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Soc Sci Med. 2018 Jun;207:71-79. doi: 10.1016/j.socscimed.2018.04.048. Epub 2018 Apr 30.

Institutionalised otherness: Patients references to psychiatric diagnostic categories.

Author information

1
University of Helsinki, Finnish Centre of Excellence in Research on Intersubjectivity in Interaction, P.O. Box 4, 00014, Finland. Electronic address: elina.weiste@ttl.fi.
2
University of Helsinki, Finnish Centre of Excellence in Research on Intersubjectivity in Interaction, P.O. Box 4, 00014, Finland. Electronic address: anssi.perakyla@helsinki.fi.
3
University of Helsinki, Finnish Centre of Excellence in Research on Intersubjectivity in Interaction, P.O. Box 4, 00014, Finland. Electronic address: taina.valkeapaa@helsinki.fi.
4
Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. Electronic address: eniko.savander@phhyky.fi.
5
Päijät-Häme Central Hospital, University of Tampere, Keskussairaalankatu 7, 15850 Lahti, Finland. Electronic address: jukka.hintikka@phhyky.fi.

Abstract

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and health problems. Patients' lifeworld explanations are often differentiated from the diagnostic explanations provided by clinicians. However, while previous conversation analytic research has elaborated the ways in which diagnostic and lifeworld explanations are interactionally structured in somatic medicine, there is little research on how these explanations are organised in psychiatry. Psychiatric diagnosis is particularly interesting because in mental disorders illness itself is not determined by any objective measurement. Understanding of the patient's problem is constructed in interaction between the patient and clinician. The focus of this research will be patients' references to diagnosis in psychiatry and the functions of these references. The findings are based on conversation analysis of 29 audio-recorded diagnostic interviews in a psychiatric outpatient clinic. Our results demonstrate that patients can utilise diagnostic categories in several ways: disavowing a category to distance their symptoms from it, accounting for their life experiences being rooted in psychiatric illnesses and explaining their illnesses as being caused by certain life experiences. We argue that these explanations are important in patients' face-work - in constructing and maintaining a coherent and meaningful view of the patient's self.

KEYWORDS:

Conversation analysis; Diagnosis; Explanation; Lifeworld; Psychiatry; Self

PMID:
29734057
DOI:
10.1016/j.socscimed.2018.04.048
[Indexed for MEDLINE]

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