Neurologists' approaches to making psychosocial attributions in patients with functional neurological symptoms
Doctors perceive consultations with patients with functional neurological symptoms (FNS) as challenging because of the dichotomy between the psychosocial nature of the symptoms and patients’ perceptions that their condition is essentially physical. Through conversation analysis, we describe some communicative strategies neurologists employ to make psychosocial attributions, ranging from unilateral to more bilateral approaches. In unilateral approaches doctors employ general explanations about the psychosocial aetiology, thereby pre-empting any potential resistance. In bilateral approaches, doctors actively involve patients in discussing potential psychosocial causes, by also making direct and specific psychosocial attributions. These practices display doctors’ great caution in this communicative task; and they exhibit an hybridization with those employed by psychologists, which might be strictly linked to this type of patients.
References
Antaki, Charles, Rebecca Barnes, and Ivan Leudar
2004 “Trouble in Agreeing on a Client’s Problem in a Cognitive-Behavioural Therapy”.
Rivista di Psicolinguistica Applicata 4: 127–138.
Bergmann, Jörg R
1992 “Veiled Morality: Notes on Discretion in Psychiatry.” In
Talk at Work. Interaction in Institutional Settings, ed. by
Paul Drew, and
John Heritage, 137–62.
Cambridge, UK: Cambridge University Press.
Burbaum, Christina, Anne-Maria Stresing, Kurt Fritzsche, Peter Auer, Michael Wirsching, and Gabriele Lucius-Hoene
2010 “Medically Unexplained Symptoms as a Threat to Patients’ Identity? A Conversation Analysis of Patients’ Reactions to Psychosomatic Attributions.” Patient Education and Counseling 79: 207–17.
Carson, Alan J., Brigitte Ringbauer, Jon Stone, Lesley McKenzie, Charles Warlow, and Michael Sharpe
2000 “Do Medically Unexplained Symptoms Matter? A Prospective Cohort Study of 300 New Referrals to Neurology Outpatients.” Journal of Neurology Neurosurgery and Psychiatry 68: 207–210.
Collins, Sarah, Paul Drew, Ian Watt, and Vikki Entwistle
2005 “‘Unilateral’ and ‘Bilateral’ Approaches in Decision-making about Treatment.” Social Science Medicine 61: 2611–2627.
Duncan, Roderick, Saif Razvi, and Sharon Mulhern
2011 “Newly Presenting Psychogenic Nonepileptic Seizures: Incidence, Population Characteristics, and Early Outcome from a Prospective Audit of a First Seizure Clinic.” Epilepsy & Behavior 20 (2): 308–311.
Hall-PatchLindsey, Richard Brown, Allan House, Stephanie Howlett, Steven Kemp, Gemma Lawton, Rebecca Mayor, Phil Smith, and Markus Reuber
2010 “Acceptability and Effectiveness of a Strategy for the Communication of the Diagnosis of Psycho-genic Nonepileptic Seizures.” Epilepsia 51: 70–78.
Heritage, John, and Raymond Geoffrey
2005 “The Terms of Agreement: Indexing Epistemic Authority and Subordination in Assessment Sequences.” Social Psychology Quarterly 68: 15–38.
Howlett, Stephanie, Richard Grünewald, Aijat Khan, and Markus Reuber
2007 “
Engagement in Psychological Treatment for Functional Neurological Symptoms – Barriers and Solutions.” Psychotherapy: Theory, Research, Practice
,
Training 44 (3): 354–360.
Jefferson, Gail
1988 “Notes on a Possible Metric Which Provides for a ‘Standard Maximum’ Silence of Approximately One Second in Conversation.” In
Conversation: An Interdisciplinary Perspective, ed. by
Roger Derek, and
Peter Bull, 1–83.Clevedon, UK: Multilingual Matters[Expanded Version in
Tilburg Papers in Language and Literature, No. 42, (1983).].
Jefferson, Gail
1991 “List Construction as a Task and Resource.” In
Interactional Competence, ed. by
George Psathas, 63–92. New York, NY: Irvington Publishers.
Joosten, Alard, Harrie Mazeland, and Betty Meyboom-de Jong
1999 “Psychosocial Explanations of Complaints in Dutch General Practice.” Family Practice 16: 245–249.
Kanaan, Richard A., David Armstrong, and Simon C. Wessely
2009 “Limits to Truth-telling: Neurologists’ Communication in Conversion Disorder.” Patient Education and Counselling 77: 296–301.
Marchant-Haycox, Susan, and Peter Salmon
1997 “Patients’ and Doctors Strategies in Consultations with Unexplained Symptoms. Interactions of Gynaecologists with Women Presenting Menstrual Problems.” Psychosomatics 38: 440–450.
Maynard, Douglas W
1997 “The News Delivery Sequence: Bad News and Good News in Conversational Interaction.” Research on Language and Social Interaction 30 (2): 93–130.
Mayor, Rebecca, Richard Grunewald, and Markus Reuber
2010 “Long-term Outcome of Brief Augmented Psychodynamic Interpersonal Therapy for Psychogenic Nonepileptic Seizures: Seizure Control and Healthcare Utilization.” Epilepsia 51: 1169–1176.
Monzoni, Chiara M., Duncan Roderick, Richard Grünewald, and Markus Reuber
2011a.
“Are there Interactional Reasons Why Doctors May Find It Hard to Tell Patients that Their Physical Symptoms May Have Emotional Causes? A Conversation Analytic Study in Neurology Outpatients.” Patient Education and Counseling 85 (3): 189–200.
Monzoni, Chiara M., Duncan Roderick, Richard Grünewald, and Markus Reuber
2011b.
“How Do Neurologists Discuss Functional Symptoms with their Patients: A Conversation Analytic Study.” Journal of Psychosomatic Research 71 (6): 377–383.
Monzoni, Chiara M., Duncan Roderick, Richard Grünewald, Sharrack Basil, and Markus
Reuber
2012 Psychogenic Non-epileptic Seizures: How Doctors Use Labels When they Communicate and Explain the Diagnosis. Sheffield, UK: MIMEO University of Sheffield.
Pomerantz, Anita
1980 “Telling My Side: Limited Access as a “Fishing” Device.” Sociological Inquiry 50 (3/4): 186–198.
Pomerantz, Anita
1984 “Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shapes." In
Strucures of Social Action, ed. by
John Maxwell Atkinson, and
John Heritage, 57–101. Cambridge: Cambridge University Press.
Pomerantz, Anita
1986 “Extreme Case Formulations: A Way of Legitimizing Claims.” Human Studies 9: 219–229.
Raymond, Geoffrey
2003 “Grammar and Social Organization: Yes/No Type Interrogatives and the Structure of Responding.” American Sociological Review 68 (Dec): 939–967.
Reuber, Markus, Alex J. Mitchell, Stephanie Howlett, and Christian E. Elger
2005 “Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant is Seizure Remission?” Epilepsia 46 (11): 1788–1795.
Reuber, Markus, Christine Burness, Stephanie Howlett, John Brazier, and Richard Grünewald
2007 “Tailored Psychotherapy for Patients with Functional Neurological Symptoms: A Pilot Study.” Journal of Psychosomatic Research 63 (6): 625–632 (Epub).
Risør, Mette B
2009 “Illness Explanations among Patients with Medically Unexplained Symptoms: Different Idioms for Different contexts.” Health (London) 13: 505–521.
Sacks, Harvey
1987 “On the Preferences for Agreement and Contiguity in Sequences in Conversation.” In
Talk and Social Organization, ed. by
Graham Button, and
John Re Lee, 54–69. Clevendon: Multilingual Matters.
Salmon, Peter
2007 “Conflict, Collusion or Collaboration in Consultations about Medically Unexplained Symptoms: The Need for a Curriculum of Medical Explanation.” Patient Education and Counseling 67: 246–254.
Schegloff, Emanuel A., and Harvey Sacks
1973 “Opening-up Closings”.
Semiotica 8: 289–327.
Schegloff, Emmanuel A
2007 A Primer for Conversation Analysis: Sequence Organization. Cambridge, England: Cambridge University Press.
Stivers, Tanya, and Federico Rossano
2010 “A Scalar View of Response Relevance”,
Research on Language & Social Interaction 43 (1): 49–56.
Teas-Gill, Virginia, and Douglas-W. Maynard
1995 “On ‘Labelling’ in Actual Interaction: Delivering and Receiving Diagnoses of Developmental Disabilities.” Social Problems 42: 11–37.
Thompson, Rebecca
2007 “What is it Like to Receive a Diagnosis of Non-Epileptic Seizures.” Unpublished D.Phil dissertation. University of Sheffield, United Kingdom.
Werner A., and Kirsti Malterud
2003 “It is Hard Work Behaving as a Credible Patient: Encounters between Women with Chronic Pain and Their Doctors.” Social Science & Medicine 57: 1409–1419.
Cited by
Cited by 1 other publications
Stortenbeker, Inge, Wyke Stommel, Tim olde Hartman, Sandra van Dulmen & Enny Das
2022.
How General Practitioners Raise Psychosocial Concerns as a Potential Cause of Medically Unexplained Symptoms: A Conversation Analysis.
Health Communication 37:6
► pp. 696 ff.
This list is based on CrossRef data as of 20 april 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers.
Any errors therein should be reported to them.