Restricted accessOtherFirst published online 2011-8
‘Oh he was forgettable’: Construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairment
Communication involving persons with cognitive impairment (CI) associated memory issues requires particular attention in the clinical setting due to the sensitive and often difficult institutional work that must take place between the patient and his or her physician. An individual with CI is often tested for memory issues during the office visit, generating a potentially face-threatening situation. Said individual may attempt to preserve positive identity or ‘save face’ (Gumperz, 1982) by using communicative coping behaviors (CCBs). This study characterizes the use of CCBs (e.g., accounts and humor) by persons with CI in clinical interviews and provides important insight on how to improve doctor—patient communication involving people with CI. In order to describe and compare CCBs used by persons with cognitive impairment, and those used by cognitively normal individuals, verbatim, in-office transcripts from both groups were analyzed. Results showed that participants with CI used more memory accounts than cognitively normal individuals and similar amounts of humor in order to save face and construct a normal identity. These data help to inform doctors and caregivers regarding the ways in which persons with CI construct and preserve a positive sense of self-identity through communication.
Ainsworth-Vaughn, N. ( 1998). Claiming power in doctor-patient talk. New York: Oxford University Press.
2.
Austin, J.L. ( 1961). A plea for excuses. In J. D. Urmson & G. Warnock (Eds.), Philosophical Papers. Oxford: Clarendon Press.
3.
Bahro, M., Silber, E., et al. (1995). How do patients with Alzheimer’s disease cope with their illness - A clinical experience report. Journal of the American Geriatrics Society, 43(1), 41-46.
4.
Baker, P.S., Yoels, W.C., & Clair, J.M. ( 1996). Emotional expressions during medical encounters: Social dis-ease and the medical gaze. In V. James & J. Gabe (Eds.), Health and the Sociology of Emotions (pp. 173-199). Oxford: Blackwell Publishers.
5.
Baker, P., Yoels, W., Clair, J.M., & Allman, R. ( 1997). Laughter in triadic geriatric medical encounters: A transcript-based analysis. In R. J. Erickson & B. Cuthbertson-Johnson (Eds.), Social Perspectives on Emotion (pp. 179-207). Greenwich, CT : JAI Press.
6.
Berscheid, E., Graziano, W., Monson, T., & Dermer, M. ( 1976). Outcome dependency: Attention, attribution and attraction . Journal of Personality and Social Psychology , 34, 978-989.
7.
Chakravarti, I.M., Laha, R.G., & Roy, J. ( 1967). Handbook of Methods of Applied Statistics (Vol. I, pp. 392-394). New York: John Wiley and Sons.
8.
Clare, L. ( 2002). We’ll fight it as long as we can: Coping with the onset of Alzheimer’s disease. Aging and Mental Health , 6, 139-148.
9.
Clare, L. ( 2003). Managing threats to self: The construction of awareness in early-stage Alzheimer’s disease. Social Science and Medicine, 57, 1017-1029.
10.
Clare, L., Goater, T., & Woods, B. ( 2006). Illness representations in early-stage dementia: A preliminary investigation. International Journal of Geriatric Psychiatry , 21(8), 761-767.
11.
Clare, L., Rowlands, J., Bruce, E., Surr, C., & Downs, M. ( 2008). The experience of living with dementia in residential care: An interpretative phenomenological analysis. The Gerontologist , 48(6), 711-720.
12.
Coser, R.L. ( 1959). Some social functions of laughter. Human Relations, 12, 171-182.
Downs, M. ( 1997). The emergence of the person in dementia research . Ageing and Society, 17, 597-607.
15.
DuBois, J. ( 1991). Transcription design principles for spoken discourse research. Pragmatics, 1(1), 71-106.
16.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician . Journal of Psychiatric Research, 12(3), 189-198.
17.
Fortinsky, R.H. ( 2001). Health care triads and dementia care: Integrative framework and future directions. Aging & Mental Health , 5, S35-S48.
18.
Gumperz, J. ( 1982). Language and Social Identity. Cambridge : Cambridge University Press.
19.
Hamilton, H.E. ( 2006). Narrative as snapshot: Glimpses into the past in Alzheimer’s discourse. Paper presented at the conference on Communicating across Age Groups - Age, Language and Society , Warsaw, Poland.
20.
Hamilton, H.E. ( 2008). Language and dementia: Sociolinguistic aspects . Annual Review of Applied Linguistics, 28, 91-110.
21.
Harman, G., & Clare, L. ( 2006). Illness representations and lived experience in early-stage dementia. Qualitative Health Research, 16(4), 484-502.
22.
Hastie, R. ( 1984). Causes and effects of causal attribution. Journal of Personality and Social Psychology, 46, 44-56.
23.
Heider, F. ( 1958). The Psychology of Interpersonal Relations. New York: Wiley.
24.
Hewstone, M., Stroebe, W., Codol, J.-P., & Stephenson, G.M. (1988). Introduction to Social Psychology. Oxford: Basil Blackwell .
25.
Hughes, J., Louw, S. J., & Sabat, S. (Eds.) (2006). Dementia: Mind, meaning, and the person. Oxford: Oxford University Press.
26.
Jones, E.E., & Davis, K.E. ( 1965). From acts to dispositions: The attributional process in person perception. In L. Berkowitz (Ed.), Advances in Experimental Social Psychology (Vol.2). New York: Academic Press.
27.
Kaplan, E., Goodglass, H., & Weintraub, S. ( 1983). Boston Naming Test. Philadelphia : Lee & Febiger.
28.
Kelley, H.H. ( 1973). The processes of causal attribution. American Psychologist, 28, 107-128.
29.
Keady, J., & Nolan, M. ( 1995). IMMEL: Assessing coping responses in the early stages of dementia. British Journal of Nursing, 4, 309-314.
30.
Keady, J., Nolan, M.R., & Gilliard, J. ( 1995). Listen to the voices of experience. Journal of Dementia Care, 3(May-June), 15-17.
31.
Kontos, P.C. ( 2006). Embodied selfhood: An ethnographic exploration of Alzheimer’s disease. In A. Leibing , & L. Cohen (Eds.), Thinking about dementia: Culture, loss, and the anthropology of senility (pp. 195-217). New Brunswick, NJ: Rutgers University Press.
32.
Leibing, A., & Cohen, L. (Eds.) (2006). Thinking about dementia: Culture, loss, and the anthropology of senility. New Brunswick, NJ: Rutgers University Press.
33.
Lindholm, C. ( 2008). Laughter, communication problems and dementia . Communication & Medicine, 5(1), 3-14.
34.
Mann, H.B., & Whitney, D.R. ( 1947). On a test of whether one of two random variables is stochastically larger than the other. Annals of Mathematical Statistics, 18, 50-60.
35.
NUD*IST. (1995). Melbourne , Australia, QSR International Pty Ltd.
36.
Oyebode, J.R., Motala, J.R., et al. (2009). Coping with challenges to memory in people with mild to moderate Alzheimer’s disease: Observation of behaviour in response to analogues of everyday situations. Aging & Mental Health , 13(1), 46-53.
37.
Pearce, A., Clare, L., & Pistrang, N. ( 2002). Managing sense of self: Coping in the early-stages of Alzheimer’s disease. Dementia, 1, 173-192.
38.
Ragan, S.L. ( 1990). Verbal play and multiple goals in the gynaecological exam interaction. Journal of Language and Social Psychology , 9(1-2), 67-84.
39.
Rhys, C., & Schmidt-Renfree, N. (2000). Facework social politeness and the Alzheimer’s patient. Clinical Linguistics & Phonetics, 14(7), 533-543.
40.
Sabat, S.R. ( 2001). The experience of Alzheimer’s disease: Life through a tangled veil. Oxford: Blackwell .
41.
Saunders, P.A. ( 1998a). ‘My brain’s on strike’: The construction of identity through memory accounts by dementia patients. Research on Aging, 20(1), 65-90.
42.
Saunders, P.A. ( 1998b). ‘You’re out of your mind!’ An analysis of humor as a face saving strategy for patients and clinicians during neuropsychological examinations. Health Communication , 10(4), 357-372.
43.
Schiffrin, D. ( 1994). Approaches to Discourse. Cambridge : Basil Blackwell.
44.
Schonbach, P. ( 1985). A taxonomy for account phases: Revised, explained, and applied. Unpublished manuscript, Ruhr Universitat, Bochum, West Germany.
Segal, D. ( 1984). Playing doctor seriously: Graduation follies at an American medical school. International Journal of Health Services, 14, 379-396.
47.
Seligman, M., Castellon, J., Cacciola, S., Luborsky, L., Ollove, M., & Downing, R. ( 1988). Explanatory style change during cognitive therapy for unipolar depression. Journal of Abnormal Psychology, 97(1), 13-18.
48.
Semin, G.R., & Manstead, A.S.R. (1983). The Accountability of Conduct: A Social Psychological Analysis. London: Academic Press.
49.
Simmons-Mackie, N.N., & Damico, J.S. ( 1997). Reformulating the definition of compensatory strategies in aphasia. Aphasiology, 11(8), 761-781.
50.
Snyder, C.R., & Higgins, R.L. ( 1988). Excuses: Their effective role in the negotiation of reality . Psychological Bulletin, 104(1), 23-35.
51.
Sykes, G.M., & Matza, D. ( 1957). Techniques of neutralization: A theory of delinquency . American Sociological Review, 22, 664-670.
52.
Tedeschi, J.T., & Riess, M. ( 1981). Verbal strategies in impression management. In C. Antaki (Ed.), The Psychology of Ordinary Explanations of Social Behavior. London: Academic Press.
53.
ten Have, P. ( 1991). Talk and institution: A reconsideration of the ’asymmetry’ of doctor-patient interaction. In B. Deirde , & Z. Don (Eds.), Talk and Social Structure (pp. 138-163). Berkeley: University of California Press.
54.
Van Dijkhuizen, M., Clare, L., & Pearce, A. ( 2006). Striving for connection. Dementia , 5(1), 73-94.
55.
Wilcoxon, F. ( 1949). Some rapid approximate statistical procedures . Stamford, CT: Stamford Research Laboratories, American Cyanamid Company.
56.
Yoels, W.C., & Clair, J.M. ( 1995). Laughter in the clinic: Humor as social organization . Symbolic Interaction, 18(1), 39-58.
