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3rd Global Conference
Making Sense of: Health, Illness and Disease
Monday 5th July - Friday 9th July 2004
St Catherine's College, Oxford
Conference Programme, Abstract & Papers
Session 12: Consultation and
Approaches
Chair: Caryl Sibbett
Prognosis versus Diagnosis. Two Different Categories Underlying Doctor-Patient
Consultation
Peter Schulz
Health Care Communication Laboratory, School of Communication Sciences,
University of Lugano , Switzerland
The asymmetrical relationship between patient and doctor, the interaction between individuals in non-equal positions as the lay person and professional expertise, have infused studies concerned with the communication of diagnostic information by doctors to patients in the consultation. In order to gain a proper understanding of how medical assessment is delivered to the patient, we first have to consider the role that diagnosis and prognosis play within doctor-patient communication. A medical-diagnostic process is a form of categorization, where the doctor tries to find an answer to the question: “To which disease-category do I attribute this patient with these symptoms, or is there no disease (as a category) present here, or does the symptom ambiguously refer to more diseases?” A closer look at prognosis shows that it is not to be misunderstood as a merely theoretical proposition. Within the concept of prognostic knowledge we can consider and emphasize the special situation of the patient. Whereas the diagnostic goal for the practitioner is to match the patient’s disease to the corresponding system of diseases, the patient is mostly interested in what he can expect for himself and his future health. This is where the concept of prognosis comes in.
Making Sense of Depression: A Psycholinguistic Approach
Ioana Todor
University of Alba Iulia, Romania
Psychotherapeutical practice underlines the importance of a patient`s personal understanding of his or her illness in the curative process. The conceptualisation of illness as a „personal experience”, part of the normal course of life, is believed to be less adaptive than the conceptualisation of illness as an „external factor”, „an enemy”, an „outsider” followed by its systematic rejection. Most psycho-sociological studies on the cognitive or social representations of depression use the classical methods of quantitative or qualitative analysis. The quantitative methodology focuses on the internal representations of concepts and on the relations between concepts. Assuming their non-propositional nature, an analysis of the metaphors can be most interesting than an analysis of the concepts for studying particular illness representations. The present study proposes a psycholinguistic approach to depression based on the study of the metaphors most frequently used by the patients. The metaphor is view like „an experiential framework in which newly acquired, abstract concepts may be accommodated” (G. Lakoff, M. Johnson, Methaphors We Live By, 1980). An investigation of the extensive and unconscious system of metaphors used by individuals to express commonplace thoughts allows us to make an in-depth analysis of some individual experiences of depression. We have chosen as most appropriate for our purpose Lakoff`s cognitive model for the analysis of metaphor (Lakoff, Women, Fire and Dangerous Things, 1984). Our analysis pays special attention to the "refuge in illness" and to the defensive function of symptoms, an aspect less covered by similar research in the area.
