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.
Atkinson, R. ( 1998). The life story interview. Thousand Oaks, CA: Sage.
2.
Avdi, E. ( 2005). Negotiating a pathological identity in the clinical dialogue: Discourse analysis of a family therapy. Psychology & Psychotherapy: Theory, Research and Practice, 78, 493-511.
3.
Barrett, R.J. ( 2005). Space, repetition and collective interlocution: Psychiatric interviews in a Borneo longhouse. Communication & Medicine , 1(1), 25-34.
4.
Bavelas, J.B., Coates, L., & Johnson, T. ( 2000). Listeners as co-narrators. Journal of Personality and Social Psychology, 79(6), 941-952.
5.
Beck, A.T. ( 1976). Cognitive therapy and the emotional disorders. New York: International University Press.
6.
Beevers, C.G., & Miller, I.W. ( 2004). Depression-related negative cognition: Mood-state and trait dependent properties. Cognitive Therapy and Research , 28(3), 293-307.
7.
Berger, P.L., & Luckmann, T. ( 1966). The social construction of reality: A treatise in the sociology of knowledge. Garden City, NJ: Anchor Books.
8.
Bergmann, J.R. ( 1992). Veiled morality: Notes on discretion in psychiatry. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 137-162). Cambridge, MA: Cambridge University Press.
9.
Bokey, K., & Walter, G. ( 2002). Literature and psychiatry: The case for a close liaison . Australasian Psychiatry, 10(4), 393-400.
10.
Bokhour, B.G., Berlowitz, D.R., Long, J.A., & Kressin, N.R. ( 2006). How do providers assess antihypertensive medication adherence in medical encounters? Journal of General Internal Medicine , 21(6), 577-583.
11.
Boyd, E., & Heritage, J. ( 2006). Taking the patient’s medical history: Questioning during comprehensive history taking. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interactions between primary care physicians and patients (pp. 151-184). Cambridge, MA: Cambridge University Press.
12.
Burr, V. ( 2003). Social constructionism (2nd ed.). London: Psychology Press .
13.
Caplan, P.J., & Cosgrove, L. ( 2004). Bias in psychiatric diagnosis. Lanham, MD: Jason Aronson.
14.
Carlat, D.J. ( 2005). The psychiatric interview: A practical guide. Philadelphia: Lippincott Williams & Wilkins.
15.
Cheek, J. ( 2004). At the margins? Discourse analysis and qualitative research . Qualitative Health Research, 14, 1140-1150.
16.
Cooper-Patrick, L., Gallo, J.J., Gonzales, J.J., Vu, H.T., Powe, N.R., Nelson, C., et al. (1999). Race, gender and partnership in the patient-physician relationship. JAMA, 282(6), 583-589.
17.
Davies, B., & Harré, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour , 20(1), 44-63.
18.
Fairclough, N. ( 1992). Discourse and social change. Cambridge, MA: Polity Press.
19.
Fairclough, N. (1995). Media discourse. London: Edward Arnold. Fairclough, N. (2001). Language and power (2nd ed.). London: Longman.
20.
Forgas, J. P. (Ed). (2006). Affect in social thinking and behavior. New York: Psychology Press.
21.
Foucault, M. ( 1980). Power/knowledge: Selected interviews and other writings, 1972-1977. (C. Gordon, Ed.). New York: Pantheon.
22.
Frankel, R. ( 1995). Some answers about questions in clinical interviews. In. G. H. Morris & R. J. Chenail (Eds.), The talk of the clinic: Explorations in the analysis of medical and therapeutic discourse (pp. 49-70.). Hillsdale, NJ: Lawrence Erlbaum.
23.
Frosh, S., Burck, C., Strickland-Clark, L., & Morgan, K. ( 1996). Engaging with change: A process study of family therapy . Journal of Family Therapy, 18(2), 141-161.
24.
Galasiński, D. ( 2008). Men’s discourses of depression. Basing-stoke, UK: Palgrave.
25.
Georgaca, E. ( 2001). Voices of the self in psychotherapy: A qualitative analysis . British Journal of Medical Psychology, 74, 223-236.
26.
Haidet, P., & Paterniti, D.A. (2003). "Building" a history rather than "taking" one: A perspective on information sharing during the medical interview. Archives of Internal Medicine, 163(10), 1134-1140.
27.
Halliday, M.A.K., & Hasan, R. ( 1989). Language, context, and text: Aspects of language in a social-semiotic perspective. Oxford, UK: Oxford University Press.
28.
Harré, R., & Moghaddam, F. ( 2003). Introduction: The self and others in traditional psychology and in positioning theory. In R. Harre & F. Moghaddam (Eds.), The self and others. Positioning individuals and groups in personal, political, and cultural contexts (pp. 1-12). Westport, CT: Praeger.
29.
Harré, R., & Slocum, N. ( 2003). Disputes as complex social events: On the uses of positioning theory. In R. Harre & F. Moghaddam (Eds.), The self and others. Positioning individuals and groups in personal, political, and cultural contexts (pp. 123-136). Westport, CT: Praeger.
30.
Haslam, N., & Ernst, D. ( 2002). Essentialist beliefs about mental disorders. Journal of Social and Clinical Psychology, 21, 628-644.
31.
Hassan, I., McCabe, R., & Priebe, S. ( 2007). Professional-patient communication in the treatment of mental illness: A review. Communication and Medicine, 4(2), 141-152.
32.
Holstein, J.F., & Gubrium, J.A. ( 1995). The active interview. Thousand Oaks, CA: Sage.
33.
Hutchby, I. ( 2001). "Witnessing": The use of first-hand knowledge in legitimating lay opinions on talk radio. Discourse Studies, 3(4), 481-497.
34.
Johnstone, L. ( 2000). Users and abusers of psychiatry: A critical look at psychiatric practice. London: Brunner-Rutledge .
35.
Kleinman, A. ( 1988). The illness narratives: Suffering, healing, and the human condition. New York: Basic Books .
36.
MacKinnon, R.A., Michels, R., & Buckley, P.J. ( 2006). The psychiatric interview in clinical practice. Washington, DC: American Psychiatric Publishing.
37.
Madill, A., & Barkham, A. ( 1997). Discourse analysis of a theme in one successful case of brief psychodynamic-interpersonal psychotherapy. Journal of Counseling Psychology, 44(2), 232-244.
38.
McKenzie, P.J. ( 2004). Positioning theory and the negotiation of information needs in a clinical midwifery setting. Journal of the American Society for Information Science and Technology, 55(8), 685-694.
39.
Medical Center of Postgraduate Education [Centrum Medyczne Kształcenia Podyplomowego]. (2002). Program specjalizacji z Psychiatrii [Program of specialization in psychiatry in Poland]. Retrieved February 1, 2009, from http://www.cmkp.edu.pl/programy_pdf/psychiatria%20podst.pdf
40.
Mellor, D., Davison, T., McCabe, M., George, K., Moore, K., & Ski, C. ( 2006). Satisfaction with general practitioner treatment of depression among residents of aged care facilities. Journal of Aging and Health, 18(3), 435-457.
41.
Millwood, J., & Heath, M.R. ( 2000). Food choice by older people: The use of semi-structured interviews with open and closed questions. Gerodontology, 17(1), 25-32.
42.
Mishler, E.G. ( 1984). The discourse of medicine: Dialectics of medical interviews . Norwood, NJ: Ablex.
43.
Mishler, E.G. ( 1986). Research interviewing: Context and narrative. Cambridge, MA: Harvard University Press.
44.
Moore, B. S., & Isen, A. M. (Eds.). (1990). Affect and social behavior . Cambridge, MA: Cambridge University Press.
45.
Othmer, E., & Othmer, S.C. ( 1994). The clinical interview using the DSM-IV. Washington, DC: American Psychiatric Press.
46.
Pilgrim, D. ( 2007). The survival of psychiatric diagnosis. Social Science and Medicine, 65(3), 536-544.
47.
Pinto, D., Ribeiro B.T., & Dantas, M.T.L. (2005). "Let the heart speak out"-Interviewing practices by psychiatrists from two different traditions. Communication & Medicine, 2(2), 177-188.
48.
Pomerantz, A. ( 1980). Telling my side: "Limited access" as a "fishing" device . Sociological Inquiry, 50, 186-198.
49.
Poskiparta, M., Kettunen, T., & Liimatainen, L. (1998). Reflective questions in health counseling. Qualitative Health Research, 8, 682-693.
50.
Pridmore, S. ( 2000). The psychiatric interview: A guide to history taking and the mental state examination. Amsterdam: Harwood Academic.
51.
Ribeiro, T.L., & Bastos, L.C. ( 2005). Telling stories in two psychiatric interviews. A discussion on frame and narrative. AILA Review, 18, 58-75.
52.
Robinson, J., & Heritage, J. ( 2006). Physicians’ opening questions and patients’ satisfaction. Patient Education and Counseling, 60, 279-285.
53.
Roter, D., Rosenbaum, J., de Negri, B., Renaud, D., DiPreteBrown, L., & Hernandez, O. ( 1998). The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education, 32(2), 181-189.
54.
Sadler, J.Z. ( 2005). Values and psychiatric diagnosis. Oxford, UK: Oxford University Press.
55.
Shea, S.C. ( 1998). The psychiatric interview: The art of understanding. Philadelphia: Saunders.
56.
Speer, S.A., & Parsons, C. ( 2006). Gatekeeping gender: Some features of the use of hypothetical questions in the psychiatric assessment of transsexual patients. Discourse & Society, 17(6), 785-812.
57.
Speer, S.A., & Parsons, C. ( 2007). Suppose you couldn’t go any further with treatment, what would you do? Hypothetical questions in interactions between psychiatrists and transsexual patients. In A. Hepburn & S. Wiggins (Eds.), Discursive research in practice: New approaches to psychology and everyday interaction (pp. 182-199). Cambridge, MA: Cambridge University Press.
58.
Spitzer, R.L. ( 2001).Values and assumptions in the development of DSM-III-R: An insider’s perspective and a bleated response to Sadler, Hulgus, and Agich’s "On values in recent American psychiatric classification." Journal of Nervous & Mental Disease, 189(6), 351-359.
59.
Stanghellini, G. ( 2004). The puzzle of the psychiatric interview. Journal of Phenomenological Psychology, 35(2), 173-195.
60.
Stanghellini, G. ( 2007). The grammar of the psychiatric interview. A plea for the second-person mode of understanding. Psychopathology, 40, 69-74.
61.
Sullivan, H.S. ( 1970). The psychiatric interview. New York : W. W. Norton.
62.
Takemura, Y., Atsumi, R., & Tsuda, T. ( 2007). Identifying medical interview behaviors that best elicit information from patients in clinical practice. Tohoku Journal of Experimental Medicine, 213, 121-127.
63.
Takemura, Y., Sakurai, Y., Yokoya, S., Otaki, J., Matsuoka, T., Ban, N., et al. (2005). Open-ended questions: Are they really beneficial for gathering medical information from patients? Tohoku Journal of Experimental Medicine, 206, 151-154.
64.
Tappen, R.M., Williams-Burgess, C., Edelstein, J., Touhy, T., & Fishman, S. ( 1997). Communicating with individuals with Alzheimer’s disease: Examination of recommended strategies. Archives in Psychiatric Nursing, 11(5), 249-256.
65.
van Langenhove, L., & Harré, R. (1999). Introducing positioning theory. In R. Harré & L. van Langenhove (Eds.), Positioning theory: Moral context of intentional action (pp. 14-31). Oxford, UK: Blackwell.
66.
Verhaeghe, P. ( 2004). On being normal and other disorders: A manual for clinical psychodiagnostics. New York: The Other Press.
67.
Waitzkin, H. ( 1991). The politics of medical encounter. How patients and doctors deal with social problems. New Haven, CT: Yale University Press.
68.
Wilson, T.P. ( 1991). Social structure and the sequential organization of interaction . In D. Boden & D. H. Zimmerman (Eds.), Talk and social structure: Studies in ethnomethodology and conversation analysis (pp. 22-43). Cambridge, MA: Polity Press.
69.
World Health Organization. (1998). Klasyfikacja zaburzeń psychicznych i zaburzeń zachowania w ICD-10. Badawcze kryteria diagnostyczne [Polish translation of International Classification of Diseases, ICD-10; World Health Organization, 1993]. Kraków-Warszawa, Poland: Vesalius-IPiN.
70.
World Psychiatric Association. (2003). IGDA 2: Interviewing the patient. British Journal of Psychiatry , 182(Suppl. 45), 42-43.
71.
Zachar, P., & Kendler, K.S. ( 2007). Psychiatric disorders: A conceptual taxonomy. American Journal of Psychiatry, 164, 557-565.
72.
Zimmermann, C., del Piccolo, L., & Mazzi, M.A. ( 2003). Patient cues and medical interviewing in general practice: Examples of the application of sequential analysis. Epidemiologia E Psichiatria Sociale, 12(2), 115-123.
