The social reality of depression: on the situated construction, negotiation and management of a mental illness category in primary care

This project is a study of the way that people use language actively to achieve certain ends in communication, the way that they organise their spoken discourse to construct, convincingly, the state of their lives, both ‘internal’ and ‘external’. It does this primarily through an analysis of the systematic properties of the descriptive, communicative and interpretative skills which members use in the accomplishment of the meanings central to everyday existence. More specifically, this project is a study of verbal accounts of, and doctor-patient interaction relating to, clinical depression. The project begins from the premise that most social studies of depression and its diagnosis have been subject to the same problematic treatment of language as a ‘transparent medium’ as the psychiatric frames upon which the modern clinical understanding of depression in the UK is itself based. I aim, in view of this, to demonstrate how hitherto neglected elements in the social analysis of the condition can be revealed with the application of an alternative methodology, a methodology which treats talk-in-interaction as a dynamic and constructive phenomenon rather than a neutral conduit for the passage of information. The empirical data takes the form of a set of General Practitioners from a single practice in the North West talking freely about depression and their experiences of diagnosing it, and actual consultations between these GPs and their patients. Drawing upon Wittgenstein, Ethnomethodology, Discursive Psychology and, particularly, Conversation Analysis this project examines the ways in which doctors and patients construct, negotiate and manage ‘depressive’ meanings in the course of medical interaction, always holding tightly to Wittgenstein’s maxim that practice gives words their significance