Abstract
It is well-documented, within most medical and much health psychology, that many individuals find diagnoses of depression confusing or even objectionable. Within a corpus of research and practical clinical guidance dominated by the social-cognitive paradigm, the explanation for resistance to a depression diagnosis (or advice pertaining to it) within specific interactions is bordering on the canonical; patients misunderstand depression itself, often as an output of an associated social stigma that distorts public knowledge. The best way to overcome corollary resistance in situ is, logically thus, taken to be a clarification of the true (clinical) nature of depression. In this paper, exploring the diagnosis of depression in UK primary care contexts, the social-cognitive position embedded in contemporary medical reasoning around this matter is critically addressed. It is firstly highlighted how, even in a great deal of extant public health research, the link between an individual holding “correct” medical knowledge and being actively compliant with it is far from inevitable. Secondly, and with respect to concerns around direct communication in clinical contexts, a body of research emergent of Discursive Psychology and Conversation Analysis is explored so as to shed light on how non-cognitive concerns (not least those around the local interactional management of a patient’s social identity) that can inform the manner in which ostensibly “tricky” medical talk plays-out in practice, especially in cases where a mental illness is at stake. Finally, observations are drawn together in a formal Discursive Psychological analysis of a small but highly illustrative sample of three cases where a depression diagnosis is initially questioned or disputed by a patient in primary care but, following further in-consultation activity, concordance with the diagnosis is ultimately reached—a specific issue hitherto unaddressed in either DP or CA fields. These cases specifically reveal the coordinative attention of interlocutors to immediate concerns regarding how the patient might maintain a sense of being an everyday and rational witness to their own lives; indeed, the very act of challenging the diagnosis emerges as a means by which a patient can open up conversational space within the consultation to address such issues. While the veracity of the social-cognitive model is not deemed to be without foundation herein, it is concluded that attention to local interactional concerns might firstly be accorded, such that the practical social concerns and skills of practitioners and patients alike might not be overlooked in the endeavour to produce generally applicable theories.
Highlights
In contemporary psychological research, in the clinical and health domains, there is a widely-reported concern that many individuals find diagnoses of depression troubling or even objectionable, and will often show some form of active resistance when the diagnosis is made (Van Voorhees et al, 2005; Highfield et al, 2010; Wimsatt et al, 2015)
The analytic work presented in this paper has explored interactional issues underpinning situated patient resistance to diagnoses of depression
The first, and most fundamental, of these is that such activity can be an invited phenomenon, arising from the GPs’ formulations of depression diagnoses as “bad news.”
Summary
In the clinical and health domains, there is a widely-reported concern that many individuals find diagnoses of depression troubling or even objectionable, and will often show some form of active resistance when the diagnosis is made (Van Voorhees et al, 2005; Highfield et al, 2010; Wimsatt et al, 2015). A range of work in the discursive and interactional sciences has, to date, highlighted how the reduction of any clinical interaction principally to matters of information transfer and processing tends to obscure the complex social contexts inhabited by clinicians and patients, and the practical social skills of the interactants (Silverman, 1997; Stivers, 2006; Miller, 2013) It is often acknowledged in clinical directives around depression diagnosis themselves that factors such as culture, use of language, ad hoc social skills and personal understandings can play important roles in frontline medicine (Tylee et al, 1996; Tylee and Jones, 2005; National Institute for Clinical Excellence, 2016). Generalizing explanations for resistance, and recommendations for reaching resolution, tend to prevail
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