This article takes a discursive psychology approach to the analysis of medical case narratives. An analysis of interview extracts on the topic of ME (CFS) shows how GPs use bio-psycho-social reasoning to construct the patient’s identity and to define their illness as mental or physical. Patients’ identities are ‘talked up’ using bio-psycho-social ‘evidence’; they are constructed in the process of explaining the origins of an illness as mental or physical. This has much in common with identity construction in the illness narratives of ME patients. The analysis also shows how identity construction can function as a justification for defining an illness as psychosomatic and effectively ‘shifting the blame’ for what might otherwise be treated as medical failure or uncertainty. These processes show how a discursive analysis can shed more light on how bio-psycho-social reasoning functions in doctors’ case constructions.
Antaki, C. and Widdicombe, S. (Eds.). (1998). Identities in talk. London: Sage.
2.
Arber, M. and Macintyre, A. (1994). Chronic fatigue syndrome or myalgic encephalomyelitis. British Medical Journal, 22 January, 243-243.
3.
Atkinson, J.M. and Drew, P. (1979). Order in court: The organization of verbal interaction in judicial settings. London: Macmillan.
4.
Atkinson, P. (1995). Medical talk and medical work: The liturgy of the clinic. London: Sage.
5.
Austin, J.L. (1962). How to do things with words. Oxford: Clarendon Press.
6.
Barrett, R.J. (1988). Clinical writing and the documentary construction of schizophrenia. Culture, Medicine, and Psychiatry, 12, 265–299.
7.
Charmaz, K. (1983). Loss of self: A fundamental form of suffering in the chronically ill. Sociology of Health and Illness, 5, 168–195.
8.
Cohen-Cole, S.A. (1991). The medical interview: The three function approach. St Louis, MO: Mosby.
9.
Cornwell, J. (1984). Hard earned lives: Accounts of health and illness from east London. London: Tavistock.
10.
Eccleston, C. , C. De C.Williams, A. and Stainton-Rogers, W. (1997). Patient’s and professional’s understandings of the causes of chronic pain: Blame, responsibility and identity protection. Social Science and Medicine, 45(5), 699–709.
11.
Edwards, D. (1997a). Discourse and cognition. London: Sage.
12.
Edwards, D. (1997b). The relevant thing about her: Social identity categories in use. In C. Antaki and S. Widdicombe (Eds.), Identities in talk, pp. 15–33. London: Sage.
13.
Edwards, D. and Middleton, D. (1986). Joint remembering: Constructing an account of shared experience through conversational discourse. Discourse Processes, 9, 423–459.
14.
Edwards, D. and Potter, J. (1992). Discursive psychology. London: Sage.
15.
Engel, G.L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.
16.
Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535–544.
17.
Frank, A.W. (1997). Illness as moral occasion: Restoring agency to ill people. Health, 1(2), 131–148.
18.
Garfinkel, H. (1967). Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice-Hall.
19.
Gilbert, N.G. and Mulkay, M. (1984). Opening Pandora’s Box: A sociological analysis of scientist’s discourse. Cambridge: Cambridge University Press.
20.
Goudsmit, E.M. and Gadd, R. (1991). All in the mind? The psychologisation of illness. The Psychologist, 4, 449–453.
21.
Grice, H.P. (1975). Logic and conversation. In P. Cole and J. Morgan (Eds.), Syntax and semantics 3: Speech acts, pp. 41–58. New York: Academic Press.
22.
Guggenbuhl-Craig, A. and Micklem, N. (1988). No answer to Job: Reflections on the limitations of meaning in illness. In M. Kidel and S. Rowe-Leete (Eds.), The meaning of illness, pp. 141–153. London: Routledge.
23.
Harper, D.J. (1999). Tablet talk and depot discourse: Discourse analysis and psychiatric medication. In C. Willig (Ed.), Applied discourse analysis. Social and psychological interventions, pp. 125–144. Buckingham: Open University Press.
24.
Heritage, J.C. (1984). Garfinkel and ethnomethodology. Cambridge: Polity.
25.
Horton-Salway, M. (1998). Mind and body in the discursive construction of ME. PhD thesis, Loughborough University.
26.
Horton-Salway, M. (2001a). Narrative identities and the management of personal accountability in talk about ME: A discursive psychology approach to illness narrative. Journal of Health Psychology, 6(2), 247–259.
27.
Horton-Salway, M. (2001b). The construction of ME: The discursive action model. In M. Wetherell, S. Taylor and S.J. Yates (Eds.), Discourse as data: A guide to analysis, pp. 147–188. London: Sage & The Open University.
28.
Horton-Salway, M. (forthcoming). Mind and body talk: The authorship of meaning in talk about depression.
29.
Hunter, K.M. (1991). Doctor’s stories: The narrative structure of medical knowledge. Princeton, NJ: Princeton University Press.
30.
Jefferson, G. (1985). An exercise in the transcription and analysis of laughter. In T. Van Dijk (Ed.), Handbook of discourse analysis, vol. 3, pp. 25–34. London: Academic Press.
31.
Jefferson, G. (1990). List construction as a task and resource. In G. Psathas (Ed.), Interaction competence, pp. 63–92. Lanham, MD: University Press of America.
32.
Kirmayer, L.J. (1988). Mind and body as metaphors: Hidden values in biomedicine. In M. Lock and D.R. Gordon (Eds.), Biomedicine examined, pp. 57–93. Dordrecht: Kluwer Academic Publishers.
33.
Kleinman, A.M. (1988). The illness narratives: Suffering, healing and the human condition. New York: Basic Books.
34.
Latour, B. (1987). Science in action. Milton Keynes: Open University Press.
35.
Middleton, J.F. (1997). The patient’s agenda. MD thesis, Leicester University.
36.
Mishler, E. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.
37.
Ogden, J. (2000). Health psychology: A textbook, 2nd edn.Buckingham: Open University Press.
38.
Pollner, M. (1987). Mundane reason: Reality in everyday and sociological discourse. Cambridge: Cambridge University Press.
39.
Potter, J. (1996). Representing reality: Discourse, rhetoric and social construction. London: Sage.
40.
Rabin, S. , Maoz, B. and Elata-Alster, G. (1999). Doctor’s narratives in Balint groups. British Journal of Medical Psychology, 72, 121–125.
41.
Radley, A. (1994). Making sense of illness: The social psychology of health and disease. London: Sage.
42.
Radley, A. and Billig, M. (1996). Accounts of health and illness: Dilemmas and representations. Sociology of Health and Illness, 18, 220–240.
Robinson, I. (1990). Personal narratives, social careers and medical courses: Analysing life trajectories in autobiographies of people with multiple sclerosis. Social Science and Medicine, 30, 1173–1186.
45.
Royal College of General Practitioners (RCGP). (1972). The future General Practitioner: Learning and teaching. Exeter: British Medical Journal.
46.
Sacks, H. (1989). Harvey Sacks – lectures 1964–1965. Edited by G. Jefferson. Special issue of Human Studies, 12(3–4), 183–404.
47.
Schegloff, E. (1997). Whose text? Whose context?Discourse and Society, 8(2), 165–187.
48.
Searle, J.R. (1969). Speech acts. Cambridge: Cambridge University Press.
49.
Shotter, J. and Gergen, K.J., Eds. (1989). Texts of identity. London: Sage.
50.
Smith, D. (1978). K is mentally ill: The anatomy of a factual account. Sociology, 12, 23–53.
51.
Soyland, A.J. (1991). Common-sense in clinical discourse. Text, 11, 223–240.
52.
Soyland, A.J. (1994). Functions of the psychiatric case summary. Text, 14(1), 113–140.
53.
Stimson, G.V. (1976). General Practitioners, ‘trouble’ and types of patients. In M. Stacey (Ed.), Sociology of the NHS. Sociological Review Monograph, 22, pp. 43–60. Keele: University of Keele.
54.
Stoeckle, J.D. and Barsky, A.J. (1981). Attributions: Uses of social science knowledge in the ‘doctoring’ of primary care. In L. Eisenberg and D. Kleinman (Eds.), The relevance of social science for medicine, pp. 223–240. London: D. Reidel Publishing Company.
55.
Taussig, M.T. (1980). Reification and the consciousness of the patient. Social Science and Medicine, 14B, 3–13.
56.
Ten Have, P. (1995). Medical ethnomethodology: An overview. Human Studies, 18, 245–261.
57.
Weinman, J. (1987). Diagnosis as problem-solving. In An outline of psychology as applied to medicine, 2nd edn.London: Wright.
58.
Wessely, S. (1990). Old wine in new bottles: Neurasthenia and ‘ME’. Psychological Medicine, 20, 35–53.
59.
Westcare. (1994). Report from The National Task Force on Chronic Fatigue Syndrome (CFS) Post Viral Fatigue Syndrome (PVFS) Myalgic Encephalomyelitis (ME). Department of Health.
60.
Woolgar, S. (1988). Science: The very idea. Chichester: Ellis Horwood/London: Tavistock.
61.
Yardley, L. (1996). Reconciling discursive and materialist perspectives on health and illness: A reconstruction of the biopsychosocial approach. Theory and Psychology, 6(3), 485–508.
