Conversation Analysis and Medicine

Beginning with phone calls to an emergency psychiatric hospital and suicide prevention center, the roots of Conversation Analysis (CA) are embedded in systematic analyses of routine problems occurring between ordinary persons facing troubling health challenges, care providers, and the institutions they represent. After more than 50 years of research, CA is now a vibrant and robust mode of scientific investigation that includes close examination of a wide array of medical encounters between patients and their providers. Considerable efforts have been made to overview CA and medicine as a rapidly expanding mode of inquiry and field of research. Across a span of 18 years, we sample from 10 of these efforts to synthesize important priorities and findings emanating from CA investigations of diverse interactional practices and health care institutions. Key topics and issues are raised that provide a unique opportunity to identify and track the development and maturity of CA approaches to medical encounters. Attention is also given to promising new modes of research, and to the potential and challenges of improving medical practices by translating basic and rigorous empirical findings into innovative interventions for medical education. A case is made that increasing reliance on CA research can positively impact training and policies shaping the delivery of humane and quality medical care.

Gender Differences in Suicidal Intent and Choice of Method Among Suicide Attempters

The objective was to examine gender differences in choice of method and suicidal intent among persons referred to a suicide prevention center. A total of 351 consecutive patients who had attempted suicide were interviewed using the European Parasuicide Study Interview Schedule I (EPSIS I) while participating in a 2-week inpatient treatment program. They were invited to a 1-year follow-up interview, and followed in the National Patient Register. Compared to women, men who had attempted suicide were older, had better self-esteem, fewer depressive symptoms, and higher total suicidal intention scores, but they were not more likely to use violent methods. Neither use of violent method nor dangerousness of the attempt was associated with suicidal intention. Although men had higher suicide intent scores than women, there were no significant gender differences in the number of repeat suicide attempts during a 1-year follow-up period. Suicidal intent was not related to dangerousness of suicide method.

A Critique of Volunteer-Staffed Suicide Prevention Centres

This study compares the Los Angeles Suicide Prevention Center program with that of the Samaritan Centre in the London area. The author interviewed senior personnel and reviewed the training program for volunteers in both centres. He also monitored calls but was prohibited from listening in on the callers’ conversation in the Samaritan program due to their strict policy of confidentiality and anonymity. The purpose of the study was to learn the nature of the calls with special emphasis on suicide risk and degree of crisis; to assess the functioning of the volunteers in detail and compare it with professionals; to assess the usefulness of the programs in lowering the suicide rate and in other functions, particularly dealing with crises and case finding. It was found that the involvement with callers is very similar in both centres; that only a small percentage of callers had a significant suicidal drive; that many of the callers were in crisis and a useful service was provided for them; that the line was frequently abused and misused; that the volunteers coped extremely well with disturbed callers even though their responses were often different from professionals. There is no evidence that these and similar, primarily telephone, services lower the suicide rate; they seem to be more effective as crisis centres than as suicide prevention centres.

Suicide Prevention Center Outreach: Callers and Noncallers Compared

Two suicidal groups receiving mental health treatment, 46 clients who had called a suicide and crisis service and 29 clients who were not known to the service and represented a sample of the greater suicidal population-at-risk, were compared on selected demographic and clinical information located in their psychiatric folders. Three scales, the Suicide Death Prediction Scale, the Suicide Prevention Center Assessment of Suicide Potential Scale, and the Social Readjustment Rating Scale, were applied retrospectively to this information. The results indicated that the two groups did not differ demographically, but callers had significantly lower scores on both the Social Readjustment Rating Scale and the Suicide Potential Scale. Also, significantly fewer callers received psychiatric hospitalization. The findings suggest that the callers represented a sample of somewhat lower suicide risk.