On Addressing Discursive Coherence and Topicality in the Medical Discourse ofSchizophrenia

This study aims at comparing and contrasting the patterns of coherence that identify putative dyadic co-regulation between a patient and his psychiatrist when the patient is first admitted to a psychiatric ward at Shahid Ayatollah Modarres Hospital in Isfahan for treatment of paranoid schizophrenia with acute exacerbation and the normal (non-communication-disordered) talk exchanged when he is discharged after a 21-day hospital stay. The purpose of this study is twofold. Initially, it looks at how the interactants synergically constitute denotative meaning and at how discourse coherence is attained or crumbles away. Next, it looks at how interactants impart metamessages for what is arising at that instant, and how the paranoid schizophrenic case coherently indicates and evaluates the fabric of discourse in both interviews. Existing research employs frame analysis to demystify what activity is being acted out and how interactants mean what they say. This study exploits topic analysis to detect what a patient does when he participates and contributes in the final interview on the day of discharge or when he verbally withdraws himself from conversational topic (diagnostic interview) on the day of admission. The findings in this study unravel that schizophrenia discourse, albeit incoherent on the substratum of topicality/focality, can be unitary on another substratum (i.e., frame). Furthermore, it delineates how the patient coherently invokes various frames of talk and rightly appraises the discourse event in which he finds himself. This dialogic study has ramifications for the inherent power disparity between the doctor and the patient in today s medical milieux

Keywords:

Discursive Coherence , Topicality , Medical Discourse , Schizophrenia , Power Disparity