“It Was Really Sick:” Managing Moral Evaluations during Personality Disorder Interviews

Abstract

Moral aspects are closely related to psychiatric assessment. Personality disorders, especially, form a morally loaded category, as the diagnostic process involves questioning behaviors that go against social norms. Consequently, being interviewed about these matters may be face‐threatening for the patients. However, the study of the role of morality in psychiatric face‐to‐face interactions has been scarce. This paper explores how the patients and nurses orient themselves to moral matters during personality disorder interviews in two Finnish psychiatric outpatient clinics. This article uses Erving Goffman's frame theory to differentiate how different orientations come into play during the interviews. Conversation analysis forms the methodological basis for the work. In personality disorder interviews, it is possible to observe information‐gathering, moral, and everyday interaction frames. The nurses have different approaches in receiving the patients' moral considerations. They may maintain a rather neutral approach, but there are also cases of both challenging tones and more supportive and affiliating responses. Making visible how moral themes are discussed in real life enables a nuanced evaluation of psychiatric practices.