Christina Fogtmann Fosgerau

From community to conversation – and back. Exploring the interpersonal potentials of two generic pronouns in Danish

This paper combines a quantitative study of the two most important Danish pronouns used for generic reference, du and man, with interaction analyses. The quantitative study shows an overall increase in the use of generic du at the expense of man. However, a large scale quantitative study alone cannot tell us much about the finer differences between the two variants, let alone come up with explanations for the change in their use. In this paper, we demonstrate a way to supplement a quantitative study with detailed interaction analyses with the aim of interpreting the tendencies demonstrated in the quantitative study. Whereas there is no difference between generic du and man with respect to propositional meaning, our interactional analyses reveal important differences in their interpersonal potentials: Generic du is to a larger degree than man used as a resource for enactment and involvement. This difference between du and man is due to du retaining some of its second person meaning also when used generically, and the rise in the use of generic du is likely to reflect an ongoing process of intimization in the society at large.

What is depression? Psychiatrists’ and GPs’ experiences of diagnosis and the diagnostic process

The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners’ (GPs’) treatment of depression is insufficient and a collaborative care (CC) model between general practice and psychiatry has been proposed to overcome this. However, for successful implementation, a CC model demands shared agreement about the concept of depression and the diagnostic process in the two sectors. We aimed to explore how depression is understood by GPs and clinical psychiatrists. We carried out qualitative in-depth interviews with 11 psychiatrists and 12 GPs. Analysis was made by Interpretative Phenomenological Analysis. We found that the two groups of physicians differed considerably in their views on the usefulness of the concept of depression and in their language and narrative styles when telling stories about depressed patients. The differences were captured in three polarities which expressed the range of experiences in the two groups. Psychiatrists considered the diagnosis of depression as a pragmatic and agreed construct and they did not question its validity. GPs thought depression was a “gray area” and questioned the clinical utility in general practice. Nevertheless, GPs felt a demand from psychiatry to make their diagnosis based on instruments created in psychiatry, whereas psychiatrists based their diagnosis on clinical impression but used instruments to assess severity. GPs were wholly skeptical about instruments which they felt could be misleading. The different understandings could possibly lead to a clash of interests in any proposed CC model. The findings provide fertile ground for organizational research into the actual implementation of cooperation between sectors to explore how differences are dealt with.

Grasping the process of implicit mentalization

Mentalization has developed through different waves and its definition has gradually changed. Through this process mentalization theorists have not taken a particular position on the philosophical underpinnings of the understanding of others, except that Theory of Mind (ToM) is referred to as a commonsense and underlying theoretical basis. It is apparent that ToM does not explain all dimensions of Mentalization Theory (MT), especially implicit mentalization, and theorists do not account for how implicit mentalization can be captured in interaction. In this article we explain the divergence between MT and ToM and the lack of a philosophical basis for the process of understanding others in MT. We show that conversation analysis (CA) can be used to capture implicit mentalization in interaction. We argue that MT needs a theoretical and philosophical formulation about what constitutes intersubjectivity and the process of understanding others. We suggest that phenomenology could inhabit this space.

Patients’ Perspectives on Antidepressant Treatment in Consultations With Physicians

Patient perspectives on antidepressant treatment and physician attention, and responses toward these in consultations with patients diagnosed with depression, are rarely studied. We analyzed video-recorded consultations with general practitioners (GPs) and psychiatrists. We used conversation analysis and systemic functional linguistics and found that the perspectives patients expressed related to the possibility of achieving, and the inability to retain, a sense of agency. Patients also presented indirect expressions of shame and expressions suggesting alienation toward medical treatment. GPs attended to patient perspectives by talking about medication indirectly. When patients expressed their perspectives, GPs responded by being nonauthoritative but also without prompting patients to elaborate on their reflections. Psychiatrists responded authoritatively and never urged patients to reflect on their perspectives. Shared decision making did not take place because physicians did not explore patients’ perspectives in depth or offer their expertise by taking these perspectives into consideration.

Mirroring patients – or not. A study of general practitioners and psychiatrists and their interactions with patients with depression

For mentalization theorists, implicit mentalization is a key component of all forms of therapy. However, it has been difficult to grasp and to describe precisely how implicit mentalization works. It is said to take place partly by mirroring others in posture, facial expression and vocal tone. Based on studies of imitative behaviour within linguistics and psychology, we argue that interactional mirroring is an important aspect of displaying implicit mentalization. We aimed to explore if, and in that case how, mirroring is displayed by general practitioners (GPs) and psychiatrists in consultations with patients with depression. We wanted to see how implicit mentalizing unfolds in physician–patient interactions. Consultations were video-recorded and analysed within the framework of conversation analysis. GPs and psychiatrists differed substantially in their propensity to mirror body movements and verbal and acoustic features of speech. GPs mirrored their patients more than psychiatrists in all modalities and were more flexible in their interactional behaviour. Psychiatrists seemed more static, regardless of the emotionality displayed by patients. Implicitly mirroring and attuning to patients could signify enactment of implicit mentalization, according to how it is described by mentalization theorists. We discuss reasons for the differences between GPs and psychiatrists, and their implications.

The co-construction of understanding in Danish naturalization interviews

This article explores excerpts from Danish naturalization interviews. A naturalization interview is a conversation between a Danish police officer and an applicant for Danish citizenship. During the naturalization interview, the police officer decides whether the applicant fulfils a requirement by law. According to the police officers, the language requirement is fulfilled if applicants are able to understand what is said and make themselves understood. The onus is on the applicant to prove that he or she can do just that. However, this article argues that understanding is something that is co-constructed – the police officer is just as involved in the establishment of understanding as is the applicant. By analysing and comparing how different police officers respond to applicants’ answers – how police officers respond in a sequential third position – it is shown that police officers do in fact play a decisive role in the joint understanding established during the naturalization interviews. The naïve notion that it is possible to test applicants’ abilities to understand by involving applicants in so-called natural conversations with police officers is thus disclosed as – naïve.

Exploring implicit mentalizing as an online process

Abstract Therapists’ implicit mentalizing skills are essential in the treatment of mental disorders, and implicit mentalizing is considered a general social competence for understanding other people. However, no methods have been developed to tap into implicit mentalizing as a live or online process displayed in interactions. The aim of this article is to demonstrate how online implicit mentalizing processes can be explored by applying the method of conversation analysis (CA). CA uses a sequential approach to study the establishment of understanding in interactions between people. In this article, we show that a systematic exploration of implicit mentalizing processes can be done by applying this sequential approach and the underlying knowledge of CA on interactional phenomena and their functions and meanings. We demonstrate our method by thoroughly analyzing three extracts from recordings of dinner conversations at a residential care school. We make a theoretical link between mentalizing processes and the phenomenological understandings of intersubjectivity and empathy, and we suggest that this phenomenological understanding could develop the understanding of implicit mentalizing as a phenomenon. This would, in addition, be fully compatible with CA as a method for grasping implicit mentalization.