Skip to main content
SpringerLink
Log in

The objectifying discourse of doctors’ questions. Qualitative analysis of psychiatric interviews

  • Original Article
  • Published:
Social Theory & Health Aims and scope Submit manuscript

Abstract

In the article I am interested in grammatical structures of doctors’ questions posed during the first psychiatric interview. Applying the linguistic concept of nominalisation I aim to analyse how interviewing doctors fulfil the process of adjusting impersonal, formal and abstract discourses of clinical disorders in psychiatry to a non-specialised target group of patients, which is assumed in the literature. The data come from initial psychiatric interviews with patients with a preliminary diagnosis of the depressive disorder, recorded by 16 doctors in three psychiatric hospitals in Poland. I shall demonstrate that in the doctors’ questions processes and properties were constructed as abstract and impersonal objects, and thus the patients’ agency and social and temporal contexts of their behaviours were obscured. Consequently, I shall argue that the doctors cannot reach the important information about the patients’ functioning, and, moreover, that the practice ‘profesionalises’ the patients’ role. Explaining the roots of the questioning practices in the corpus I refer to the diagnostic manuals as the lingua franca of mental health professionals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Andrews, L.B. (2010) The psychiatric interview and mental status examination. In: R.E. Hales, S.C. Yudofsky and G.O. Gabbard (eds.) The American Psychiatric Publishing Textbook of Psychiatry, 5th edn. Arlington, TX: American Psychiatric Publishing, pp. 1–14.

    Google Scholar 

  • APA, American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), 4th edn. Washington DC: American Psychiatric Association.

  • Atkinson, P. (1995) Medical Talk and Medical Work: The Liturgy of the Clinic. London: Sage.

    Google Scholar 

  • Barrett, R. (1988) Clinical writing and the documentary construction of schizophrenia. Culture, Medicine and Psychiatry 12: 265–299.

    Article  Google Scholar 

  • Berkenkotter, C. and Ravotas, D. (1997) Genre as tool in the transmission of practice over time and across professional boundaries. Mind, Culture and Activity 4 (4): 256–274.

    Article  Google Scholar 

  • Beutler, L.E. and Malik, M.L. (eds.) (2002) Rethinking the DSM: A Psychological Perspective. Washington DC: American Psychological Association.

    Book  Google Scholar 

  • Boudreau, D., Cassell, E. and Fuks, A. (2009) Preparing medical students to become attentive listeners. Medical Teacher 31 (1): 22–29.

    Article  Google Scholar 

  • Boyd, E. and Heritage, J. (2006) Taking the history: Questioning during comprehensive history taking. In J. Heritage and D. Maynard (eds.) Communication in Medical Care: Interaction between Physicians and Patients. Cambridge, UK: Cambridge University Press, pp. 151–184.

    Chapter  Google Scholar 

  • Brislin, R. (1970) Back-translation for cross-cultural research. Journal of Cross-cultural Psychology 1 (3): 185–216.

    Article  Google Scholar 

  • Burr, V. (2003) Social Constructionism, 2nd edn. London: Psychology Press.

    Google Scholar 

  • Carlat, D.J. (2005) The Psychiatric Interview: A Practical Guide, 2nd edn. Philadelphia, PA: Lippincott Williams and Wilkins.

    Google Scholar 

  • Centrum Medyczne Kształcenia Podyplomowego (CMKP). (2002) Program specjalizacji w Psychiatrii. Program podstawowy dla lekarzy po stażu podyplomowym, (Programme in Specialization in Psychiatry) Warszawa, Poland: CMKP.

  • Cohen, B.J. (2003) Theory and Practice of Psychiatry. New York: Oxford University Press.

    Google Scholar 

  • Cruz, M. and Pincus, H.A. (2002) Research on the influence that communication in psychiatric encounters has on treatment. Psychiatric Services 53 (10): 1253–1265.

    Article  Google Scholar 

  • Cunningham, D.G.C. (2000) The challenges of diagnosis and continuing patient assessment. International Journal of Psychiatry in Clinical Practice 4 (1): 13–18.

    Article  Google Scholar 

  • Double, D. (2005) Beyond biomedical models: A perspective from critical psychiatry. In: J Tew (ed.) Social Perspectives in Mental Health: Developing Social Models to Understand and Work with Mental Distress. London: Jessica Kingsley, pp. 53–70.

    Google Scholar 

  • Edwards, A. and Elwyn, G. (eds.) (2009) Shared Decision-making in Health Care. Achieving Evidence-based Patient Choice. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Fairclough, N. (1992) Discourse and Social Change. Cambridge: Polity Press.

    Google Scholar 

  • Fairclough, N. (1995) Critical Discourse Analysis. London: Longman.

    Google Scholar 

  • Fairclough, N. (2003) Analysing Discourse. London: Routledge.

    Google Scholar 

  • First, M.B., Pincus, H.A., Levine, J.B., Williams, J.B.W., Ustun, B. and Peele, R. (2004) Clinical utility as a criterion for revising psychiatric diagnoses. American Journal of Psychiatry 161 (6): 946–954.

    Article  Google Scholar 

  • Fowler, R. (1991) Language in the News. London: Routledge.

    Google Scholar 

  • Fowler, R., Hodge, B., Kress, G. and Trew, T. (1979) Language and Control. London: Routledge.

    Google Scholar 

  • Freeth, R. (ed.) (2007) Humanising Psychiatry and Mental Health Care: The Challenge of the Person-centred Approach. Abingdon, UK: Radcliffe.

    Google Scholar 

  • Galasiński, D. (2008) Men's Discourses of Depression. Basingstoke, UK: Palgrave.

    Book  Google Scholar 

  • Gask, L., Bulent, C. and Baron, D. (eds.) (2011) Teaching Psychiatry: Putting Theory into Practice. Chichester, UK: John Wiley & Sons.

    Book  Google Scholar 

  • Gergen, J.K. (1973) Social psychology as history. Journal of Personality and Social Psychology 26 (2): 309–320.

    Article  Google Scholar 

  • Gergen, J.K. (1985) The social constructionist movement in modem psychology. American Psychologist 40 (3): 266–275.

    Article  Google Scholar 

  • Gotti, M. (2003) Specialized Discourse: Linguistic Features and Changing Conventions. Bern, Switzerland: Peter Lang.

    Google Scholar 

  • Hales, R.E., Yudofsky, S.C. and Gabbard, G.O. (2010) The American Psychiatric Publishing Textbook of Psychiatry, 5th edn. Arlington, TX: American Psychiatric Publishing.

    Google Scholar 

  • Halliday, M.A.K. (1978) Language and Social Semiotic. London: Edward Arnold.

    Google Scholar 

  • Halliday, M.A.K. (1985) An Introduction to Functional Grammar. London: Edward Arnold.

    Google Scholar 

  • Halliday, M.A.K (1994) An Introduction to Functional Grammar, 2nd edn. London: Edward Arnold.

    Google Scholar 

  • Halliday, M.A.K. and Martin, J.R. (1993) Writing Science. London: Falmer Press.

    Google Scholar 

  • Heritage, J. and Maynard, D.W. (eds.) (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Heritage, J. and Robinson, J.D. (2006) The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication 19 (2): 89–102.

    Article  Google Scholar 

  • Hodge, R. and Kress, G. (1993) Language as Ideology. London: Routledge.

    Google Scholar 

  • Hyden, L.C. and Mishler, E.G. (1999) Language and medicine. Annual Review of Applied Linguistics 19: 174–192.

    Article  Google Scholar 

  • IGDA Workgroup, WPA. (2003) IGDA 2: Interviewing the patient. British Journal of Psychiatry 182 (45): 37–61.

  • Jacobson, J.L. and Jacobson, A.M. (2001) Psychiatric secrets, 2nd edn. Philadelphia, PA: Hanley & Belfus.

    Google Scholar 

  • Johnstone, L. (2000) Users and Abusers of Psychiatry: A Critical Look at Psychiatric Practice. London: Brunner-Rutledge.

    Google Scholar 

  • Kaplan, H.I., Sadock, B.J. and Sadock, W.A. (2004) Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Philadelphia, PA: Lippincott Williams and Wilkins.

    Google Scholar 

  • Kendell, M.D. and Jablensky, A. (2003) Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry 160 (1): 4–12.

    Article  Google Scholar 

  • Kirmayer, L.J. (2005) Culture, context and experience in psychiatric diagnosis. Psychopathology 38 (4): 192–196.

    Article  Google Scholar 

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

    Google Scholar 

  • Kraus, A. (2003) How can the phenomenological-anthropological approach contribute to diagnosis and classification in psychiatry. In K.W.M. Fulford, K. Morris, J.Z. Sadler, and G. Stanghellini (eds.) Nature and Narrative: An Introduction to the New Philosophy of Psychiatry. Oxford: Oxford University Press, pp. 199–216.

    Chapter  Google Scholar 

  • Llewellyn-Jones, S., Jones, G. and Donnelly, P. (2001) Questions patients ask psychiatrists. Psychiatric Bulletin 25 (1): 21–24.

    Article  Google Scholar 

  • MacKinnon, R.A., Michels, R. and Buckley, P.J. (2009) The Psychiatric Interview in Clinical Practice. Washington: American Psychiatric Publishing.

    Google Scholar 

  • Martin, L., Saperson, K. and Maddigan, B. (2003) Residency training: challenges and opportunities in preparing trainees for the 21st century. Canadian Journal of Psychiatry 48 (4): 225–231.

    Google Scholar 

  • Maynard, D.W. (1991) Interaction and asymmetry in clinical discourse. American Journal of Sociology 97 (2): 448–495.

    Article  Google Scholar 

  • McCabe, R. and Priebe, S. (2008) Communication and psychosis: It's good to talk, but how? The British Journal of Psychiatry 192 (6): 404–405.

    Article  Google Scholar 

  • Mezzich, J.E. and Berganza, C.E. (2005) Purposes and models of diagnostics systems. Psychopathology 38 (4): 162–165.

    Article  Google Scholar 

  • Mezzich, J.E. and Salloum, I.M. (2008) Clinical complexity and person-centered integrative diagnosis. World Psychiatry 7 (1): 1–2.

    Article  Google Scholar 

  • Mishler, E.G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.

    Google Scholar 

  • Philips, J. (2005) Idiographic formulations, symbols, narratives, context and meaning. Psychopathology 38 (4): 180–184.

    Article  Google Scholar 

  • Pilgrim, D. (2002) The biopsychosocial model in Anglo-American psychiatry: Past, present and future. Journal of Mental Health 11 (6): 585–594.

    Article  Google Scholar 

  • Pridmore, S. (2000) The Psychiatric Interview: A Guide to History Taking and the Mental State Examination. Amsterdam, The Netherlands: Harwood Academic Publishers.

    Google Scholar 

  • Pużyński, S. (2000) Zaburzenia depresyjne w praktyce lekarza podstawowej opieki zdrowotnej (Mood disorders in General Practice) Przewodnik lekarza 3 (2): 68–76.

    Google Scholar 

  • Raymond, G. (2003) Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review 68 (6): 939–967.

    Article  Google Scholar 

  • Schegloff, E.A. (1968) Sequencing in conversational openings. American Anthropologist 70 (6): 1075–1095.

    Article  Google Scholar 

  • Schegloff, E.A. (1972) Notes on a conversational practice: Formulating place. In D.N. Sudnow (ed.) Studies in Social Interaction. New York: Macmillan, pp. 75–119.

    Google Scholar 

  • Sinclair, S. (2000) Disease narratives: Constituting doctors. Anthropology and Medicine 7 (1): 115–134.

    Article  Google Scholar 

  • Soyland, A.J. (1994) Functions of the psychiatric case-summary. Text 14 (1): 113–140.

    Google Scholar 

  • Soyland, A.J. (1995) Analyzing therapeutic professional discourse. In J. Siegfried (ed.) Therapeutic and Everyday Discourse as Behavior Change: Towards a Micro-analysis in Psychotherapy Process Research. Norwood, NJ: Ablex, pp. 277–300.

    Google Scholar 

  • Stanghellini, G. (2004) The puzzle of the psychiatric interview. Journal of Phenomenological Psychology 35 (2): 173–195.

    Article  Google Scholar 

  • Stein, D.B. and Baldwin, S. (2000) Toward an operational definition of disease in psychiatry and psychology: Implications for diagnosis and treatment. International Journal of Risk and Safety in Medicine 13 (1): 29–46.

    Google Scholar 

  • Swales, J. (1990) Genre Analysis English in Academic and Research Settings. Cambridge, UK: Cambridge University Press.

    Google Scholar 

  • Temple, B. (1997) Watch your tongue: Issues in translation and crosscultural research. Sociology 31 (3): 607–618.

    Article  Google Scholar 

  • Wakefield, J.C. (1997) Diagnosing DSM-IV – Part I: DSM-IV and the concept of disorder. Behaviour Research and Therapy 35 (7): 633–649.

    Article  Google Scholar 

  • Wakefield, J.C. (2010) Misdiagnosing normality: Psychiatry's failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment. Journal of Mental Health 19 (4): 337–351.

    Article  Google Scholar 

  • WHO, World Health Organization. (1992) The ICD-10 Classification of Mental and Behavioural Disorders – Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.

  • WHO, World Health Organization. (1993) The ICD-10 Classification of Mental and Behavioural Disorders – Diagnostic Criteria for Research. Geneva: World Health Organization.

  • WHO, World Health Organization. (1998) Klasyfikacja zaburzeń psychicznych i zaburzeń zachowania w ICD-10. Badawcze kryteria diagnostyczne (polskie tłumaczenie WHO, 1993). Kraków-Warszawa: Vesalius-IPiN.

  • Wylie, M.S. (1995) Diagnosing for dollars? The Family Therapy Networker 19 (3): 23–33.

    Google Scholar 

  • Zethsen, K.K. and Askehave, I. (2006) Medical Communication: Professional-Lay. In: J.L. Mey (ed.) Concise Encyclopedia of Pragmatics. Oxford: Elsevier, pp. 592–597.

    Google Scholar 

  • Ziółkowska, J. (2009) Positions in doctors’ questions during psychiatric interviews. Qualitative Health Research 19 (11): 1621–1631.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Social Sciences and Humanities, Wroclaw Faculty, ul. Ostrowskiego 30, Wroclaw 53–238, Poland

    Justyna Ziółkowska

Authors
  1. Justyna Ziółkowska
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ziółkowska, J. The objectifying discourse of doctors’ questions. Qualitative analysis of psychiatric interviews. Soc Theory Health 10, 292–307 (2012). https://doi.org/10.1057/sth.2012.8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/sth.2012.8

Keywords

Search

Navigation