Justyna Ziółkowska

Positions in Doctors’ Questions During Psychiatric Interviews

In this article I apply the concept of positioning to the analysis of 15 initial psychiatric interviews. I argue that through their questions the psychiatrists-in-training impose positions requiring the patients to gaze at themselves and their actual problems from particular perspectives. I point to three such positions: (a) the position of the observing assessor, from which it is expected that the patients will make a detached assessment of themselves or their problems, (b) the position of the informing witness, which requires the patients only to verify the information about themselves, and (c) the marginal one, the position of the experiencing narrator, from which talk about experiences and problems is expected. I explore the roots and consequences of the positions, with particular attention toward objectivization of the patients’ experiences in the dominant witness and assessor positions. I conclude with a discussion about the medical model in psychiatry.

Identity ambivalence and embodiment in women's accounts of the gynaecological examination

In this article we are interested in the negotiation of identities in womens narratives of their gynaecological examination and more particularly, the shifts of identity positions that permeate their stories. Taking a constructionist view of discourse and identity, we make two arguments in the article. First, we demonstrate that women talking about their gynaecological examinations constructed their selves ambiguously. The identity spaces that they discursively opened in the narratives were not inhabited. Second, we show that the embodiment of their identities — the inclusion of the body into the construction of self — fluctuates depending on the stage of the narrative of the examination.

Discursive Construction of Fatherly Suicide

ABSTRACT In this article we are interested in stories of sons and daughters about their fathers who completed suicide. The data come from 10 interviews with survivors of suicidal death of their fathers. Taking a constructionist view of discourse, we aim to analyse sons’ and daughters’ narratives in the context of two conflicting discourses of (positive) fatherhood and (negative) suicide. We shall show how they use the discursive strategies of distancing in the narratives about fathers’ suicide as a means of coping with the two conflicting discourses. And so, first, they avoid labelling the act as suicide, second, they avoid direct reference to the fact that it was their father who completed the act, third, they dilute the father’s responsibility for the act.

Managing Information Misrepresentation in the Patient’s Notes

Doctors are required to document their examinations of the patient. This task is particularly important in psychiatry, where what the patient says is practically the only source of information available to the clinician. In our article we shall focus on the process of information management in psychiatry and trace the information which was recorded in the patients’ notes back to its origin in the interview. Our data consists of eight recordings of psychiatric interviews along with the patients’ notes. Our main argument is that the notes are not merely written from the point of view of the psychiatrist, but might have little or nothing to do with the interview. We demonstrate, first, that accurate notes are a record of how the doctor conducted the interview. Second, the notes doctors made also misrepresent the interview with the patient: doctors record false information, distort it, take out of its context.

Construction of suicidal ideation in medical records

ABSTRACT In this article, the authors are interested in exploring discursive transformation of patients’ stories of suicidal ideation into medical discourses. In other words, they focus on how the narrated experience of suicidal thoughts made during the psychiatric assessment interview is recorded in the patients’ medical record. The authors’ data come from recordings of psychiatric interviews, as well as the doctors’ notes in the medical records made after the interviews, collected in psychiatric hospitals in Poland. Assuming a constructionist view of discourse, they demonstrate that lived experience of suicide ideation resulting in stories of a complex and homogeneous group of “thoughts” is reduced to brief statements of fact of presence/existence. Exploration of the relationship between the interviews and the notes suggest a stark imposition of the medical gaze upon them. The authors end with arguments that discursive practices relegating lived experience from the focus of clinical practice deprives it of information which is meaningful and clinically significant.

Time and the psychiatric interview: The negotiation of temporal criteria of the depressive disorder:

In this article, I am concerned with doctors’ negotiations of the temporal dimension of the diagnostic criteria of depressive disorders during the first psychiatric interview. The data come from 16 initial psychiatric interviews recorded by doctors in three psychiatric hospitals in Poland. Taking a constructionist view of discourse and psychiatric practices, I shall argue that the discursive practice related to temporal information about patients’ illnesses serves in gaining information, which is useful in the medical model of psychiatric diagnosis. The doctors positioned the patients’ experiences on the timeline when the illness history was taken and temporal information authenticated the information. Conversely, the patients’ current conditions were constructed in a limitless present, which allowed the psychiatrists to remove the relativity.