Treating without diagnosis: Psychoanalysis in medical settings in Argentina
Issue: Vol 11 No. 1 (2014)
Journal: Communication & Medicine
Subject Areas: Healthcare Communication Linguistics
Abstract:
This article is part of a larger research project the aim of which is to understand the discursive conditions of access and adherence to an outpatient mental health service at a public hospital in Buenos Aires, Argentina. The focus is on the historical conflict between medical discourse and psychoanalytical discourse as it emerges in the negotiation of treatment and diagnostic sequences at first consultations. This allows us to observe, on the one hand, patients who, socialized in medical discourse, and even in psychiatric discourse, expect the usual organization which first offers a diagnosis, however transitory, and then a treatment recommendation. On the other hand, however, psychoanalysts tend to reject diagnostic labels and offer treatment without further justification. This has an impact on the adherence of patients, and allows us to argue for the need of negotiating with medical discourse in order to guarantee engagement and continuity in treatment.
Author: Juan Eduardo Bonnin
References :
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Washington, DC: APA.
Anderson, J., Rainey, M. and Eysenbach, G. (2003) The impact of cyberhealthcare on the physician–patient relationship. Journal of Medical Systems 27 (1): 67–84. http://dx.doi.org/10.1023/A:1021061229743
Antaki, C., Barnes, R. and Leudar, I. (2005) Diagnostic formulations in psychotherapy. Discourse Studies 7 (6): 627–647. http://dx.doi.org/10.1177/1461445605055420
Arnoux, E. B. N. (2006) Análisis del Discurso: Modos de abordar materiales de archivo [Discourse Analysis: Ways for Approaching Archive Materials]. Buenos Aires: Santiago Arcos.
Balán, J. (1992) Cuéntame tu vida: Una biografía colectiva del psicoanálisis argentino [Tell Me About You: A Collective Biography of Argentinean Psychoanalysis]. Buenos Aires: Planeta.
Bartesaghi, M. (2009) Conversation and psychotherapy: How questioning reveals institutional answers. Discourse Studies 11 (2): 153–177. http://dx.doi.org/10.1177/1461445608100942
Blommaert, J. (2005) Discourse: A Critical Introduction. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511610295
Bolívar, A. (2010) A change in focus: From texts in contexts to people in events. Journal of Multicultural Discourses 5 (3): 213–225. http://dx.doi.org/10.1080/17447141003602312
Bonnin, J. E. (2013) The public, the private and the intimate in doctor–patient communication: Admission interviews at an outpatient mental health care service. Discourse Studies 15 (6): 687–711. http://dx.doi.org/10.1177/1461445613492249
Bonnin, J. E. (2014) Expanded answers to bureaucratic questions: Negotiating access to public healthcare. Journal of Sociolinguistics 18 (5): 685–707. http://dx.doi.org/10.1111/josl.12093
Broom, A. (2005) Virtually he@lthy: The impact of internet use on disease experience and the doctor–patient relationship. Qualitative Health Research 15 (3): 325–345. http://dx.doi.org/10.1177/1049732304272916
Crowe, M. (2000) Constructing normality: A discourse analysis of the DSM-IV. Journal of Psychiatric and Mental Health Nursing 7 (1): 69–77. http://dx.doi.org/10.1046/j.1365-2850.2000.00261.x
Foucault, M. (1969) L’Archéologie du savoir [The Archaeology of Knowledge]. Paris: Gallimard.
Garand, L., Lingler, J., Conner, K. and Dew, M. (2009) Diagnostic labels, stigma, and participation in research related to dementia and mild cognitive impairment. Research in Gerontological Nursing 2 (2): 112–121. http://dx.doi.org/10.3928/19404921-20090401-04
Giles, D. and Newbold, J. (2011) Self- and other-diagnosis in user-led mental health online communities. Qualitative Health Research 21 (3): 419–428. http://dx.doi.org/10.1177/1049732310381388
Heritage, J. and Maynard, D. (eds) (2006) Communication in Medical Care: Interaction between Primary Health Care Physicians and Patients. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511607172
Heritage, J. C. and Watson, D. R. (1979) Formulations as conversational objects. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 123–162. New York: Irvington.
Koenig, C. (2011) Patient resistance as agency in treatment decisions. Social Science & Medicine 72 (7): 1105–1114. http://dx.doi.org/10.1016/j.socscimed.2011.02.010
Lakoff, A. (2003) The Lacan ward: Pharmacology and subjectivity in Buenos Aires. Social Analysis 47 (2): 82–101. http://dx.doi.org/10.3167/015597703782352970
Lakoff, A. (2006) Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. Cambridge: Cambridge University Press.
Macchioli, F. (2012) Inicios de la terapia familiar en la Argentina. 1960–1979 [Beginnings of family therapy in Argentina. 1960–1979]. Estudos e pesquisas em psicologia 12 (1): 274–287.
Maynard, D. (2004) On predicating a diagnosis as an attribute of a person. Discourse Studies 6 (1): 53–76. http://dx.doi.org/10.1177/1461445604039439
Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.
Peräkyla, A., Antaki, C., Vehilläinen, S. and Leudar, I. (2008) Analysing psychotherapy in practice. In A. Peräkyla, C. Antaki, S. Vehilläinen and I. Leudar (eds) Conversation Analysis and Psychotherapy, 5–25. Cambridge: Cambridge University Press.
Plotkin, M. (2001) Freud in the Pampas: The Emergence and Development of a Psychoanalytic Culture in Argentina. Stanford, CA: Stanford University Press.
Richards, K. and Seedhouse, P. (2005) Applying Conversation Analysis. Basingstoke, UK: Palgrave Macmillan.
Rubistein, A. (1999) Algunas cuestiones relativas al diagnóstico en psicoanálisis [Some issues regarding diagnosis in psychoanalysis]. Revista de psicoanálisis 1: 119–127.
Schafer, R. (2005) Listening in psychoanalysis. Narrative 3 (3): 272–280.
Telles Ribeiro, B. (1994) Coherence in Psychotic Discourse. Oxford: Oxford University Press.
Thompson, S., Frydman, A., Salinas, L., Mantegazza, R., Toro, C. and Lombardi, G. (2006) El proceso diagnóstico en psicoanálisis [Diagnostic process in psychoanalysis]. Anuario de Investigaciones 14: 103–110.
Waska, R. (2006) Psychoanalysis or psychoanalytic psychotherapy? Shifting the debate from theoretical to clinical with the concept of analytic contact. Bulletin of the Menninger Clinic 70 (2): 145–159. http://dx.doi.org/10.1521/bumc.2006.70.2.145
World Health Organization (1999) International Classification of Diseases. Geneva: WHO.