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date: 22 February 2020

Abstract and Keywords

The discursive approach to psychiatry, taking as it does an ethological approach to the human organism, directs us to rules and story lines that structure our ways of dealing with the challenges thrown up by particular situated positions in our discursive world. For human beings this means engaging with the sense they are making of the world and the words they use to try and communicate that (to themselves and others). Doing things with words is behavior that draws on certain skills attuned to prompts, cues, expectations, and so on, all of which can go seriously awry in any setting where certain features are unfamiliar or where one of the participants is "impaired" or out of step with prevailing norms and assumptions. Discursive competence and the reality of the human psyche as a mode of being-in-relation-with others crucially depends on intact neural function and brain pathways slowly and cumulatively developed throughout life and is vulnerable to disruption of that substrate. Hysteria (or conversion disorder) and dementia represent two very different situations in which the discursive mismatch between an individual and his or her context of being causes the voice (and soul) of a person to be "lost in translation" so that understanding what is happening and then care and restoration demand a great deal of us not just as biomedical scientists but also as human beings who are reaching out to those who suffer and try to endure (patients) so as to help hold them in being.

Keywords: discourse, discursive psychiatry, making sense, voice, meaning and contingency, conversion disorder, dementia

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