The Four Perspectives Model for Psychological/Psychiatric Case Formulations in Analysing the Discourse of Clinical-diagnostic Case Reporting
Extending Research Horizons in Applied Linguistics - Between Interdisciplinarity and Methodological Diversity - Hadrian Aleksander Lankiewicz
Magdalena Zabielska [+]
Adam Mickiewicz University
Numerous studies conducted so far in broadly understood healthcare communication which have drawn on the theories from the neighbouring disciplines such as the sociology of medicine, social psychology, philosophy of medicine, medical anthropology or medical ethics, have proven to be effective in tapping into the construction of professional and lay identities as well as into the very nature of communication in this particularly sensitive context (Watts 2008, 2010). In the current chapter, the four perspectives model, originally developed for streamlining the construction of case formulations in psychology and psychiatry, will be applied as a tool in studying the language of clinical-diagnostic case reporting. A case report as a written medical genre discusses unknown diseases, their new aspects or anything novel about a specific treatment or drug use. On the other hand, case formulations, psychological/psychiatric equivalents of clinical-diagnostic case reports, “involve turning a patient’s narrative and all the information derived from examinations, interviews with parents and teachers, and medical and school reports into a coherent and not necessarily lengthy story that will help to develop a treatment plan” (Henderson and Martin 2015). The four perspectives model outlines four elements key to the complete description of a patient, their condition and following treatment, namely disease, dimensions, perspective and the life story (Winters et al. 2007; Havighurst and Downey 2009). What lies at the heart of this approach is that it views psychological and social factors as integral elements of each case, thus emphasising the differentiating features of psychology and psychiatry as disciplines. “[P]sychiatrists for the most part cannot use a stethoscope or the variety of tests (such as bloodwork, electrocardiograms and blood pressure readings) that other kinds of physicians routinely use as sources of information in making their diagnoses” (Berkenkotter 2008: 2). Although primarily content-related in its original milieu, the model may be applied to the study of the discourse of clinical-diagnostic case reporting. Since the model features guidelines which help to discursively construct a complete case not only from the biomedical (Wade and Halligan 2004) but also from the patient-centred (Balint et al. 1970) perspectives, it may provide useful categories of information to be included in clinical-diagnostic case reports. It may also aid the identification or choice of the corresponding linguistic resources to express the information required and help to differentiate between these two perspectives. Data for the present analysis will constitute a collection of medical case reports derived from professional medical journals. It will be demonstrated that the texts written from the clinical-diagnostic perspective can be understood better and potentially constructed more effectively with reference to particular conceptualisations of various social and mental phenomena as routinely utilised in psychology and psychiatry.