The Interactional Organisation Of Pain Displays In Medical Consultations

Abstract

<p>Pain is commonly understood as a private experience situated within the individual. However, pain also takes place in the social world, emerging as an interactional event between individuals. The current thesis examined pain displays in interaction and showed how they are sensitive to, and shaped by, the immediate social environment. Discursive psychology and conversation analysis were used as theoretical and methodological frameworks to investigate pain displays as social actions. The empirical data of the study were video recordings of medical consultations between general practitioners and patients. Pain displays within physical examinations were analysed as complex multimodal Gestalts following Mondada (2014b); these are locally constituted from a web of embodied and vocal resources. The first analytic chapter focused on pain displays and the organisation of turns. Participants oriented to pain displays as structural units with an onset, peak, and projectable completion place that organised when and how they built their turns-at-talk. Pain displays were also visible in the progressivity of turns-at-talk, emerging at transition relevant places, suspended and re-initiated with respect to speaker turns. The second analytic chapter showed that pain displays were sequentially organised. Pain displays were oriented to as responsive actions that progressed pain solicitations. However, they did not lead to activity closure, raising questions about the status of pain displays as conditionally relevant next actions. The thesis demonstrated the orderly ways pain displays were coordinated with, and contributed to, the diagnostic work of the ongoing medical interaction. Pain displays were found to be inextricably tied to the interactional environment, a finding supported by other research which has shown internal states like pain and emotion are produced as socially-organised practices. Finally, the thesis contributes to debates within multimodal research, providing support for the utility of talk-focused conversation analytic concepts to describe embodied action. The findings also have practical applications for people seeking medical help for pain.</p>