Item Details

Verbal and nonverbal communication of agency in illness narratives of patients suffering from medically unexplained symptoms (MUS)

Issue: Vol 15 No. 1 (2018)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.32305

Abstract:

The objective of the study is to explore how patients presenting medically unexplained symptoms (MUS) - that is, symptoms that do not have an obvious underlying diagnosis - communicate agency. It is assumed that agency can be exercised verbally through narrative structure and content as well as nonverbally through patients' behaviours, in particular their gestures. This, in turn, points to the ways patients conceptualize their identities and selves. Pauses and disfluencies in the patients' accounts as well as an imprecise use of gestures can indicate a cognitive or conceptual conflict and uncertainty related to MUS. This paper reports on preliminary findings obtained from the analysis of 20 video-filmed interviews with Polish patients with MUS, and presents two case studies of patients who, despite fairly similar medical test results, deliver different illness narratives: (1) a narrative indicative of low agency and characterized by fragmentation, vagueness, repetitiveness and redundancy of content, dispreference markers and the imprecise use of gestures; and (2) a narrative reflecting high agency, characterized by specificity, coherence and the precise use of gestures.

Author: Agnieszka Sowińska

View Full Text

References :

Anton, M. (2015) Sociocultural and activity theory perspectives on agency in Spanish-speaking diabetes patients. In E. Goering and M. Anton (eds) Understanding Patients’ Voices: A Multi-method Approach to Health Discourse, 87-103. Amsterdam: John Benjamins.
https://doi.org/10.1075/pbns.257.06ant

Arduser, L. (2014) Agency in illness narratives. Narrative Inquiry 24 (1): 1-27.
https://doi.org/10.1075/ni.24.1.01ard

Barker, K. K. (2010) The social construction of illness: Medicalization and the contested illness. In C. E. Bird, P. Conrad, A. M. Fremont and S. Timmermans (eds) The Handbook of Medical Sociology (6th edition), 147-162. Nashville, TN: Vanderbilt University Press.

Boruta, M. (2016) Gesture in Context: Analyses of Interviews between a General Practitioner and Patients Presenting Medically Unexplained Symptoms (MUS). Unpublished Master’s dissertation, Nicolaus Copernicus University, Torun.

Burbaum, C., Stresing, A. M., Fritzsche, K., Auer, P., Wirsching, M., and Lucius-Hoene, G. (2010) Medically unexplained symptoms as a threat to patients’ identity? A conversation analysis of patients’ reactions to psychosomatic attributions. Patient Education and Counseling 79 (2): 207-217.
https://doi.org/10.1016/j.pec.2009.09.043

Bury, M. (2001) Illness narratives: Fact or fiction? Sociology of Health & Illness 23 (3): 263-285.
https://doi.org/10.1111/1467-9566.00252

Charmaz, K. (1991) Good Days, Bad Days: The Self in Chronic Illness and Time. New Brunswick, NJ: Rutgers University Press.

Charon, R. (2001) Narrative medicine. A model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286 (15): 1897-1902.
https://doi.org/10.1001/jama.286.15.1897

Cheshire, J. and Ziebland, S. (2005) Narrative as a resource in accounts of the experience of illness. In J. Coates and J. Thornborrow (eds) Sociolinguistics of Narrative, 17-40. Amsterdam: John Benjamins.
https://doi.org/10.1075/sin.6.02che

Cienki, A. and Müller, C. (2008) Metaphor, gesture and thought. In R. W. Gibbs, Jr. (ed.) The Cambridge Handbook of Metaphor and Thought, 483-501. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511816802.029

Czachowski, S., Piszczek, E., Sowińska, A. and Olde Hartman, T. C. (2012) GPs’ challenges in the management of patients with medically unexplained symptoms in Poland: A focus group-based study. Family Practice 29 (2): 228-234. doi: 10.1093/fampra/cmr065.
https://doi.org/10.1093/fampra/cmr065

Czachowski, S., Terluin, B., Izdebski, A. and Izdebski, P. (2012) Evaluating the cross-cultural validity of the Polish veresion of the Four-Dimensional Symptom Questionnaire (4DSQ) using differential item functioning (DIF) analysis. Family Practice 29 (5) : 609-615.
https://doi.org/10.1093/fampra/cms016

De Fina, A. and Georgakopoulou, A. (2012) Analyzing Narrative: Discourse and Sociolinguistic Perspectives. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9781139051255

Dipper, L., Pritchard, M., Morgan, G. and Cocks, N. (2015) The language gesture connection: Evidence from aphasia. Clinical Linguistics & Phonetics 29 (8-10): 748-763.
https://doi.org/10.3109/02699206.2015.1036462

Duranti, A. (2004) Agency in Language. In A. Duranti (ed.) A Companion to Linguistic Anthropology. Oxford: Blackwell.
https://doi.org/10.1111/b.9781405144308.2005.00001.x

Elderkin-Thompson, V., Silver, R. C. and Waitzkin, H. (1998) Narratives of somatizing and non-somatizing patients in a primary care setting. Journal of Health Psychology 3 (3): 407-428.
https://doi.org/10.1177/135910539800300309

Ellgring, H. (2008) Nonverbal Communication in Depression. Cambridge: Cambridge University Press.

Ekman, P. and Friesen, W. V. (1969) The repertoire of nonverbal behavior: Categories, origins, usage, and coding. Semiotica 1 (1): 49-98.
https://doi.org/10.1515/semi.1969.1.1.49

Frank, A. (1995) The Wounded Storyteller: Body, Illness and Ethics. Chicago: University of Chicago Press.
https://doi.org/10.7208/chicago/9780226260037.001.0001

Goering, E. (2015) Metaphors as mirrors into what it means to be diabetic. In E. Goering and M. Anton (eds) Understanding Patients’ Voices: A Multi-method Approach to Health Discourse, 71-86. Amsterdam: John Benjamins.
https://doi.org/10.1075/pbns.257.05goe

Heath, C. (1986) Body Movement and Speech in Medical Interaction. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511628221

Heath, C. (2002) Demonstrative suffering: The gestural (re)embodiment of symptoms. Journal of Communication 52 (3): 597-616.
https://doi.org/10.1111/j.1460-2466.2002.tb02564.x

Heath, C., Hindmarsh, J. and Luff, P. (2010) Video in Qualitative Research. London: Sage.

Japp, P. M. and Japp, D. K. (2005) Desperately seeking legitimacy: Narratives of a biomedically invisible disease. In L. M. Harter, P. M. Japp and C. S. Beck (eds) Narratives, Health and Healing: Communication Theory, Research and Practice, 107-130. Mahwah, NJ: Erlbaum.

Jefferson, G. (2004) Glossary of transcript symbols with an introduction. Pragmatics and Beyond (new series) 125: 13-34.
https://doi.org/10.1075/pbns.125.02jef

Kendon, A. (2000) Language and gesture: Unity or duality? In D. McNeill (ed.) Language and Gesture: Window into Thought and Action, 47-63. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511620850.004

Kita, S. (2000) How representational gestures help speaking. In D. McNeill (ed.) Language and Gesture: Window into Thought and Action, 162-185. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511620850.011

Kita, S. and Özyürek, A. (2007) How does spoken language shape iconic gestures? In S. Duncan, J. Cassel and E. Levy (eds) Gesture and the Dynamic Dimension of Language, 67-74. Amsterdam: John Benjamins.
https://doi.org/10.1075/gs.1.07kit

Labov, W. and Waletzky, J. (1967) Narrative analysis: Oral versions of personal experience. Journal of Narrative and Life History 7 (1-4): 3-38.
https://doi.org/10.1075/jnlh.7.02nar

Max Planck Institute (2016) ELAN 4.9.4. Max Planck Institute for Psycholinguistics, The Language Archive, Nijmegen, The Netherlands. Available online: http://tla.mpi.nl/tools/tla-tools/elan/

McNeill, D. (1992) Hand and Mind: What Gestures Reveal about Thought. Chicago: University of Chicago Press.

McNeill, D. (2000) Language and Gesture: Window into Thought and Action. Cambridge: Cambridge University Press.

Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.

Mishler, E. G. (1999) Storylines: Craftartists’ Narratives of Identity. Cambridge, MA: Harvard University Press.

Nettleton, S., O’Malley, L., Watt, I. and Duffey, P. (2004) Enigmatic illness: Narratives of patients who live with medically unexplained symptoms. Social Theory and Health 2 (1): 47-66.
https://doi.org/10.1057/palgrave.sth.8700013

Nettleton, S., Watt, I., O’Malley, L. and Duffey, P. (2005) Understanding the narratives of people who live with medically unexplained illness. Patient Education and Counseling 56 (2): 205-210.
https://doi.org/10.1016/j.pec.2004.02.010

Olde Hartman, T. C., Blankenstein, A. H., Molenaar, A. O., Bentz van den Berg, D., Van der Horst, H. E., Arnold, I. A., Burgers, J. S., Wiersma T. and Woutersen-Koch, H. (2013) NHG guideline on medically unexplained symptoms (MUS). Huisarts Wet 56 (5): 222-230.

Özyürek, A. (2002) Do speakers design their co-speech gestures for their addresees? The effects of addressee location on representational gestures. Journal of Memory and Language 46 (4): 688-704.
https://doi.org/10.1006/jmla.2001.2826

Parry, R. (2010) Video-based conversation analysis. In I. Bourgeault, R. Dingwall and R. de Vries (eds) The SAGE Handbook of Qualitative Methods in Health Research, 373-396. London: Sage.
https://doi.org/10.4135/9781446268247.n20

Philippot, P, Feldman R, Coats E. (2003) The role of nonverbal behavior in clinical settings. In P. Philippot, R. Feldman and E. Coats (eds) Nonverbal Behavior in Clinical Settings, 3-13. New York, NY: Oxford University Press.
https://doi.org/10.1093/med:psych/9780195141092.003.0001

Riessman, C. K. (2002) Illness narratives: Positioned identities. Paper presented at the Health Communication Research Centre, Cardiff University, Wales, UK.

Schmid Mast, M. (2007) On the importance of nonverbal communication in the physician-patient interaction. Patient Education and Counselling 67 (3): 315-318.
https://doi.org/10.1016/j.pec.2007.03.005

Sowińska, A. (2014) ‘I must do everything to eliminate my negative attitude’: Polish general practitioners’ emotions toward patients with medically unexplained symptoms. In F. Baider and G. Cislaru (eds) Emotions in Context, 309-330. Amsterdam: John Benjamins.
https://doi.org/10.1075/pbns.241.18sow

Sowińska, A. (2018) ‘I didn’t want to be Psycho no. 1’: Identity struggles in narratives of patients presenting medically unexplained symptoms. Discourse Studies 20 (4): 506-522. https://doi.org/10.1177/1461445618754433
https://doi.org/10.1177/1461445618754433

Sowińska, A. and Czachowski, S. (2018) Patients’ experiences of living with medically unexplained symptoms (MUS): A qualitative study. BMC Family Practice 19 (1): 23. doi 10.1186/s12875-018-0709-6
https://doi.org/10.1186/s12875-018-0709-6

Williams, G. (1984) The genesis of chronic illness: Narrative reconstruction. Sociology of Health and Illness 6 (2): 175-200.
https://doi.org/10.1111/1467-9566.ep10778250

World Health Organization (1992) International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10). Geneva: World Health Organization.