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Part of
Discourses of Helping Professions
Edited by Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy
[Pragmatics & Beyond New Series 252] 2014
► pp. 289–314

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.
Published online: 18 December 2014
DOI logo
https://doi.org/10.1075/pbns.252.12mon
References (35)
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.Google Scholar
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.Google Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
Heritage, John, and Raymond Geoffrey. 2005. “The Terms of Agreement: Indexing Epistemic Authority and Subordination in Assessment Sequences.” Social Psychology Quarterly 68: 15–38. DOI logoGoogle Scholar
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.Google Scholar
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).].Google Scholar
. 1991. “List Construction as a Task and Resource.” In Interactional Competence, ed. by George Psathas, 63–92. New York, NY: Irvington Publishers.Google Scholar
. 2004. “Glossary of Transcript Symbols with an Introduction.” In Conversation Analysis: Studies from the First Generation, ed. by Gene H. Lerner, 13–31. Amsterdam: John Benjamins. DOI logoGoogle Scholar
Joosten, Alard, Harrie Mazeland, and Betty Meyboom-de Jong. 1999. “Psychosocial Explanations of Complaints in Dutch General Practice.” Family Practice 16: 245–249. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
. 2011b. “How Do Neurologists Discuss Functional Symptoms with their Patients: A Conversation Analytic Study.” Journal of Psychosomatic Research 71 (6): 377–383. DOI logoGoogle Scholar
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.Google Scholar
Pomerantz, Anita. 1980. “Telling My Side: Limited Access as a “Fishing” Device.” Sociological Inquiry 50 (3/4): 186–198. DOI logoGoogle Scholar
. 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.Google Scholar
. 1986. “Extreme Case Formulations: A Way of Legitimizing Claims.” Human Studies 9: 219–229. DOI logoGoogle Scholar
Raymond, Geoffrey. 2003. “Grammar and Social Organization: Yes/No Type Interrogatives and the Structure of Responding.” American Sociological Review 68 (Dec): 939–967. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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). DOI logoGoogle Scholar
Risør, Mette B. 2009. “Illness Explanations among Patients with Medically Unexplained Symptoms: Different Idioms for Different contexts.” Health (London) 13: 505–521. DOI logoGoogle Scholar
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.Google Scholar
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. DOI logoGoogle Scholar
Schegloff, Emanuel A., and Harvey Sacks. 1973. “Opening-up Closings”. Semiotica 8: 289–327. DOI logoGoogle Scholar
Schegloff, Emmanuel A. 2007. A Primer for Conversation Analysis: Sequence Organization. Cambridge, England: Cambridge University Press. DOI logoGoogle Scholar
Stivers, Tanya, and Federico Rossano. 2010. “A Scalar View of Response Relevance”, Research on Language & Social Interaction 43 (1): 49–56. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
Cited by (1)

Cited by one other publication

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. DOI logo

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