Mindful Medicine: Symptom Presentations of Mental Health Concerns and Prescribing Patterns in the Primary Care Visit

• In Event: 598 - Section on Sociology of Mental Health Roundtable Session
  In Refereed Roundtable: Table 13. Mind and Body

Abstract

This paper investigates primary care encounters in which mental health issues are topicalized and negotiated. Using the methodology of conversation analysis, I categorize the linguistic structures patients employ to deliver mental health concerns and/or present mental health symptoms during the visit, and explore subsequent displays of understanding by physicians. I then analyze patterns by which physicians negotiate mental health drug prescribing where patients display varying intensities of prescription lobbying and differing levels of symptom specificity. In an age where mental health is highly problematized, this paper finds that such issues are treated as highly transactional in the doctor-patient interface. Further, in comparison to societal understandings of mental health prescribing behaviors, physicians are quite discriminatory in their patters of prescribing to those with mental health concerns: patients who present with concrete symptoms of a mental health problem (e.g. heart palpitations, trouble sleeping, hearing voices, vertigo, weight loss) are extremely likely to receive a prescription for a mental health drug, whereas patients who present with opaque symptoms (e.g. feeling down, tired, blue, sad) are very unlikely to receive a prescription.

Author

• Alexandra Lee Tate, University of California-Los Angeles