer, and the result of the evaluation is not always announced by the doctor. The doctor consistently repeats the patient’s answer without evaluating it and then adds a follow-up question. At least parts of the repeated cycles in the sequence of doctor-patient interaction exhibit the following pattern: Doctor’s question > Patient’s answer > Doctor’s echo > (optional Doctor's follow-up question). When the doctor's questions seek real information—and do not just test capacity—they sometimes resort to a reformulation of the patient’s answers instead of just repeating it; this reformulation works as a prompt. The questions in the clinical interview appear to follow two lines of accountability: the ordinary conversational order and that which is provided by the professional reasoning aimed at checking diagnostic hypotheses. The second line is not usually accessible to the patient.
Keywords: psychiatry, diagnostic interview, talk-in-interaction, exam questions, performance
ASJC: 3301
Article received: April 17, 2024
Article accepted: June 10, 2024
Kovalev Yu. V. (2023) Clinical iconography in psychiatry. Moscow: Prospekt. — in Russ.
Krylov V. I. (2011) Clinical psychopathology and evidence-based medicine (problem of diagnosis methodology). Psychiatry and Psychopharmacotherapy,13 (4): 9-13. — in Russ.
Kupriyanov V. V., Sukharebsky L. M., Novinsky G. D. (1971) Patient’s face: Atlas. Moscow: Publishing house “Mednauchposobie”. — in Russ.
Mendelevich V. D. (2019) Psychiatric propaedeutics. Practical guide. Moscow: Publishing House “Gorodets”. — in Russ.
Baker M. G. (2002) The wall between neurology and psychiatry. BMJ, 324(7352): 1468–1469. https://doi.org/10.1136/bmj.324.7352.1468
Bourdieu P., Nice, R., Wacquant, L. (2004). The peasant and his body. Ethnography, 5(4): 579–599. http://dx.doi.org/10.1177/1466138104048829
Didi-Huberman G. (2004). Invention of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière. Translated by Alisa Hartz. Cambridge (MA): MIT Press.
Eco U., Sebeok Th., ed. (1988). The Sign of Three: Dupin, Holmes, Peirce (Advances in Semiotics).Indiana University Press: Bloomington and Indianapolis.
Killen A. (2017) Psychiatry and its Visual Culture in the Modern Era, The Routledge History of Madness and Mental Health, ed. G. Eghigian. New York: Routledge: 172-190.
Levinson, S. (1979). Activity types and language. Linguistics, 17(5-6): 365-400. https://doi.org/10.1515/ling.1979.17.5-6.365
Malhi G. S., Keshavan M. S. (2007). Biology and psychology to psychobiology. Acta Neuropsychiatrica, 19(3): 211–212. http://dx.doi.org/10.1111/j.1601-5215.2007.00218.x
Peirce Ch.S. (1958-1966) Collected papers. Vols. 1-6 edited by Charles Hartshorne and Paul Weiss; vols. 7-8 edited by A. W. Burks. Cambridge: Belknap Press of Harvard University Press.
Peräkylä A. (2012). Conversation analysis in psychotherapy. In T. Stivers & J. Sidnell (Eds.), Handbook of conversation analysis. Chichester, England: Blackwell: 551-574.
Psillos S. (2011). An explorer upon untrodden ground: Peirce on abduction, The Handbook of the History of Logic, 10: 117-151. https://doi.org/10.1016/B978-0-444-52936-7.50004-5
Rich L. E., Simmons J., Adams,D., Thorp S., & Mink M. (2008). The Afterbirth of the Clinic: a Foucauldian perspective on “House M. D.” and American medicine in the 21st century. Perspectives in Biology and Medicine, 51(2): 220-237. http://dx.doi.org/10.1353/pbm.0.0007
Ropper A. H., Burrel B. D. (2019). How the brain lost its mind: sex, hysteria, and the riddle of the mental illness. Avery: New York
Rosenberg C. E. (2002). The tyranny of diagnosis: specific entities and individual experience. The Milbank quarterly, 80(2): 237–260. https://doi.org/10.1111/1468-0009.t01-1-00003
Sackett D. L., Rosenberg W. M., Gray J. A., Haynes, R. B., & Richardson W. S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ (Clinical research ed.), 312(7023): 71–72. https://doi.org/10.1136/bmj.312.7023.71
Sacks H. (1992). Lectures on Conversation. Blackwell: Cambridge (MA), Oxford, 1992.
Schegloff E. A. (2007). Sequence Organization in Interaction: A Primer in Conversation Analysis. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511791208
Searle J. R. (1969). Speech acts: An essay in the philosophy of languages. Cambridge University Press.
Sebeok Th.A, Umiker-Sebeok J. (1988). “You Know My Method”. A Juxtaposition of Charles S. Peirce and Sherlock Holmes. In: The Sign of Three: Dupin, Holmes, Peirce (Advances in Semiotics). Indiana University Press: Bloomington and Indianapolis: 11-54.
Sebeok Th.A. (1986) Symptom. In: Sebeok, Th.A. I Think I Am a Verb. Plenum Press:New York: 45-58.
Timmermans S., Berg M. (2003) The Gold Standard. The Challenge of Evidence-Based Medicine and Standardization in Health Care. Philadelphia: Temple University Press.
Weiste E., Anssi Peräkylä (2013) A comparative conversation analytic study of formulations in psychoanalysis and cognitive psychotherapy. Research on Language and Social Interaction, 46 (4): 299–321. http://dx.doi.org/10.1080/08351813.2013.839093
© Article. Ilya Utekhin, David V. Oganyan, 2024.