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Bio-Psycho-Social Reasoning in GPs’ Case Narratives: The Discursive Construction of ME Patients’ Identities

Mary Horton-Salway

The Open University, UKmkhs2{at}tutor.open.ac.uk

This article takes a discursive psychology approach to the analysis of medical case narratives. An analysis of interview extracts on the topic of ME (CFS) shows how GPs use bio-psycho-social reasoning to construct the patient’s identity and to define their illness as mental or physical. Patients’ identities are ‘talked up’ using bio-psycho-social ‘evidence’; they are constructed in the process of explaining the origins of an illness as mental or physical. This has much in common with identity construction in the illness narratives of ME patients. The analysis also shows how identity construction can function as a justification for defining an illness as psychosomatic and effectively ‘shifting the blame’ for what might otherwise be treated as medical failure or uncertainty. These processes show how a discursive analysis can shed more light on how bio-psycho-social reasoning functions in doctors’ case constructions.

Key Words: bio-psycho-social • case narratives • General Practitioners • identity construction

Health:, Vol. 6, No. 4, 401-421 (2002)
DOI: 10.1177/136345930200600401
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