Case 2: Discourse analysis in medical settings
Submitting InstitutionUniversity of Wolverhampton
Unit of AssessmentModern Languages and Linguistics
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
This case study focuses upon discourse analytical research showing the
importance of understanding communication activities in clinical settings,
most particularly in mental health care and in transplantation medicine.
The research described below has had an immediate impact upon educational
and professional practice in medical settings in two European countries.
The change that was engendered by the research can be seen both in
educating clinicians in Poland as well as in changing communication
practices of the British NHSBT.
The case study draws on Critical Discourse Analytic (CDA) research into
two areas of healthcare: discursive practices in the area of mental health
and insights into the narratives of organ and tissue donation.
The research consists of a large multi-project investigation into the
discursive practices of both service users and clinicians in the provision
of psychiatric and psychological health care. It focuses on:
- the discursively constructed experience of mental illness (depression,
ICD10: F31-32, and schizophrenia, ICD10: F20; Galasinski 2008 &
- the therapeutic process and other professional practices (Galasinski,
2008, 2011; Galasinski & Kozlowska, 2010, 2012)
- professional practice (Galasinski, 2012; Galasinski & Opalinski,
At its most general, this research shows that discourse analysis (and its
critical strand, CDA), with its anchoring in a lexico-grammatical analysis
of the data, can give clinicians a firmer empirical basis for their
professional judgement. By providing insight into the linguistic form,
CDA's microanalysis is based on phenomena (such as passive voice or
nominalisation) which are independent of those who observe, analyse and
interpret them. In such a way, qualitative discourse analytic research can
help clinicians in understanding the complexities of the experience of
mental illness; enhancing their sensitivity to the linguistic form of
their patients' stories promotes deeper reflection thereon. Moreover,
discourse analysis can offer more sophisticated answers to the questions
of what it means to be a patient, to be mentally ill, to be in psychiatric
care, and, in the process, it can build on a sound empirical basis to
change and improve the care received by the most vulnerable. In the same
way, examination of the discursive mechanisms underpinning the therapeutic
process offers a better understanding thereof, which leads to its
The research flagged up a number of hitherto unexplored issues in the
study of the discourses of mental health care. More specifically, it:
a. questioned the relevance of the so-called `depressed mood' in the
clinical presentation of the depressive episode in men, adding
empirically-based support to the calls for differentiating diagnostic
criteria for depression for men and women;
b. suggested discursiveness (with the consequences of its performativity
and anchorage in the local narrative context) of insight into
c. showed a very weak `lived' understanding of clinical significance (a
crucial concept in psychiatric diagnosis) amongst psychiatrists;
d. demonstrated significant weaknesses in psychometric testing, offering
evidence both for poor understanding of a major test of gauging severity
of depressive symptoms (the Beck Depression Inventory), and showing the
negotiative nature of the discursive position of the questionnaire
e. showed a significant hiatus between how psychiatrists understand
insight and the body of research into it.
The second and much newer avenue of the research focused upon in this
case study is an analysis of narrated experiences of bereaved families
refusing consent for transplantation of their deceased relatives' organs
(Sque & Galasinski, 2013). This is the first text-orientated discourse
analytic study of the transplantation experience. This research showed the
importance of the insights offered by discourse analytic microanalysis in
understanding the experience of transplantation. It produced results that
were novel and potentially ground-breaking in the social science of
More specifically, the research offered a new understanding of the
decision process involved in the refusal of organ and tissue donation.
While the literature before the study assumed that families followed the
wishes of their deceased relatives, and, later, that the refusal was based
on the family's wish to keep their relative's body intact, the study
questioned these assumptions. The analysis of the families' narratives
showed that in fact those who take the decision are far more concerned
with their own feelings about and perceptions of organ retrieval.
References to the research
 Galasinski, D (2008) Men's discourses of depression,
Basingstoke: Palgrave, 2008.
 Sque, M. & Galasinski, D. (2013) `Keeping her whole': Bereaved
families' accounts of declining a request for organ donation. Cambridge
Quarterly of Healthcare Ethics, 22(1), 55-63.
 Galasinski, D. & Kozlowska, O. (2013) Interacting with a
questionnaire. Respondents' constructions of questionnaire completion. Quality
and Quantity. 47, 3509-3520. DOI 10.1007/s11135-012-9733-0.
 Galasinski, D. & Opalinski, K. (2012) Psychiatrists' accounts of
insight. Qualitative Health Research, 22(11), 1460-7. DOI:
 Galasinski, D. (2012) Psychiatrists' accounts of clinical
significance in depression. Polish Psychological Bulletin, 43(2),
 Galasinski, D. & Kozlowska (2010) Questionnaires and lived
experience. Strategies of coping with the quantitative frame. Qualitative
Inquiry, 16(4), 271-284. Doi: 10.1177/1077800409354068.
All articles (apart from ) have been published in journals indexed by
the Thomson Reuters' Journal Citation Reports and have impact factors
which are significant for their fields. The novelty of the research
reported on in  makes it a significant publication.
Details of the impact
The research has resulted in significant changes in professional
education and training of clinical psychologists. The results of the
research have been incorporated by the University of Social Sciences
and Humanities, Warsaw into the training programme for
specialisation in clinical psychology for clinicians in the Lower Silesia
region of Poland (equivalent of the English programmes training for the
Doctorate in Clinical Psychology). Modules focusing on exploring
experiences of mental illness, insight, interview techniques and
note-taking were introduced. The assumptions behind the research have also
informed the latest recruitment strategy for new candidates for the
programme. Considerably more weight was given to assessment of candidates
focusing upon the narrated experiences of their patients. The reach of
these changes is very significant - approximately 20% of all specialists
in clinical psychology in Poland are now trained within the Programme.
The research has also been disseminated to professionals (psychologists
and psychiatrists) as lectures and workshops in a number of venues in
Poland, and most particularly:
- Psychiatric Clinical Hospital of the Wroclaw Medical University
- Polish Psychiatric Association (October, 2009)
- General Psychiatric Hospital, Lubliniec (April, 2009).
The research has also been used by the NHSBT Consent Workshop (chaired by
Emma Winstanley, National Referral Centre Manager, NHSBT, Speke), tasked
with reviewing the consent process in terms of language, deceased donor
family requirements and legislation. This resulted in improving the
process of obtaining consent for organ and tissue donation in the United
Kingdom. In particular, the impact consists in the panel's adoption of
wide-ranging recommendations as to the language of consent documentation
and leaflets. The recommendations were aimed at explicating and changing
the discursive `structure of faith' behind the documentation to be used by
the NHSBT. Most recommendations were adopted by the panel, directly
impacting upon the form of the consent forms and leaflets for the bereaved
families. Apart from this immediate impact, this activity is expected to
have a long-term impact upon the level and quality of information received
by the families being asked to give consent for retrieval of their
relatives' organs and tissues, and in the process of the care for those
involved in giving consent for organ and tissue retrieval.
The influence of these changes is far-reaching. 7,500 people are waiting
for a transplant in the United Kingdom (1,000 die as a result of not
receiving a transplant every year). Approximately 3,500 people die in
circumstances where they can donate. The research described in this case
study will have impact upon every request for consent for organ and tissue
retrieval in the United Kingdom.
Sources to corroborate the impact
- Letter from Dr Justyna Ziolkowska, Co-ordinator of the Lower Silesia
Programme for Specialisation in Clinical Psychology.
- Letter from Dr Piotr Baranowski, Consultant, Psychiatric Clinical
Hospital of the Wroclaw Medical University, and the representative of
the Polish Psychiatric Association in Wroclaw.
- Letter from Dr Artur Jedrzejewski, Deputy Director, General
Psychiatric Hospital, Lubliniec.
- Letter from Ms Emma Winstanley, National Referral Centre Manager,