HUMSS - Anssi Peräkylä

Identity Ambivalence in Psychiatric Interviews

In diagnostic interviews in psychiatry, clinicians elicit information about patient behaviours and experiences that can be understood as symptoms of underlying disorders. In personality disorders -- such as borderline personality -- the relevant symptoms involve behaviours that in the general cultural sense are considered as "bad":  for example losing one's temper, shouting at others, and physical violence.  In terms of the sociologist Erving Goffman (1963), such behaviours can be "stigmatizing": they are "blemishes of character" that can discredit the social identity of the person. Through conversation analysis of video recorded assessment interviews, I will show how one patient, young woman, deals with such stigma when being interviewed about her impulsive behaviours. Her relation to her own impulsive behaviours is ambivalent. When describing her behaviours, se on one hand displays that she considers her own behaviours as reproachable. This is done by inserting negative evaluations in her talk, by employing "extreme case formulations" that depict the behaviours as out of the ordinary and excessive, and by bodily displays of negative stance. Yet, this patient, on the other hand, also displays a different relation to her behaviours. Through lexical, prosodic and bodily means, she sometimes adopts a nonchalant and defiant stance when describing her impulsive behaviours. When describing impulsive episodes, she shows that in spite of the impulsivity, she still acts responsibly; and that others, not only herself, are responsible for such episodes. In the discussion, I will suggest that, in spite of the assumed moral neutrality of medical discourse, the participants in psychiatric interview are thoroughly oriented to the threat to patient's identity that the interview entails.