In a longitudinal conversation analytical (CA) case study, we examined patient engagement in a psychiatric assessment process (nine clinical interviews) with a young woman who eventually received the diagnosis of personality disorder. Based on Goffman, we consider engagement in interaction as consisting of three facets: engagement in the action at hand, bodily engagement with the co‐participant, and engagement with the local moral order of the encounter. The patient begins the assessment process with high engagement and ends it up in low engagement. Yet, during this process, the patient oscillates between moments of high and low engagement. We show how the Goffmanian idea of engagement can be elaborated by CA. On the other hand, the Goffmanian view enriches CA by bringing to the foreground the interconnectedness of the different facets of engagement. A video abstract is available at https://youtu.be/S7BA7HRFvJ0.
What does it mean to claim that somebody’s personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians’ and the patients’ approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient – and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected – not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.
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