‘Good’ communication in schizophrenia: A conversation analytic definition

Abstract

Schizophrenia is one of the most serious conditions psychiatrists are likely to encounter. Its complex psychopathology includes changes in thought and perception - Delusions and hallucinations. Along with personal distress, this detachment from ‘reality’ (psychosis) brings complexity to psychiatrists’ interviews with patients. Not least, at times, an ontological ‘incompatibility’. The clinician must walk a ‘tightrope’: asking questions of appropriate depth and pace, while maintaining an attitude of non-confrontation and non-collusion around psychotic symptoms (Turkington & Siddle, 1998). Meanwhile, the heterogeneous course and clinical presentation of schizophrenia (Van Os & Kapur, 2009) creates a second delicate balance to achieve. The psychiatrist must understand the individual in their unique psychosocial context: diagnostically disentangling ‘pathological’ behaviour from what may be valid attempts to deal with distress or disturbances caused by particular social circumstances (see BPS, 2014). Achieving this means putting patient experience at the heart of psychiatric communication - a ‘partnership’ paradigm of care (NICE, 2009), removed from psychiatry’s historic reputation of social repression.