Diagnosing as an interactional achievement in psychiatric interviews

Abstract

What is involved in exploring a patient’s mental state? How is a diagnosis or a decision about a patient’s psychopathological status accomplished? How do psychiatrists make patients talk about their problems? The first encounter, in a psychiatric hospital, between a psychiatrist and the prospective patient is quite significant for the fate of the latter. In a psychiatric intake interview (PII) the psychiatrist’s official task is to determine whether a person should be hospitalised - Voluntarily or involuntarily - as a patient on the basis of the person’s observable behaviour during the interview. Customarily, this implies that the psychiatrist needs to solicit the patient to talk about the problems that brought him/her to hospital and make a decision regarding the candidate patient’s mental state. In the other type of psychiatric interview, the subsequent psychiatric interview, the psychiatrist’s assignment is to monitor the behavioural progress of a psychiatric in-patient, with the view to a possible future discharge. For example, in the adult psychiatric treatment interview, psychiatrists are charged with asking questions of the patients with appropriate depth and pace (Thompson & McCabe, Chapter 20, this volume).