"Are You Saying She's Mentally Ill Then?" Explaining Medically Unexplained Seizures in Clinical Encounters

  • Catherine M. Robson University of York
  • Olaug S. Lian University of Tromsø
Keywords: medical sociology, social construction of illness and disease, health communication, neurology, patient-provider relationships, film recordings, observational study, discourse analysis, critical discourse analysis

Abstract

Bodily phenomena that are difficult to identify, localize, explain and cure with the aid of modern biomedical knowledge and technology leave ample room for cultural influence. That makes them a perfect case for studying the cultural dimension of medical knowledge and practice. Building on this assumption we qualitatively explore the communication between neurologists and women with seizure disorders of uncertain etiology, often labeled psychogenic non-epileptic seizures (PNES), in a specialist clinic in England. Based on an interpretation of film-recordings of eight naturally-occurring clinical consultations we discuss the following questions: How do neurologists explain the name, the cause and the treatment options to these patients? How do patients and their companions respond to these explanations? And finally, what makes these interactions so difficult? Our interpretation of the data is inspired by critical discourse analysis, and framed within a social constructionist perspective on medical knowledge and practice.

We found that the neurologists presented the diagnosis and its cause—inappropriate stress management—through objective language that conveyed a high degree of certainty. Patient-parties often disagreed, and found it hard to believe that these physical symptoms had a psychological origin. Companions often acted as advocates for the patients in negotiations with the doctors. The polarized debate between psychogenic and somatic understandings of the seizures that emerged illuminates how the Cartesian dualism between body and mind complicates clinical encounters—a dualism doctors explicitly reject, but presumably accept. We argue that it is impossible to overcome this polarization without acknowledging the cultural dimension of medical knowledge and practice.

URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160122

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Author Biographies

Catherine M. Robson, University of York

Catherine M. ROBSON completed her doctoral studies at the Centre for Advanced Study in Language and Communication, University of York, United Kingdom; where she explored the differential topical, linguistic and interactional features of seizure patient talk (differences in how people with epilepsy and psychogenic non-epileptic seizure (PNES) describe their seizure experiences). Her PhD studentship was fully funded by Epilepsy Action UK. Before joining the Centre Catherine worked as a medical social worker, National Health Service (NHS) clinical auditor, and as a research consultant on numerous health, social care and redevelopment projects throughout England. Her research interests include medical sociology, health communication (particularly doctor-patient interactions), social inequalities in health, and applied research methods. She is currently on maternity leave and living in South Africa.

Olaug S. Lian, University of Tromsø

Olaug S. LIAN, Dr. Polit. in sociology (1999), is a professor of medical sociology and chair of the research group Medical Humanities at the Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway. She also works as a research advisor at the University Hospital of Northern Norway. Her research relates to a wide range of topics within the field of medical sociology, with a special interest in culturally contingent aspects of health and illness, medical knowledge, medical practice, and the organization of health care services. During her academic life she has published three books, in addition to many journal articles, both nationally and internationally. She is currently working on a research project financed through a grant from the Norwegian Research Council that relates to medically contested chronic conditions.

Published
2015-11-29
Section
Single Contributions