Interactions in psychiatric care consultation in Akan speaking communities
DOI:
https://doi.org/10.1558/cam.32241Keywords:
Akan, code-mixing, cultural psychiatry, Ghana, mental illness, patient-centered care, proverbs, shared decision-makingAbstract
The present paper examines interactions in psychiatric care consultation in selected hospital settings in three Akan-speaking communities in Ghana, based on 45 audio-recorded doctor/nurse-patient interactions. Using a discourse pragmatics approach, we note how language is used in the management of communication in psychiatric consultations, and how the dominance of healthcare practitioners is enacted. Specifically, we focus on some of the strategies used by the participants to manage the multilingual communicative settings, such as code-mixing. Our findings also suggest that the use of proverbs as a diagnostic tool in psychiatric consultations in Ghana needs to be reviewed. We propose that in order for patients to experience consultation sessions that are more interactive, with possible therapeutic benefits, health practitioners need to make considerable efforts to involve the patients in decisions regarding their health.
References
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Alarcón, R. D. (2009) Culture, cultural factors and psychiatric diagnosis: Review and projections. World Psychiatry 8 (3): 131-139. https://doi.org/10.1002/j.2051-5545.2009.tb00233.x
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Ansah, G. N. (2014) Re-examining the fluctuations in language in-education policies in post-independence Ghana. Multilingual Education 4 (1): 1-15. https://doi.org/10.1186/s13616-014-0012-3
Barron A. and Schneider K. (2014) Discourse pragmatics: Signposting a vast field. In K. P. Schneider and A. Barron (eds) Pragmatics of Discourse. Handbooks of Pragmatics 3: 1-33. Berlin: De Gruyter Mouton. https://doi.org/10.1515/9783110214406
Brannon G. E. (2016) History and mental status examination. Medscape. Retrieved from: https://emedicine.medscape.com/article/293402-overview
Bhugra, D. and Osborne, T. (2006) Cultural assessment and management. Psychiatry 5 (11): 379-382. https://doi.org/10.1053/j.mppsy.2006.08.007
Byrne, P. S. and Long, B. E. L. (1976) Doctors Talking to Patients. London: RCGP Publications.
Cohen, N. J., Farnia, F. and Im?Bolter, N. (2013) Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry 54 (7): 733-744. https://doi.org/10.1111/jcpp.12060
Cong Z. (2008) Application of proverbs in psychotherapy for the Chinese. World Cultural Psychiatry Research Review 3 (1): 16-19.
Cutting, J. (2002). Pragmatics and Discourse: A Resource Book for Students. London: Routledge.
Das, B. (2012) Code-switching as a communicative strategy in conversation. Global Media Journal - Indian Edition 3 (2): 1-20.
Delis, D. C., Kramer, J. H., Fridlund, A. J. and Kaplan, E. (2012) A cognitive science approach to neuropsychological assessment. In P. McReynolds, J. C. Rosen and G. J. Chelune (eds) Advances in Psychological Assessment, Volume 7, 101-132. New York: Springer.
https://doi.org/10.1007/978-1-4613-0555-2_4
Elmer, T., Rabenschlag, F., Schori, D., Zuaboni, G., Kozel, B., Jaeger, S., Mahlke, C., Heumann, K., Theodoridou, A. and Jaegar M. (2018) Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland. Psychiatry Research 262: 400-406.
https://doi.org/10.1016/j.psychres.2017.09.014
Favazza A. R. and Oman, M. (1984) Foundations of cultural psychiatry. In J. E. Mezzich and C. E. Berganza (eds) Cultural Psychopathology, 15-35. New York: Columbia University Press.
Ghana Statistical Service (2012) 2010 Population and Housing Census Summary Report of Final Results. Accra: Ghana Statistical Service. Available online: http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf
Giles, H., Coupland, N. and Coupland, J. (1991) Accommodation theory: Communication, context, and consequence. In H. Giles, J. Coupland and N. Coupland (eds) Contexts of Accommodation: Developments in Applied Sociolinguistics, 1-68. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511663673.001
Hassan, G., Kirmayer, L. J., MekkiBerrada A., Quosh, C., Chammay, R., Deville-Stoetzel, J. B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. and Ventevogel, P. (2015) Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict. Geneva: UNHCR.
https://doi.org/10.1017/S2045796016000044
Jäger, M. (2017) Informeller Zwang in der therapeutischen Beziehung [Informal coercion within the therapeutic relationship]. Praxis: Schweizerische Rundschau für Medizin 106 (2): 91-96. https://doi.org/10.1024/1661-8157/a002585
Jäger, M. and Rössler, W. 2009 Informeller Zwang zur Verbesserung der Behandlungsbereitschaft psychiatrischer Patienten [Informal coercion to enhance treatment adherence among psychiatric patients]. Neuropsychiatrie 23 (4): 206-215. https://doi.org/10.5414/NEPBand23206
https://doi.org/10.5414/NEPBand23206
Jacobs, E. A., Lauderdale D. S., Meltzer, D., Shorey, J. M., Levinson, W. and Thisted, R. A. (2001) Impact of interpreter services on delivery of health care to limited English proficient patients. Journal of General Internal Medicine 16 (7): 468-474. https://doi.org/10.1046/j.1525-1497.2001.016007468.x
Koh, H. K. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Department of Health and Human Services.
Kramer, J. E., Wang, C. B., Kwong, K., Lee, E. and Chung, H. (2002) Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine 176 (4): 227-231.
Manley, M. R. S. (2000) Psychiatric interview, history and mental status exam. In H. I. Kaplan and B. J. Sadock (eds) Comprehensive Textbook of Psychiatry (7th edition), 652-677. Philadelphia, PA: Lippincott Williams & Wilkins.
Matras, Y. (2009) Language Contact. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511809873
McCabe R., Heath C., Burns T. and Priebe S. (2002) Engagement of patients with psychosis in the consultation: Conversation analytic study. British Medical Journal 325: 1148-1151.
https://doi.org/10.1136/bmj.325.7373.1148
Nieva, V. F. and Sorra, J. (2003) Safety culture assessment: A tool for improving patient safety in healthcare organizations. Quality and Safety in Healthcare 12 (suppl. 2): 17-23.
https://doi.org/10.1136/qhc.12.suppl_2.ii17
Obeng, S. G. (2005) Akan and Nyo languages. In P. Strazny (ed.) Encyclopedia of Linguistics, 28-31. New York: Routledge.
Odebunmi, A. (2012) Code Selection at First Meetings: A Pragmatic Analysis of Doctor-Client Conversations in Nigeria. InLiSt: Interaction and Linguistic Structures 48. Available online: http://www.inlist.uni-bayreuth.de/issues/48/InLiSt48.pdf
Penn, N. E., Jacob, T. C. and Brown, M. (1988) Familiarity with proverbs and performance of a black population on Gorham’s proverbs test. Perceptual and Motor Skills 66 (3): 847-854.
https://doi.org/10.2466/pms.1988.66.3.847
Pestana-Santos, A., Loureiro, L., Santos, V. and Carvallio, I. P. (2018) Patients with schizophrenia assessing psychiatrists’ communication skills. Psychiatry Research 269: 13-20.
https://doi.org/10.1016/j.psychres.2018.08.040
Rao, N. R. (2007) The influence of culture on learning of psychiatry: The case of Asian-Indian international medical graduates. International Journal Applied Psychoanalytic Studies 4 (2): 128-143. https://doi.org/10.1002/aps.128
Roberts, C. and Sarangi, S. (2005) Theme-oriented discourse analysis of medical encounters. Medical Education 39 (6): 632-640. https://doi.org/10.1111/j.1365-2929.2005.02171.x
Romaine, S. (1995) Bilingualism. Oxford: Blackwell. https://doi.org/10.1016/B978-012589042-7/50019-0
Sarangi, S. (2004) Towards a communicative mentality in medical and healthcare practice. Communication and Medicine 1 (1): 1-11. https://doi.org/10.1515/come.2004.002
Simons, G. F. and Fennig, C. D. (eds) (2017) Ethnologue: Languages of the world (20th edition). Dallas, TX: SIL International. Available online: http://www.ethnologue.com
Spring, M. A., Ross, P. J., Etkin, N. L. and Deinard, A. S. (1995) Sociocultural factors to the use of prenatal care by Hmong women, Minneapolis. American Journal of Public Health 85: 1015-1017.
https://doi.org/10.2105/AJPH.85.7.1015
Themistocleous, M., McCabe, R., Rees, N., Hassan, I., Healey, P. G. T. and Priebe, S. (2009) Establishing mutual understanding in interaction: An analysis of conversational repair in psychiatric consultations. Communication & Medicine 6 (2): 165-176.
https://doi.org/10.1558/cam.v6i2.165
Tseng W. S. (2001) Handbook of Cultural Psychiatry. San Diego, CA: Academic Press.
https://doi.org/10.1016/B978-012701632-0/50128-5
US Department of Health and Human Services (2001) Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services.
Weiss, M. G. (ed.) (2001) Psychiatric diagnosis and illness experience. In A. T. Yilmaz, M. G. Weiss and A. Riecher-Rössler (eds) Cultural Psychiatry: Euro International Perspectives. Bibliotheca Psychiatrica 169: 21-34. Basel: Karger. https://doi.org/10.1159/000059548
Zethsen, K. K. and Askehave, I. (2009) Medical communication: Professional-lay. In J. L. Mey (ed.) Concise Encyclopedia of Pragmatics (2nd edition), 592-597. Oxford: Elsevier.
Alarcón, R. D. (2009) Culture, cultural factors and psychiatric diagnosis: Review and projections. World Psychiatry 8 (3): 131-139. https://doi.org/10.1002/j.2051-5545.2009.tb00233.x
Amfo, N. A. A., Houphouet, E. E., Dordoye, E. and Thompson, R. (2018) ‘Insanity is from home’: The expression of mental health challenges in Akan. International Journal of Language and Culture 5 (1): 1-28. https://doi.org/10.1075/ijolc.16016.amf
Ansah, G. N. (2014) Re-examining the fluctuations in language in-education policies in post-independence Ghana. Multilingual Education 4 (1): 1-15. https://doi.org/10.1186/s13616-014-0012-3
Barron A. and Schneider K. (2014) Discourse pragmatics: Signposting a vast field. In K. P. Schneider and A. Barron (eds) Pragmatics of Discourse. Handbooks of Pragmatics 3: 1-33. Berlin: De Gruyter Mouton. https://doi.org/10.1515/9783110214406
Brannon G. E. (2016) History and mental status examination. Medscape. Retrieved from: https://emedicine.medscape.com/article/293402-overview
Bhugra, D. and Osborne, T. (2006) Cultural assessment and management. Psychiatry 5 (11): 379-382. https://doi.org/10.1053/j.mppsy.2006.08.007
Byrne, P. S. and Long, B. E. L. (1976) Doctors Talking to Patients. London: RCGP Publications.
Cohen, N. J., Farnia, F. and Im?Bolter, N. (2013) Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry 54 (7): 733-744. https://doi.org/10.1111/jcpp.12060
Cong Z. (2008) Application of proverbs in psychotherapy for the Chinese. World Cultural Psychiatry Research Review 3 (1): 16-19.
Cutting, J. (2002). Pragmatics and Discourse: A Resource Book for Students. London: Routledge.
Das, B. (2012) Code-switching as a communicative strategy in conversation. Global Media Journal - Indian Edition 3 (2): 1-20.
Delis, D. C., Kramer, J. H., Fridlund, A. J. and Kaplan, E. (2012) A cognitive science approach to neuropsychological assessment. In P. McReynolds, J. C. Rosen and G. J. Chelune (eds) Advances in Psychological Assessment, Volume 7, 101-132. New York: Springer.
https://doi.org/10.1007/978-1-4613-0555-2_4
Elmer, T., Rabenschlag, F., Schori, D., Zuaboni, G., Kozel, B., Jaeger, S., Mahlke, C., Heumann, K., Theodoridou, A. and Jaegar M. (2018) Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland. Psychiatry Research 262: 400-406.
https://doi.org/10.1016/j.psychres.2017.09.014
Favazza A. R. and Oman, M. (1984) Foundations of cultural psychiatry. In J. E. Mezzich and C. E. Berganza (eds) Cultural Psychopathology, 15-35. New York: Columbia University Press.
Ghana Statistical Service (2012) 2010 Population and Housing Census Summary Report of Final Results. Accra: Ghana Statistical Service. Available online: http://www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf
Giles, H., Coupland, N. and Coupland, J. (1991) Accommodation theory: Communication, context, and consequence. In H. Giles, J. Coupland and N. Coupland (eds) Contexts of Accommodation: Developments in Applied Sociolinguistics, 1-68. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511663673.001
Hassan, G., Kirmayer, L. J., MekkiBerrada A., Quosh, C., Chammay, R., Deville-Stoetzel, J. B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. and Ventevogel, P. (2015) Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict. Geneva: UNHCR.
https://doi.org/10.1017/S2045796016000044
Jäger, M. (2017) Informeller Zwang in der therapeutischen Beziehung [Informal coercion within the therapeutic relationship]. Praxis: Schweizerische Rundschau für Medizin 106 (2): 91-96. https://doi.org/10.1024/1661-8157/a002585
Jäger, M. and Rössler, W. 2009 Informeller Zwang zur Verbesserung der Behandlungsbereitschaft psychiatrischer Patienten [Informal coercion to enhance treatment adherence among psychiatric patients]. Neuropsychiatrie 23 (4): 206-215. https://doi.org/10.5414/NEPBand23206
https://doi.org/10.5414/NEPBand23206
Jacobs, E. A., Lauderdale D. S., Meltzer, D., Shorey, J. M., Levinson, W. and Thisted, R. A. (2001) Impact of interpreter services on delivery of health care to limited English proficient patients. Journal of General Internal Medicine 16 (7): 468-474. https://doi.org/10.1046/j.1525-1497.2001.016007468.x
Koh, H. K. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Department of Health and Human Services.
Kramer, J. E., Wang, C. B., Kwong, K., Lee, E. and Chung, H. (2002) Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine 176 (4): 227-231.
Manley, M. R. S. (2000) Psychiatric interview, history and mental status exam. In H. I. Kaplan and B. J. Sadock (eds) Comprehensive Textbook of Psychiatry (7th edition), 652-677. Philadelphia, PA: Lippincott Williams & Wilkins.
Matras, Y. (2009) Language Contact. Cambridge: Cambridge University Press.
https://doi.org/10.1017/CBO9780511809873
McCabe R., Heath C., Burns T. and Priebe S. (2002) Engagement of patients with psychosis in the consultation: Conversation analytic study. British Medical Journal 325: 1148-1151.
https://doi.org/10.1136/bmj.325.7373.1148
Nieva, V. F. and Sorra, J. (2003) Safety culture assessment: A tool for improving patient safety in healthcare organizations. Quality and Safety in Healthcare 12 (suppl. 2): 17-23.
https://doi.org/10.1136/qhc.12.suppl_2.ii17
Obeng, S. G. (2005) Akan and Nyo languages. In P. Strazny (ed.) Encyclopedia of Linguistics, 28-31. New York: Routledge.
Odebunmi, A. (2012) Code Selection at First Meetings: A Pragmatic Analysis of Doctor-Client Conversations in Nigeria. InLiSt: Interaction and Linguistic Structures 48. Available online: http://www.inlist.uni-bayreuth.de/issues/48/InLiSt48.pdf
Penn, N. E., Jacob, T. C. and Brown, M. (1988) Familiarity with proverbs and performance of a black population on Gorham’s proverbs test. Perceptual and Motor Skills 66 (3): 847-854.
https://doi.org/10.2466/pms.1988.66.3.847
Pestana-Santos, A., Loureiro, L., Santos, V. and Carvallio, I. P. (2018) Patients with schizophrenia assessing psychiatrists’ communication skills. Psychiatry Research 269: 13-20.
https://doi.org/10.1016/j.psychres.2018.08.040
Rao, N. R. (2007) The influence of culture on learning of psychiatry: The case of Asian-Indian international medical graduates. International Journal Applied Psychoanalytic Studies 4 (2): 128-143. https://doi.org/10.1002/aps.128
Roberts, C. and Sarangi, S. (2005) Theme-oriented discourse analysis of medical encounters. Medical Education 39 (6): 632-640. https://doi.org/10.1111/j.1365-2929.2005.02171.x
Romaine, S. (1995) Bilingualism. Oxford: Blackwell. https://doi.org/10.1016/B978-012589042-7/50019-0
Sarangi, S. (2004) Towards a communicative mentality in medical and healthcare practice. Communication and Medicine 1 (1): 1-11. https://doi.org/10.1515/come.2004.002
Simons, G. F. and Fennig, C. D. (eds) (2017) Ethnologue: Languages of the world (20th edition). Dallas, TX: SIL International. Available online: http://www.ethnologue.com
Spring, M. A., Ross, P. J., Etkin, N. L. and Deinard, A. S. (1995) Sociocultural factors to the use of prenatal care by Hmong women, Minneapolis. American Journal of Public Health 85: 1015-1017.
https://doi.org/10.2105/AJPH.85.7.1015
Themistocleous, M., McCabe, R., Rees, N., Hassan, I., Healey, P. G. T. and Priebe, S. (2009) Establishing mutual understanding in interaction: An analysis of conversational repair in psychiatric consultations. Communication & Medicine 6 (2): 165-176.
https://doi.org/10.1558/cam.v6i2.165
Tseng W. S. (2001) Handbook of Cultural Psychiatry. San Diego, CA: Academic Press.
https://doi.org/10.1016/B978-012701632-0/50128-5
US Department of Health and Human Services (2001) Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services.
Weiss, M. G. (ed.) (2001) Psychiatric diagnosis and illness experience. In A. T. Yilmaz, M. G. Weiss and A. Riecher-Rössler (eds) Cultural Psychiatry: Euro International Perspectives. Bibliotheca Psychiatrica 169: 21-34. Basel: Karger. https://doi.org/10.1159/000059548
Zethsen, K. K. and Askehave, I. (2009) Medical communication: Professional-lay. In J. L. Mey (ed.) Concise Encyclopedia of Pragmatics (2nd edition), 592-597. Oxford: Elsevier.
Published
2019-07-03
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How to Cite
Amfo, N. A. A., Houphouet, E. E., Dordoye, E. K., & Thompson, R. (2019). Interactions in psychiatric care consultation in Akan speaking communities. Communication and Medicine, 15(1), 40-52. https://doi.org/10.1558/cam.32241
