Edited Volume by Lisa Mikesell
In the past before improving technologies allowed for the direct observation of brain activity, b... more In the past before improving technologies allowed for the direct observation of brain activity, brain damaged patients were a prime avenue for understanding language structure and inferring back to brain function. Now with the rapid developments in neuroscience, what has been discovered about the brain can inform our view of language allowing us to build hypotheses about the role particular brain regions perform in language use. Brain damaged patients thus become populations which serve as test cases. While technologies in neuroscience have improved, so has our understanding and techniques for observing and analyzing social and communicative behavior.
FTD patients have right hemisphere, frontal and temporal pole atrophy which leaves their cognitive abilities intact, but their social interactions impaired and their personalities changed. The description of FTD as a pathological change in social behavior provides the motivation in this volume to apply ethnomethodological and conversation analytic approaches to the organization of patients’ interactions. These approaches do more than document the disease and its effects on loved ones by revealing phenomena that can be analyzed empirically as causing systematic changes in the patients’ social interactions.
This volume opens with a discussion of the frontal lobes and their expected involvement in language use and social interaction. Several chapters then use conversation analysis to examine a range of FTD social behaviors in real-world interactions both in and outside of the clinic. The remaining chapters show how the ethnomethodological approach applied throughout the book can be helpful in better understanding the neurobiology of discourse, the process of socialization, and the role of social motives and moral emotions in maintaining relationships.
Journal Articles by Lisa Mikesell
This paper investigates caregivers’ use of directives to repair embodied engagements of individua... more This paper investigates caregivers’ use of directives to repair embodied engagements of individuals diagnosed with frontotemporal dementia. High entitlement/low contingency (HE/LC) formats (e.g., imperatives) are consistently employed to elicit an alternative engagement in a current course of action that is treated as required for the accomplishment of an ongoing activity. In selecting directive formats, caregivers appear to orient to whether the alternative engagement is essential for the completion of an activity, how urgent or time-sensitive it is for the activity’s progressivity, and whether the current engagement is of a compulsive-type. Less essential, less urgent engagements elicit slightly mitigated formats, and compulsive-type engagements are repaired with multiple directives. The affordance of HE/LC directives in activity-focused contexts is that they explicitly identify the trouble source and often articulate the next action required for the activity’s progression. Additionally HE/LC formats expect compliance, which may minimally derail the progressivity of an activity compared to more mitigated forms. HE/LC formats in activity repair contexts reveal caregivers’ claimed rights to determine another’s actions as well as sensitivity to the activity requirements and progression. Data are in American English.
Clinically, frontotemporal dementia (FTD) is described as primarily affecting personality and int... more Clinically, frontotemporal dementia (FTD) is described as primarily affecting personality and interpersonal conduct and resulting in social behavioral disruptions, thus often giving rise to interpersonal conflict. Conflict behavior in both typical and dementia populations is frequently identified as explicit physical and verbal acts such as assault, yelling or insulting, and research often situates conflict and collaboration as opposing dimensions. The premise of this article is to examine the unfolding of moments in which individuals diagnosed with FTD and their carers demonstrate opposing orientations towards an activity in real time interaction: A home nurse needing to fulfill an institutional agenda – taking sitting blood pressure – seeks the cooperation from an individual who, in attempting to lie down, interferes with this agenda. These moments constitute sources of interactional conflict that carers attempt to resolve. However, often conflict behavior and cooperative behavior are not neatly teased apart; for instance, individuals often display conflicting orientations towards a overarching or guiding activity while cooperating in more immediate and discrete interactional tasks. These verbal/nonverbal conflicts are not large acts of aggression; rather, they may be viewed as arising within the mundane moments of life that individuals face in everyday contexts and frequently.
Translational Research, 2015
The transfer of new discoveries into both clinical practice and the wider community calls for rel... more The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits" the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large.
Health communication, Jan 3, 2015
Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, a... more Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic exper...
American Journal of Public Health, 2015
Belmont Report principles focus on the well-being of the research subject, yet community-engaged ... more Belmont Report principles focus on the well-being of the research subject, yet community-engaged investigators often eschew the role of subject for that of participant. We conducted semistructured interviews with 29 community and academic investigators working on 10 community-engaged studies. Interviews elicited perspectives on ethical priorities and ethical challenges. Interviewees drew on the Belmont Report to describe 4 key principles of ethical community-engaged research (embodying ethical action, respecting participants, generalizing beneficence, and negotiating justice). However, novel aspects of the participant role were the source of most ethical challenges. We theorize that the shift in ethical focus from subject to participant will pose new ethical dilemmas for community-engaged investigators and for other constituents interested in increasing community involvement in health research. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e9. doi:10.2105/AJPH.2014.302403).
Administration and Policy in Mental Health and Mental Health Services Research, 2014
Community mental health journal, 2014
This study elicited provider and administrator preferences in implementing an evidence-based prac... more This study elicited provider and administrator preferences in implementing an evidence-based practice (EBP) for bipolar disorder or psychosis, family-focused therapy (FFT). Providers (n = 35) and administrators (n = 5) from three community mental health centers took part in FFT training and participated in pre- and post-training focus groups. Transcripts were examined using conventional content analysis. Providers and administrators discussed barriers to implementing EBPs. Successful EBPs were described as incorporating flexibility and close supervision to maximize provider adherence. Providers expressed preferences for structured EBPs like FFT that have both explicit implementation steps and built-in flexibility.
American Journal of Public Health, 2013
Qualitative Health Research, 2012
Schizophrenia Bulletin, 2012
The ecological validity of neurocognitive and functional measures in severe mental illness is poo... more The ecological validity of neurocognitive and functional measures in severe mental illness is poorly understood because of a lack of validated research methods to study community life-as-lived. We describe the development of a video ethnography method that measures naturalistic behaviors with codes called community performance indicators (CPIs). The method could provide a strategy to test the ecological validity of neurocognitive and functional assessments. We gathered up to 18.5 hours of video ethnography data on each of 9 subjects with schizophrenia selected for high or low composite scores on the MATRICS Consensus Cognitive Battery (MCCB). We used video ethnography to capture subjects' everyday behaviors in their usual environments. We established 4 CPIs that showed excellent inter-rater and promising test-retest reliability: (1) behavioral activity level, (2) goal pursuit, (3) social interaction, and (4) problem solving. (1) High and low MCCB subjects showed statistically significantly differences on all 4 CPIs. (2) MCCB composite scores were correlated with all 4 CPIs (r = .54 to -.77, P .01 to .07). (3) The MCCB domain scores demonstrated some specificity in their correlations with the CPIs; eg, verbal learning, reasoning/problem solving, and social cognition were correlated with CPI domains of social interaction and problem solving. We present a method for reliably measuring everyday functional performance in schizophrenia. Results from a small select sample suggest that CPIs capture skills associated with neurocognition, supporting their use in a larger study of ecological validity.
Discourse Studies, 2010
Fronotemporal dementia (FTD) is a young-onset neurodegenerative dementia that primarily affects s... more Fronotemporal dementia (FTD) is a young-onset neurodegenerative dementia that primarily affects social behaviors. This paper examines the use of repetitional response in FTD discourse, finding that patients often use repeats to assert agency or epistemic authority (i.e. to claim rights to knowledge). For example, repetitional response are often used by patients to exert some autonomy when their interlocutors display a belief about the patients' lack of knowledge about basic functioning. FTD has been associated with echolalia, the meaningless use of repetition; however, this analysis shows that the use of repetitional responses in FTD discourse can be meaningful and thus suggests that, at least in early stages of the dementia, echolalia is not always an accurate characterization of FTD patients' use of repetitional responses.
Keywords: agency, discourse, echolalia, epistemic authority, frontotemporal dementia, repetition
Http Dx Doi Org 10 1080 08351810902864552, May 13, 2009
Frontotemporal dementia (FTD) is a dementia difficult to diagnose because, in the early stages, i... more Frontotemporal dementia (FTD) is a dementia difficult to diagnose because, in the early stages, it leaves patients with intact cognitive functioning and a range of social deficits. For example, FTD causes changes in tactfulness and manners, violations of interpersonal space, and emotional appropriateness (Jagust, Reed, Seab, Kramer, & Budinger, 1989). Until recently (for exceptions see Mates, Mikesell, & Smith, 2010) these characterizations have come from (a) brief clinical interviews and observations from neuropsychological testing and (b) caregivers’ secondhand reports. Given the social
nature of FTD, research is needed to examine the ordinary interactions of FTD patients, ones not colored by caregivers’ memories or constrained by the structure of a clinic. Using conversation analysis, this article explores two common conversational practices of one patient, SD. This research shows that while SD’s practices may appear appropriate in single, isolated turns, they are often inappropriate in more extended sequences. SD can respond locally to individual turns, that is, he can display local
understanding, but he often misunderstands the aims of the sequence, often failing to demonstrate understanding. SD, for instance, shows difficulty understanding the interlocutor’s goal of open-ended first pair-parts (FPPs) (eg., wh-questions). As such, SD’s interlocutors design their talk to adapt to his incompetencies by constraining their FPPs. These constraints are in an attempt to elicit a more appropriate response from SD and enable him to produce a more appropriate response incrementally, turn-by-turn.
Conference Presentations by Lisa Mikesell
Frontotemporal dementia (FTD) is a young onset neurodegenerative dementia that affects social beh... more Frontotemporal dementia (FTD) is a young onset neurodegenerative dementia that affects social behavior and interpersonal conduct. A core feature of FTD is “loss of insight,” which refers to patients’ inaccurate perception of their behavioral changes. Loss of insight influences how patients show understanding in interaction, which can be accomplished by varying degrees. Claims of understanding use resources made available by others (eg., verbal repetition), presenting minimal, but not necessarily inappropriate, understanding. Displays of understanding are often reformulations of another interlocutor’s utterance; therefore, a partial understanding is made public. Demonstrations, on the other hand, tend to be action-oriented and therefore provide unambiguous public evidence of one’s understanding. Patients’ claims and displays tend to align with their interlocutors and thus, on the surface, progress a common interactional agenda. Patients’ demonstrations, however, frequently conflict w...
Uploads
Edited Volume by Lisa Mikesell
FTD patients have right hemisphere, frontal and temporal pole atrophy which leaves their cognitive abilities intact, but their social interactions impaired and their personalities changed. The description of FTD as a pathological change in social behavior provides the motivation in this volume to apply ethnomethodological and conversation analytic approaches to the organization of patients’ interactions. These approaches do more than document the disease and its effects on loved ones by revealing phenomena that can be analyzed empirically as causing systematic changes in the patients’ social interactions.
This volume opens with a discussion of the frontal lobes and their expected involvement in language use and social interaction. Several chapters then use conversation analysis to examine a range of FTD social behaviors in real-world interactions both in and outside of the clinic. The remaining chapters show how the ethnomethodological approach applied throughout the book can be helpful in better understanding the neurobiology of discourse, the process of socialization, and the role of social motives and moral emotions in maintaining relationships.
Journal Articles by Lisa Mikesell
Keywords: agency, discourse, echolalia, epistemic authority, frontotemporal dementia, repetition
nature of FTD, research is needed to examine the ordinary interactions of FTD patients, ones not colored by caregivers’ memories or constrained by the structure of a clinic. Using conversation analysis, this article explores two common conversational practices of one patient, SD. This research shows that while SD’s practices may appear appropriate in single, isolated turns, they are often inappropriate in more extended sequences. SD can respond locally to individual turns, that is, he can display local
understanding, but he often misunderstands the aims of the sequence, often failing to demonstrate understanding. SD, for instance, shows difficulty understanding the interlocutor’s goal of open-ended first pair-parts (FPPs) (eg., wh-questions). As such, SD’s interlocutors design their talk to adapt to his incompetencies by constraining their FPPs. These constraints are in an attempt to elicit a more appropriate response from SD and enable him to produce a more appropriate response incrementally, turn-by-turn.
Conference Presentations by Lisa Mikesell
FTD patients have right hemisphere, frontal and temporal pole atrophy which leaves their cognitive abilities intact, but their social interactions impaired and their personalities changed. The description of FTD as a pathological change in social behavior provides the motivation in this volume to apply ethnomethodological and conversation analytic approaches to the organization of patients’ interactions. These approaches do more than document the disease and its effects on loved ones by revealing phenomena that can be analyzed empirically as causing systematic changes in the patients’ social interactions.
This volume opens with a discussion of the frontal lobes and their expected involvement in language use and social interaction. Several chapters then use conversation analysis to examine a range of FTD social behaviors in real-world interactions both in and outside of the clinic. The remaining chapters show how the ethnomethodological approach applied throughout the book can be helpful in better understanding the neurobiology of discourse, the process of socialization, and the role of social motives and moral emotions in maintaining relationships.
Keywords: agency, discourse, echolalia, epistemic authority, frontotemporal dementia, repetition
nature of FTD, research is needed to examine the ordinary interactions of FTD patients, ones not colored by caregivers’ memories or constrained by the structure of a clinic. Using conversation analysis, this article explores two common conversational practices of one patient, SD. This research shows that while SD’s practices may appear appropriate in single, isolated turns, they are often inappropriate in more extended sequences. SD can respond locally to individual turns, that is, he can display local
understanding, but he often misunderstands the aims of the sequence, often failing to demonstrate understanding. SD, for instance, shows difficulty understanding the interlocutor’s goal of open-ended first pair-parts (FPPs) (eg., wh-questions). As such, SD’s interlocutors design their talk to adapt to his incompetencies by constraining their FPPs. These constraints are in an attempt to elicit a more appropriate response from SD and enable him to produce a more appropriate response incrementally, turn-by-turn.
In the second part of the book, the authors argue that language acquisition is based on an "interactional instinct" that emotionally entrains the infant on caregivers. This relationship provides children with a motivational and attentional mechanism that ensures their acquisition of language. In adult second language acquisition, the interactional instinct is no longer operating, but in some individuals with sufficient aptitude and motivation, successful second-language acquisition can be achieved.
The Interactional Instinct presents a theory of language based on linguistic, evolutionary, and biological evidence indicating that language is a culturally inherited artifact that requires no a priori hard wiring of linguistic knowledge.
presume an unknowing addressee (e.g., correcting, advising), speakers deploy I know to resist the action as unnecessary while accepting its grounds. Second, in responding to actions that presume a knowing addressee (e.g., some assessments), speakers use I know to endorse the action, claiming an independently reached agreement (in this way, doing “being on the same page”). Data are in American and British English.