Lars-Christer Hydén

Who's Talking : Drawing Conclusions from Focus Groups - Some Methodological Considerations

The central argument of this article is that participants in focus groups may talk and interact in many capacities. As a consequence a central methodological question in analysing focus group material is whos talking—that is, in what way are the utterances of individual members of the focus group to be interpreted. This problem is discussed by using material from three focus groups discussing the phenomenon ‘burnout’. We suggest that the participants of focus groups may constitute themselves in various ways, even just as an array of individuals talking together, without being a group and that they may shift between these different modes of interacting. Two interactive problems seem to be particularly important in the establishment of a focus group. A first interactive problem for the participants is to establish a common ground; a second is to add their contributions to the common ground. This has implications in the way the researcher is able to attribute attitudes and opinions to persons in focus groups.

Suffering, Hope and Diagnosis : On the Negotiation of Chronic Fatigue Syndrome

The medical interview has a central place in the transformation of suffering into disease. The focus in this article is on patients with suspected chronic fatigue syndrome (CFS). Central to the diagnosis of CFS is the absence of a clear medical pathology causing symptoms. To patients it is of central importance to present themselves in the medical interview in a way that makes a diagnosis of CFS possible, which provides both hope for a cure and a social legitimization of their suffering. To doctors it is important that they maintain their position as a medical authority and gatekeeper. This means that in a medical examination the doctor and the patient together must explore the patients suffering to define symptoms enabling a diagnosis of CFS. The central issue in this article is how doctors and patients in medical interviews negotiate symptoms and diagnostic criteria in search of a legitimate diagnosis and illness, and how this constitutes the central concern in the patients and doctors collaborative diagnosis work in the medical encounter.

Confabulation: sense-making, self-making and world-making in dementia

This study is concerned with the productive aspects of confabulation as it occurs spontaneously in dementia care, in its context, and in interaction with other care recipients. Confabulation is approached as a social and discursive event with distinct narrative features; plots and formerly established genres of plots, storylines, are used by confabulators in order to understand, manage and interact socially in the present situation. Three main functions of confabulation are discerned: 1) making sense of the current situation (sense-making); 2) maintaining a personal identity in interaction with others (self-making); and 3) organizing and legitimizing joint action in the world (world-making). The resources used by confabulating subjects are sparse and not well adjusted to changing conditions, as the number of accessible storylines is limited. This makes it difficult to apply storylines that explain the current situation satisfactorily, provide useful guidelines for how to act, as well as preserve a positive self-identity. Helping with this constitutes a major challenge in dementia care.

Pain Gestures: The Orchestration of Speech and Body Gestures

This article is about the use and function of gestures in pain communication. More specifically how we can communicate an internal bodily experience like pain with the help of gestures. This is of great importance both in everyday situations and in medical consultations of various types. Our focus in this article is on the issues of the gesture as a communicative resource, how verbal and nonverbal communicative resources are related to each other and in what way gestures contribute to the structure of different types of pain. Thirty-seven patients have been interviewed about their pain experiences and the main result is that several communicative modalities are interwoven in the pain accounts. Three different functions of gestures were identified: the pointing, iconic and symbolic functions. The clinical relevance of this approach to gestures in pain communication is to take note of the intricate interplay of different communicative resources used in the pain description, and to emphasize both verbal and nonverbal interaction in the clinical conversation as a resource in the care situation.

Exploration of communicative patterns of consultations in palliative cancer care

Building on the research conducted on institutional communication, and the analysis of actual communication taking place in clinical settings, this study describes and highlights features of palliative care consultations and focuses on the distribution of discursive space (i.e., share of words, lengths of turns), occurring topics and conversational frames. Six consultations between physicians, patients and significant others were videotaped and all participants took part in audio-taped interviews. The recordings were transcribed and analysed in regard to expectations of, the discursive space of, and topics addressed in the consultations. The distribution of the discursive space was unequal; the physicians had the greatest share of words and length of turns in all six consultations, and they mostly initiated discussion of medical issues connected to examinations and treatment, while only patients initiated the topic of the patients future. During the consultations, institutional framing tended to dominate over client framing. There was found to be room for further study of the structure and content of palliative care consultations with emphasis on how the voice of the patient can manifest itself within the framework of the medical agenda of the consultation and its significance for palliative cancer team work.

Living with Chronic Pain: A Dynamic Learning Process

This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on ...This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individuals discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.

LANGUAGE AND MEDICINE

Research on the forms and functions of language in medical practice and training has expanded rapidly during the past two decades, a development marked by diversity in theoretical perspectives and methods brought to bear on a variety of problems. Although we label the area as “language and medicine,” it includes other health professionals and nonclinical settings. Our discussion is organized under four headings that we believe represent primary topics and domains of interest among investigators as well as the variability within the field: speaking to patients, speaking with patients, speaking about patients, and speaking by patients. A few exemplar studies will be cited in each section and the contributions and limitations of approaches in each topic area will be noted.

Storytelling in dementia: Embodiment as a resource

In narrative research about persons with dementia, much research focuses on individual storytellers and their stories often stressing the discursive or textual aspects of stories. As persons with Alzheimer’s disease generally have difficulties in telling stories according to often implicit narrative norms, they may appear to be less competent and agentive than what is actually the case. In the article, I argue for a change of focus from the textual aspects of narratives and the story as a product, to a focus on performative aspects and the embodied aspects of storytelling. A focus on the storytelling activity implies a change from the individual storyteller to the interaction with other participants in the storytelling situation. Drawing on two particular cases of storytelling, I stress the collaborative and embodied aspects of storytelling and argue that embodiment is less an individual expressive phenomenon than it is an interactive resource.

Communicative disability and stories: Towards an embodied conception of narratives

In this article we show that persons with communicative disabilities are often involved in storytelling that does not necessarily conform to the conventional expectations of what constitutes a narrative. By analyzing the relationship between story and storytelling event, and the relation between what could be called the primary storyteller and the vicarious storyteller, we show that storytellers with communicative disabilities are often quite inventive in finding ways of presenting themselves as competent storytellers even though they may have certain problems vocally animating a coherent, structured story. This lead us to conclude a necessary redefinition of what a narrative is - that it could be performed as well as it could be told - and that such a redefinition stresses methodological issues: in order to be able to study the life stories of people with communicative disabilities we need to use both narrative and ethnographic research methods.

Time and Bodily Changes in Advanced Prostate Cancer: Talk About Time As Death Approaches

The disease trajectory of living with incurable cancer is characterized by increasing bodily deterioration and problems. In this paper, we have focused on the change in temporal awareness as manifested in the narrations of two men with hormone refractory prostate cancer and skeletal metastases as they approach death. The two men participated in in-depth research interviews during the last part of their lives, sharing a similar disease trajectory with increasing bodily change and decreasing physical function. Both died a lingering, cancer-related death. The first and last research interviews were analyzed using a discourse analytic method. Findings show that the temporal awareness in the interviews changes as the illness progresses and death approaches. In the last interviews, the present is flooded with bodily problems; the past and the future are hardly present except for the future beyond the mens own deaths. Pain, fatigue, nausea, and other symptoms figure largely in this change, and there is no time for much more than attending to bodily needs in a present that is dominated by problems. Here, the importance of alleviating bodily problems once again becomes paramount, and two questions are raised: Is the often reported withdrawal from life, when death is imminent, a physical necessity rather than a psychological one, and is it possible to free time from the time-consuming problems of the present by means of a more concentrated attempt to alleviate these problems?