Clinical writing and the documentary construction of schizophrenia

Abstract

Psychiatric practice involves writing as much as it involves talking. This study examines the interpretive processes of reading, writing and interviewing which are central to the clinical interaction. It is part of a broader ethnographic study of an Australian psychiatric hospital (which specializes in the treatment of patients with a diagnosis of schizophrenia). The paper examines two major types of written assessment of patients--the admission assessment and the 'complete work-up.' Writing is analyzed as performance, thereby focusing on the transformations that are effected in patients, their perceptions of their schizophrenia, and their total identity. One crucial transformation is from 'person suffering from schizophrenia' to 'schizophrenic.' The paper aims to show that as much as psychiatry is a 'talking cure' it is also a 'writing cure.'

Practices of reading and writing: the constitutive role of the patient record in medical work

“…As Barrett (1988) notes regarding the psychiatric admission form he studied, 'the structure of the record implied that the author's conclusions (Diagnosis and Opinion) be read as a logical (if provisional) sequitur of the data base -as if derived by induction'. The records studied here did not ask for an 'opinion' but for a 'problem list' or a 'conclusion' -but the logical structure of the scientific process of data-gathering and hypothesis-generation is inscribed here just as much.…”

Deconstructing `Paranoia'

“…The reification of form over 'meaningless' content One of the surprising things about diagnostic classification systems like the DSM-IV, ICD-10 and interview schedules like the Present State Examination (Wing, Cooper & Sartorious, 1974) is that they pay relatively little attention to the content of particular phenomena and much more to their form. These frameworks transform behaviour into symptoms which are either present or absent (Barrett, 1988). Thus what a psychiatric patient talks about in the course of a diagnostic interview becomes transformed into a 'belief' which in turn may be transformed into a 'delusion' if it meets certain criteria.…”

“…Thinking about one's emotional state, discussing it with others, talking with one's general practitioner or other health professional are all textually constituted. Furthermore, professionals' diagnoses and treatment decision-making are discursively constructed (Barrett, 1988;Hak, 1989Hak, , 1992Harper, 1994a;Soyland, 1994b). Moreover psychology and psychiatry are deeply metaphorical disciplines (Leary, 1990;Soyland, 1994a).…”

Histories of suspicion in a time of conspiracy: a reflection on Aubrey Lewis's history of paranoia

“…There is wide use of case material sometimes only briefly described. Barrett's (1988) work has shown how the ambiguity and complexity of what is said in the context of a psychiatric interview becomes transformed into uncomplicated objectified symptoms in psychiatric case-notes. Furthermore, we rarely have first-hand accounts of experiences of distress, only second-hand and highly interested case descriptions by 'mad-doctors'.…”