Interactionally, the workplace may be dilemmatic for a person with “invisible” chronic illness. Risks of stigmatization exist if they disclose their condition to colleagues. Meanwhile, not disclosing threatens well-being and entitlements. Using Bakhtin’s dialogism as a theoretical framework, we explored these social aspects of illness: inductively analyzing narratives from 20 participants with multiple sclerosis (MS). Capitalizing on concepts from dialogical and conversation analysis, links between (in)visibility, knowledge, and belief were examined with respect to symptoms and co-worker judgment. Perceived medical legitimacy creates a core social dilemma. At the intersection of genre and action, participants systematically used parody to subvert the traditional workplace hierarchy. “Oh-prefaced” direct reported speech (OPDRS) was deployed to exaggerate workplace interactions, undermining managers/colleagues who misattributed (in)visible symptoms. Parodic OPDRS index emotive interactional dilemmas. As subversions of organizational power, OPDRS denote those very areas where employees feel disempowered. Sensitivity to OPDRS can provide diagnostic support and complement evaluation frameworks.
BakhtinM. M. (1981). The dialogic imagination: Four essays (HolquistM., Ed.; EmersonC.HolquistM., Trans.). Austin, TX: University of Texas Press.
2.
BakhtinM. M. (1984). Problems of Dostoevsky’s poetics (EmersonC., Ed. & Trans.). Minneapolis: University of Minnesota Press.
3.
BeattyJ. E.JoffeR. (2006). An overlooked dimension of diversity: The career effects of chronic illness. Organizational Dynamics, 35, 182–195. doi:10.1016/j.orgdyn.2006.03.006
4.
ButlerJ. A.ModaffD. P. (2016). Motivations to disclose chronic illness in the workplace. Qualitative Research Reports in Communication, 17, 77–84. doi:10.1080/17459435.2016.1143387
5.
ButtnyR. (1998). Putting prior talk into context: Reported speech and the reporting context. Research on Language and Social Interaction, 31, 45–58. doi:10.1207/s15327973rlsi3101_3
6.
CharmazK. (2002). Stories and silences: Disclosures and self in chronic illness. Qualitative Inquiry, 8, 302–328. doi:10.1177/107780040200800307
7.
CharmazK. (2010). Disclosing illness and disability in the workplace. Journal of International Education in Business, 3, 6–19. doi:10.1108/18363261011106858
8.
CliftR. (2001). Meaning in interaction: The case of actually. Language, 77, 245–291. doi:10.1353/lan.2001.0074
9.
Couper-KuhlenE. (2007). Assessing and accounting. In HoltE.CliftC. (Eds.), Reporting talk: Reported speech in interaction (pp. 81–119). Cambridge, UK: Cambridge University Press.
10.
CoxT.KaranikaM.GriffithsA.HoudmontJ. (2007). Evaluating organizational-level work stress interventions: Beyond traditional methods. Work & Stress, 21, 348–362. doi:10.1080/02678370701760757
11.
DodierN. (1985). Social uses of illness at the workplace: Sick leave and moral evaluation. Social Science & Medicine, 20, 123–128. doi:10.1016/0277-9536(85)90296-5
12.
DrewP. (1998). Complaints about transgressions and misconduct. Research on Language and Social Interaction, 31, 295–325. doi:10.1080/08351813.1998.9683595
13.
DueñasM.OjedaB.SalazarA.MicoJ. A.FaildeI. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of Pain Research, 9, 457–467. doi:10.2147/JPR.S105892
14.
FlensnerG.LandtblomA. M.SöderhamnO.EkA. C. (2013). Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: A cross-sectional study. BMC Public Health, 13, Article 224. doi:10.1186/1471-2458-13-224
15.
FordH. L.WicksC. R.StroudA.TennantA. (2018). Psychological determinants of job retention in multiple sclerosis. Multiple Sclerosis Journal, 25, 419–426.
16.
Fox TreeJ. E.SchrockJ. C. (1999). Discourse markers in spontaneous speech: Oh what a difference an oh makes. Journal of Memory and Language, 40, 280–295. doi:10.1006/jmla.1998.2613
17.
FrankA. W. (2005). What is dialogical research, and why should we do it?Qualitative Health Research, 15, 964–974. doi:10.1177/1049732305279078
18.
FrederickA. (2017). Visibility, respectability, and disengagement: The everyday resistance of mothers with disabilities. Social Science & Medicine, 181, 131–138. doi:10.1016/j.socscimed.2017.03.030
19.
GarfieldA. C.LincolnN. B. (2012). Factors affecting anxiety in multiple sclerosis. Disability and Rehabilitation, 34, 2047–2052. doi:10.3109/09638288.2012.667503
20.
GomersallT.MadillA. (2014). Chronotope disruption as a sensitizing concept for understanding chronic illness narratives. Health Psychology, 34, 407–416. doi:10.1037/hea0000151
21.
HeritageJ. (1984). A change-of-state token and aspects of its sequential placement. In Maxwell AtkinsonJ.HeritageJ. (Eds.), Structures of social action (pp. 299–345). Cambridge, UK: Cambridge University Press.
22.
HeritageJ. (1998). Oh-prefaced responses to inquiry. Language in Society, 27, 291–334. doi:10.1017/S0047404500019990
23.
HeritageJ. (2002). Oh-prefaced responses to assessments: A method of modifying agreement/disagreement. In FordC.FoxB.ThompsonS. (Eds.), The language of turn and sequence (pp. 196–224). New York: Oxford University Press.
24.
HeritageJ. (2009). Negotiating the legitimacy of medical problems: A multi-phase concern for patients and physicians. In BrashersD.GoldsmithD. (Eds.), Communicating to manage health and illness (pp. 147–164). New York: Routledge.
25.
HoltE. (1996). Reporting on talk: The use of direct reported speech in conversation. Research on Language and Social Interaction, 29, 219–245. doi:10.1207/s15327973rlsi2903_2
26.
HoltE. (2000). Reporting and reacting: Concurrent responses to reported speech. Research on Language and Social Interaction, 33, 425–454. doi:10.1207/S15327973RLSI3304_04
27.
IronsideP. M.ScheckelM.WesselsC.BaileyM. E.PowersS.SeeleyD. K. (2003). Experiencing chronic illness: Cocreating new understandings. Qualitative Health Research, 13, 171–183. doi:10.1177/1049732302239597
28.
JamesD. M.PilnickA.HallA.CollinsL. (2016). Participants’ use of enacted scenes in research interviews: A method for reflexive analysis in health and social care. Social Science & Medicine, 151, 38–45. doi:10.1016/j.socscimed.2015.12.040
29.
JeffersonG. (1983). Issues in the transcription of naturally-occurring talk: Caricature versus capturing pronunciational particulars. Tilburg Papers in Language and Literature, 34, 1–12.
30.
MadillA.SullivanP. (2010). Medical training as adventure-wonder and adventure-ordeal: A dialogical analysis of affect-laden pedagogy. Social Science & Medicine, 71, 2195–2203. doi:10.1016/j.socscimed.2010.09.048
31.
MarkleG. L.AttellB. K.TreiberL. A. (2014). Dual, yet dueling illnesses: Multiple chronic illness experience at midlife. Qualitative Health Research, 25, 1271–1282. doi:10.1177/1049732314559948
32.
McCoskerB.MoranC. C. (2012). Differential effect of self-esteem and interpersonal competence on humor styles. Psychology Research and Behavior Management, 5, 143-150.
33.
McGonagleA. K.BeattyJ. E.JoffeR. (2014). Coaching for workers with chronic illness: Evaluating an intervention. Journal of Occupational Health Psychology, 19, 385–398. doi:10.1037/a0036601
34.
MegariK. (2013). Quality of life in chronic disease patients. Health Psychology Research, 1, e27. doi:10.4081/hpr.2013.e27
35.
MooreP.HardingK. E.ClarksonH.PickersgillK. P.WardleM.RobertsonN. P. (2013). Demographic and clinical factors associated with changes in employment in multiple sclerosis. Multiple Sclerosis, 19, 1647–1654. doi:10.1177/1352458513481396
36.
MunirF.JonesD.LekaS.GriffithsA. (2005). Work limitations and employer adjustments for employees with chronic illness. International Journal of Rehabilitation Research, 28, 111–117. doi:10.1097/00004356-200506000-00003
37.
MunirF.RandallR.YarkerJ.NielsenK. (2009). The influence of employer support on employee management of chronic health conditions at work. Journal of Occupational Rehabilitation, 19, 333–344. doi:10.1007/s10926-009-9199-7
38.
MunirF.YarkerJ.HaslamC.LongH.LekaS.GriffithsA.CoxS. (2007). Work factors related to psychological and health-related distress among employees with chronic illness. Journal of Occupational Rehabilitation, 17, 259–277. doi:10.1007/s10926-007-9074-3
39.
MyersG. (1999). Functions of reported speech in group discussions. Applied Linguistics, 20, 376–401. doi:10.1093/applin/20.3.376
40.
ParsonsT. (1951). The social system. New York: Free Press.
41.
ParsonsT. (1975). The sick role and the role of the physician reconsidered. The Milbank Memorial Fund Quarterly, 53, 257–278. doi:10.2307/3349493
42.
PetrinJ.AkbarN.TurpinK.SmythP.FinlaysonM. (2018). The experience of persons with multiple sclerosis using MSINFoRm: An interactive fatigue management resource. Qualitative Health Research, 28, 778–788. doi:10.1177/1049732317753584
43.
PilnickA.HindmarshJ.GillV. T. (2011). Communication in healthcare settings: Policy, participation and new technologies. Sociology of Health & Illness, 33, 503–505. doi:10.1111/j.1467-9566.2011.01333.x
44.
SandelowskiM. (1998). The call to experts in qualitative research. Research in Nursing & Health, 21, 467–471. doi:10.1002/(SICI)1098-240X(199810)21:5<467::AID-NUR9>3.0.CO;2-L
45.
SantuzziA.WaltzP. R. (2016). Disability in the workplace: A unique and variable identity. Journal of Management, 42, 1111–1135. doi:10.1177/0149206315626269
46.
SciangulaA.MorryM. M. (2009). Self esteem and perceived regard: How I see myself affects my relationship satisfaction. Journal of Social Psychology, 149, 143-158.
47.
SchegloffE. A. (1996). Confirming allusions: Toward an empirical account of action. American Journal of Sociology, 102, 161–216. doi:10.1086/230911
48.
SchegloffE. A.LernerG. (2009). Beginning to respond: Well-prefaced responses to wh-questions. Research on Language and Social Interaction, 42, 91–115. doi:10.1080/08351810902864511
49.
SchiffrinD. (1987). Discourse markers. New York: Cambridge University Press.
50.
SchrammE.BergerM. (2013). Interpersonal psychotherapy for work-related stress depressive disorders. Der Nervenarzt, 84, 813–822.
51.
SidnellJ.StiversT. (Eds.). (2012). The handbook of conversation analysis. Boston, MA: Wiley-Blackwell.
52.
SimmonsR.TribeK.McDonaldE. (2010). Living with multiple sclerosis: Longitudinal changes in employment and the importance of symptom management. Journal of Neurology, 257, 926–936. doi:10.1007/s00415-009-5441-7
53.
SmithM. M.ArnettP. A. (2005). Factors related to employment status changes in individuals with multiple sclerosis. Multiple Sclerosis, 11, 602–609. doi:10.1191/1352458505ms1204oa
54.
SullivanP. (2012). Qualitative data analysis using a dialogical approach. London: Sage.
55.
ThompsonL.HowesC.McCabeR. (2016). Effect of questions used by psychiatrists on therapeutic alliance and adherence. The British Journal of Psychiatry, 209, 40–47. doi:10.1192/bjp.bp.114.151910
56.
ThompsonL.McCabeR. (2018). How psychiatrists recommend treatment and its relationship with patient uptake. Health Communication, 33, 1345–1354. doi:10.1080/10410236.2017.1350916
57.
TresterA. M. (2009). Discourse marker “oh” as a means for realizing the identity potential of constructed dialogue in interaction. Journal of Sociolinguistics, 13, 147–168. doi:10.1111/j.1467-9841.2009.00402.x
58.
TurnerJ.KellyB. (2000). Emotional dimensions of chronic disease. Western Journal of Medicine, 172, 124–128. doi:10.1136/ewjm.172.2.124
59.
VickersM. (1997). Life at work with “invisible” chronic illness (ICI): the “unseen”, unspoken, unrecognized dilemma of disclosure. Journal of Workplace Learning, 9, 240-242. doi: 10.1108/13665629710190040
60.
VickersM. (2012). “For the crime of being different . . .”: Multiple sclerosis, teams, and stigmatization at work—Lessons from a case study. Employee Responsibilities and Rights Journal, 24, 177–195. doi:10.1007/s10672-011-9186-y
61.
WerthS. (2015). Managerial attitudes: Influences on workforce outcomes for working women with chronic illness. The Economic and Labour Relations Review, 26, 296–313. doi:10.1177/1035304615571244
62.
WicksC.WardK.StroudA.TennantA.FordH. L. (2016). Multiple sclerosis and employment: Associations of psychological factors and work instability. Journal of Rehabilitation Medicine, 48, 799–805. doi:10.2340/16501977-2142
63.
WiggintonB.LafranceM. N. (2014). “I think he is immune to all the smoke I gave him”: How women account for the harm of smoking during pregnancy. Health, Risk & Society, 16, 530–546. doi:10.1080/13698575.2014.951317
