Patients’ representations of depressive symptoms and physicians’ responses in clinical encounters

Abstract

Depression is defined by a list of symptoms. However, patients' experiences of these symptoms and the ways they are represented in medical consultations are not well described. Applying the methods of systemic functional linguistics and conversation analysis, we aim to explore how patients diagnosed with depression represent their depressive symptoms in medical consultations, and how physicians respond to patients' representations.We analyzed 30 video-recorded consultations between general practitioners or psychiatrists and patients with moderate depression, and found that one third of the patients represented experiences of activity located in the head or brain. The patients' representations of such head/brain symptoms were instantiated through a delimited set of transitivity patterns - material Processes and relational Processes - without any specification of agency. The transitivity patterns reflected experiences of head/brain symptoms taking place outside the patients' control. When physicians engaged with patients' head/brain experiences, they tried to make them fit into their own understanding of depression, which did not include head/brain symptoms detached from the patients' agency. Linguistic and interactional methods could promote insights into patients' experiences of depressive illness and we suggest that more focus should be placed on understanding patients' experiences, and that the intersubjective understanding of the patient could be further studied using linguistic methods.