Hello everyone, you must think that I am becoming obsessed with contested illnesses. The truth is, I think it is an important part of any primary care practice, and we need to wrap our minds around the issue, so to speak, to both become competent practitioners, as well as to think more systemically about patients’ needs vs. wants in any health system.
To me, discourse analysis is a very interesting method to delve into qualitative aspects of not only what someone is saying about a topic, but also how they are saying it, and sometimes when, why and why then as well. It is all about the colour and contour of conversation that reveals a lot about underlying motive and meaning.
I was interested in this study:
Knowing ‘ME’ Knowing You: The Discursive Negotiation of Contested Illness within a Family by Doug Crix, Jacqui Stedmon, Cordet Smart and Rudi Dallos, University of Plymouth
http://www.omicsgroup.org/journals/2167-1044/2167-1044-1-119.pdf
This is a case description of a single family with an adolescent suffering from chronic fatigue syndrome (CFS--the “ME” in the title is a play with the alternate name of the illness. It stands for “Myalgic Encephalomyelitis” but most of us avoid it because of the lack of documented brain inflammation in the illness). The analyzed conversation is truly fascinating.
I am running out of room, but briefly, discourse analysis in this family was able to reveal:
- conflict around the underlying cause of the illness, and the adolescent’s “agency” or “intentionality” with respect to it, i.e. her ability to control the course of the illness. E.g. to her sister, symptoms miraculously disappeared when the adolescent’s boyfriend was around.
- Potential meanings to the illness, which started immediately after a divorce centered around the mother’s own CFS. This may be leading to an enabling dynamic between the mother and the patient
Overall, the study permitted a richer exploration of the conflict surrounding CFS, one that took us beyond the traditional mind vs. body debate to reveal deeper layers of meaning and experience for a particular patient--embedded in her family dynamic.
