interactive frames and knowledge schemas in interaction

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206 SOCIAL PSYCHOLOGY QUARTERLY

In examining talk in a pediatric setting, weare interested in the duality of what emerges ininteraction: the stability of what occurs as aconsequence of the social context, and thevariability of particular interactions which re-sults from the emergent nature of discourse. On

one hand, meanings emerge which are not givenin advance; on the other, meanings which areshaped by the doctor's or patient's priorassumptions (as we will argue, their knowledgeschemas) may be resistant to change by theinterlocutor's talk.

As Cicourel (1975) cautioned over a decadeago, when social scientists create a data base foraddressing the issues involved in integratingstructure and process in the study of participantsin medical settings, their textual material should"reflect the complexities of the different modal-ities and emergent contextual knowledge inher-ent in social interaction" (p. 34). One importantway that Cicourel, and after him RichardFrankel (forthcoming), sought to observe suchcomplexities has been to compare discourseproduced in spoken and written modalities. Wehave adopted this practice and have alsodeveloped a method of analyzing videotapes ofparticipants in more than one setting.

OUf analysis is based on videotapes ofinteraction involving a cerebral palsied child,her family, and a group of health careprofessionals at a university medical facility.(More detailed background to the study isprovided below). We began by focusing on thepediatric examination/interview. In preliminaryanalysis, we applied the notion of frames(Tannen and Wallat, 1982; 1983). Comparinginteraction involving different combinationsfrom the same pool of participants in fivedifferent settings, as well as spoken and writtenmodalities, we investigated the negotiation,elaboration and condensation of information(Tannen and Wallat, 1986) and confrontedissues of family involvement in medical practice(Tannen and Wallat, forthcoming). In this paperwe develop and expand our discussion offrames; briefly recap our earlier analysis offrames in the pediatric interview/examination;and then further develop and illustrate theiroperation by reference to new examples. Wethen develop and expand our notion of knowl-edge schemas, using new examples as well asfurther analysis of an example presented forother purposes in an earlier study (Tannen andWallat, 1986). Based on our refinement of theterms frames and schemas, we show how thetwo interact and affect communication. Finally,we consider the implications of our study bothfor medical practice and for analysis of humaninteraction.

FRAMES AN D SCHEMAS

The term frame, and related terms such asscript, schema, prototype, speech activity,template and module, have been variously usedin linguistics, artificial intelligence, anthropol-ogy and psychology. Tannen (1979) reviewsthis literature and suggests that all theseconcepts reflect the notion of structures ofexpectation. Yet that early treatment of a varietyof concepts of frames and schemas in thedisciplines of linguistics, cognitive psychologyand artificial intelligence said little about thetype of frames that Goffman (1974) so exhaus-tively analyzed, as he himself observed (Goff-man, 1981 b). The present paper broadens thediscussion of frames to encompass and integratethe anthropological/sociological sense of theterm.

The various uses of frame and related termsfall into two categories. One is interactive"frames of interpretation" which characterize

the work of anthropologists and sociologists.We refer to these as frames, following Bateson(1972), who introduced the term, as well asmost of those who have built on his work,including scholars in the fields of anthropology(Prake, 1977), sociology (Goffman, 1974) andlinguistic anthropology (Gumperz, 1982; Hymes,1974). The other category is knowledge struc-tures, which we refer to as schemas, but whichhave been variously labeled in work in artificialintelligence (Minsky, 1975; Schank and Abel-son, 1977), cognitive psychology (Rumelhart,1975), and linguistic semantics (Chafe, 1977;Fillmore, 1975; 1976).

INTERACTIVE

FRAMES

The interactive notion of frame refers to adefinition of what is going on in interaction,without which no utterance (or movement orgesture) could be interpreted. To use Bateson'sclassic example, a monkey needs to knowwhether a push from another monkey is intendedwithin the frame of play or the frame offighting. People are continually confronted withthe same interpretive task. In order to compre-hend any utterance, a listener (and a speaker)must know within which frame it is intended:for example, is this joking? Is it fighting?Something intended as a joke but interpreted asan insult (it could of course be both) can trigger

a fight.Goffman (1974) sketched the theoreticalfoundations of frame analysis in the work ofWilliam James, Alfred Schutz and HaroldGatfinkel to investigate the socially constructednature of reality. Building on their work, as wellas that of linguistic philosophers John Austinand Ludwig Wittgenstein, Goffman developed a


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207RAMES AND SCHEMAS IN INTERACTION

complex system of terms and concepts toillustrate how people use multiple frameworksto make sense of events even as they constructthose events. Exploring in more detail thelinguistic basis of such frameworks, Goffman(1981a) introduced the term footing to describehow, at the same time that participants frameevents, they negotiate the interpersonal relation-ships, or "alignments," that constitute thoseevents.

The interactive notion of frame, then, refersto a sense of what activity is being engaged in,how speakers mean what they say. As Ortega yGasset (1959, p. 3), a student of Heidegger,puts it, "Before understanding any concretestatement, it is necessary to perceive clearly'what it is all about' in this statement and 'whatgame is being played,' " 1 Since this sense isgleaned from the way participants behave ininteraction, frames emerge in and are consti-tuted by verbal and nonverbal interaction.

KNOWLEDGE SCHEMAS

We use the term knowledge schema to refer toparticipants' expectations about people, objects,events and settings in the world, as distin-guished from, alignments being negotiated in aparticular interaction. Linguistic semanticistshave been interested in this phenomenon, asthey have observed that even the literal meaningof an utterance can be understood only byreference to a pattern of prior knowledge. Thisis fundamental to the writing of Heidegger (forexample 1962, p. 199), as in his often quotedargument (p. 196) that the word "hammer" canhave no meaning to someone who has neverseen a hammer used. To borrow an examplefrom Fillmore (1976), the difference betweenthe phrases "o n land" and "o n the ground" canbe understood only by reference to an expectedsequence of actions associated with travel onwater and in the air, respectively. Moreover, theonly way anyone can understand any discourseis by filling in unstated information which isknown from prior experience in the world. Thisbecame clear to researchers in artificial intelli-gence as soon as they tried to get computers tounderstand even the simplest discourse-hence,for example, the need for Schank and Abelson's(1977) restaurant script to account for the use ofthe definite article "the" in a minimal discoursesuch as, "John went into a restaurant; he asked

the waitress for amenu."

Researchers in the area of medical sociology

Thanks to A.L. Becker for calling our attention toOrtega y Gasset. For a discussion of framing based onnumerous examples from everyday life, see Chapter 5,"Framing and Reframing," in Tannen (1986).

and anthropology such as Kleinman (1980) andMishler (1984) have observed the problem ofdoctors' and patients' divergent knowledgeschemas, although they may not have used thisterminology. Cicourel (1983), for example,describes the effects of differing "structures ofbelief" in a gynecological case. The contribu-tion of our analysis is to show the distinctionand interaction between knowledge schemas andinteractive frames.

At an earlier stage of this study, we referredto the interactive notion of frame as "dynamic"and the knowledge structure notion of schema as"static," but we now realize that all types ofstructures of expectations are dynamic, asBartlett (1932), whose work underlies much ofpresent day schema theory, pointed out, and asothers (for example, Prake, 1977) have empha-sized. That is, expectations about objects,people, settings, ways to interact and anythingelse in the world are continually checked againstexperience and revised.

The Interaction of Frames and Schemas

We demonstrate here a particular relationshipbetween interactive frames and knowledgeschemas by which a mismatch in schemastriggers a shifting of frames. Before proceedingto demonstrate this by reference to detailedanalysis of pediatric interaction, we will illus-trate briefly with reference to an example of atrivial, fleeting and mundane interchange thatwas part of a telephone conversation.

One author (Tannen) was talking to a friendon the telephone, when he suddenly yelled,"YOU STOP THAT!" She knew from the wayhe uttered this command that it was addressed toa dog and not her. She remarked on the fact thatwhen he addressed the dog, he spoke insomething approximating a southern accent. Thefriend explained that this was because the doghad learned to respond to commands in thataccent, and, to give another example, heillustrated the way he plays with the dog: "I say,'GO GIT THAT BALL!' " Hearing this, thedog began running about the room looking forsomething to fetch. The dog recognized theframe "play'" in the tone of the command; hecould not, however, understand the words thatidentified an outer frame, "referring to playingwith the dog," and mistook the reference for aliteral invitation to play.

This example illustrates, as well, that people(and dogs) identify frames in interaction byassociation with linguistic and paralinguisticcues- the way words are uttered-in addition towhat they say. That is, the way the speakeruttered "you stop that!" was associated with theframe "disciplining a pet" rather than "chattingwith a friend." Tannen drew on her familiarity

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with the use of linguistic cues to signal frameswhen she identified her friend's interjection"You stop that!" as addressed to a dog, not her.But she also drew on the knowledge that herfriend was taking care of someone's dog. Thiswas part of her knowledge schema about her

friend. Had her schema included the informationthat he had a small child and was allergic todogs, she might have interpreted the samelinguistic cues as signalling the related frame,"disciplining a misbehaving child." Furthermore, her expectations about how any speakermight express orders or emotions, i.e., framesuch expressions, were brought to bear in thisinstance in conjunction with her expectationsabout how this particular friend is likely tospeak to her, to a dog and to a child; that is, aschema for this friend's personal styIe. Thusframes and schemas interacted in her comprehension of the specific utterance.

The remainder of this paper illustrates framesand schemas in a videotaped interaction in amedical setting: the examination of a child by apediatrician in the presence of the mother. Itdemonstrates that an understanding of interactive frames accounts for conflicting demands onthe pediatrician. In addition to communicativedemands arising from multiple interactive frames,much of the talk in the pediatric encounter ca nbe understood as resulting from differingknowledge schemas of the mother and thepediatrician. This will be illustrated withreference to their schemas for health andcerebral palsy. Finally, it is the mismatch inknowledge structure schemas that prompts themother to ask questions which require the doctorto switch frames.

BACKGROUND OF TH E STUDY

The videotapes on which our analysis is basedwere obtained from the Child DevelopmentCenter of the Georgetown University MedicalSchool, following our presentation of a proposalto the Cent er's Interdisciplinary Research Committee. The videotapes had been made as rawmaterial for a demonstration tape giving anoverview of the Center's services, and thereforedocumented all the encounters involving asingle family and Center staff, which took placeover three weeks.

The primary goal of the Center is to provideinterdisciplinary training to future professionals

in serving developmentally disabled childrenand their families. Staff members work ininterdisciplinary teams which include an audiologist, speech pathologist, pediatrician, socialworker, nutritionist, dentist, nurses and anoccupational, educational and physical therapist. Each professional meets with the child and,in some cases, other family members; then all

meet to pool the results of their evaluations,which are presented to the parents in a groupmeeting.

The parents of lody, the eight-year-oldcerebral palsied child in this study, werereferred to the Center by the parents of another

child. Their chief concern was lody's publicschool placement in a class for mentally retardedchildren. Their objective, which was met, wasto have a Center representative meet with thesupervisor of special education in their districtand have lody placed in a class for theorthopedically rather than mentally handicapped.

In addition to the spastic cerebral palsy(paralysis resulting from damage to the brainbefore or during birth), lody was diagnosed ashaving a seizure disorder; a potentially lethalarteriovenous malformation in her brain (thiswas subsequently, and happily, rediagnosed as aless dangerous malformation involving veinsonly, rather than both arteries and veins; facial

hemangiomas (red spots composed of bloodfilled capillaries); and slight scoliosis (curvatureof the spine).

We began our analysis by focusing on thepediatrician's examination/interview, which tookplace with the mother present. As part of ouranalysis, we met, separately, with the doctorand the mother, first talking with them and thenreviewing segments of the tape. The motherexpressed the opinion that this doctor "wasgreat ," in explicit contrast with others who "cutyou of f and make you feel stupid" and deliverdevastating information (for example, "she'd bea vegetable") in an oftband manner.

INTERACTIVE FRAMES IN APEDIATRIC EXAMINATION

The goal of this paper, as announced at theoutset, is to show that examining Jody in he rmother's presence constituted a significantburden on the pediatrician, which can beattributed to a conflict in framing resulting frommismatched schemas. To demonstrate thisinteraction between frames and schemas, wewill first show what framing is and how itworks, beginning with the crucial linguisticcomponent of register.

Linguistic Registers

A key element in framing is the use ofidentifiab Ie linguistic registers. Register, asFerguson (1985) defines it, is simply "variationconditioned by use": conventionalized lexical,syntactic an d prosodic choices deemed appropriate for the setting and audience. Early analysisof the videotape of the pediatrician examiningJody indicated that the pediatrician used three


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distinct registers in addressing each of three tion), and drawn out vowel sounds, accompaaudiences (Tannen and Wallat, 1982). We will nied by smiling. For example, while examiningbriefly recap the findings of that study. Jody's ears with an ophthalmoscope (ear light)"

In addre&sing the child, the pediatrician uses the pediatrician pretends to be looking for"motherese": a teasing register characterized by various creatures, and Jody responds withexaggerated shifts in pitch, marked prosody delighted laughter: (See Appendix for transcrip(long pauses followed by bursts of vocaliza- tion conventions.)

Doctor: Let me look in your ear. Do you have a monkey in your ear?Child: [laughing] No::::.Doctor: N o : : : ? . . Let's see. . . . I .. see . . . . . . a birdie!Child: [[laughing] No:::.Doctor: [smiling] No.

In stark contrast to this intonationally exagger pediatric residents who might later view theated register, the pediatrician uses a markedly videotape in the teaching facility. We call thisflat intonation to give a running account of the "reporting register." For example, looking infindings of her examination, addressed to no Jody's throat, the doctor says, with only slightpresent party, but designed for the benefit of stumbling:

Doctor: Her canals are- are fine, they're open, urn hertympanic membrane was thin, and light,

Finally, in addressing the mother, the pediatri- as for example:cian uses conventional conversational register,

Doctor: As you know, the important thing is that she does havedifficulty with the use of her muscles.

Re g iste r-Shifting smoothly from teasing the child while examining her throat, to reporting her findings, to

Throughout the examination the doctor moves explaining to the mother what she is looking foramong these registers. Sometimes she shifts and how this relates to the mother's expressedfrom one to another in very short spaces of time, concern with the child's breathing at night.as in the following example in which she moves

[Teasing register]

Doctor: Let' s see. Can you open up like this, Jody. Look.

[Doctor opens her own mouth]Child: Aaaaaaaaaaaaah.Doctor: [Good. That's good.Child: Aaaaaaaaaaah.

[Reporting register]

Doctor: /Seeing/ for the palate, she[has a high arched palateChild: AaaaaaaaaaaaaaaaaaaaaaahDoctor: but there's no cleft,

[maneuvers to grasp child's jaw]

[Conversational register]. . . what we'd want to look for is to see how she . . .mmoves her palate . . . . Which may be some of thedifficulty with breathing that we're talking about.

The pediatrician's shifts from one register to there's no cleft," and comes to rest firmly inanother are sometimes abrupt (for example, conversational register with "what we'd want towhen she turns to the child and begins teasing) look fo r. . . ") . In the following example, sheand sometimes gradual (for example, her shifts from entertaining Jody to reportingreporting register in "high arched palate" begins findings and back to managing lady in a teasingto fade into conversational register with "but tone:


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[Teasing register]

Doctor: That's my light.Child: /This goes up there.!Doctor: It goes up there. That's right.

[Reporting register]

Now while we're examining her head we're feeling forlymph nodes in her neck . . . or for any masses . . .okay . . . also you palpate the midline for thyroid,for goiter. . . if there's any.

[Teasing register]

Now let us look in your mouth. Okay? With my light.Can you open up real big? . . Oh, bigger . . . . Ohbigger . . . Bigger.

Frame-Shifting video audience of pediatric residents. Theconsultation frame requires that she talk to the

Although register shifting is one way of mother and ignore the crew and the child- or,accomplishing frame shifts, it is not the only rather, keep the child "o n hold, " to useway. Frames are more complex than register. Goffman 's term, while she answers the mother'sWhereas each audience is associated with an questions. These frames are balanced nonverbidentifiable register, the pediatrician shifts

ally as well as verbally. Thus the pediatricianfootings with each audience. In other words, she keeps one arm outstretched to rest her hand onnot only talks differently to the mother, the child the child while she turns away to talk to theand the future video audience, but she also deals mother, palpably keeping the child "o n hold."with each of these audiences in different ways,depending upon the frame in which she isoperating. Juggling Frames

The three most important frames in thisinteraction are the social encounter; examination Often these frames must be served simultaof the child and a related outer frame of its neously, such as when the pediatrician entervideotaping; and consultation with the mother. tains the child and examines her at the sameEach of the three frames entails addressing each time, as seen in the example where she looks inof the three audiences in different ways. For her ear and teases Jody that she is looking for aexample, the social encounter requires that the monkey. The pedi atrician's reporting registerdoctor entertain the child, establish rapport with reveals what she was actually looking at (Jody'sthe mother and ignore the video camera and ear canals and tympanic membrane). Bu t

crew. The examination frame requires that she balancing frames is an extra cognitive burden,ignore the mother, make sure the video crew is as seen when the doctor accidentally mixes theready and then ignore them, examine the child, vocabulary of her diagnostic report into herand explain what she is doing for the future teasing while examining Jody's stomach:

[Teasing register]

Doctor: Okay. All right. Now let me /?/ let me see what Ican find in there. Is there peanut butter and jelly?Wait a minute'

Child: l N0Doctor: 1No peanut butter and jelly in there?Child: No.

[Conversational register]

Doctor: Bend your legs up a little bit. . . . That's right.[Teasing register]

Okay? Okay. Any peanut butter and jelly in here?lChild:Doctor:

N01No.

No. There's nothing in there. Is your spleenpalpable over there?l

Child: No.


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The pediatrician says the last line, "I s yourspleen palpable over there?" in the same teasingregister she was using for peanut butter andjelly, and Jody responds with the same delightedgiggling "No" with which she responded to theteasing questions about peanut butter and jelly.

The power of the paralinguistic cues with whichthe doctor signals the frame "teasing" is greaterthan that of the words spoken, which in this caseleak out of the examination frame into theteasing register.

In other words, for the pediatrician, eachinteractive frame, that is, each identifiableactivity that she is engaged in within theinteraction, entails her establishing a distinctfooting with respect to the other participants.

The Interactive Production of Frames

Our analysis focuses on the pediatrician'sspeech because our goal is to show that themismatch of schemas triggers the frame switcheswhich make this interaction burdensome for her.Similar analyses could be performed for anyparticipant in any interaction. Furthermore, allparticipants in any interaction collaborate in thenegotiation of all frames operative within thatinteraction. "Thus, the mother and c hild collabo-rate in the negotiation of frames which are seenin the pediatrician's speech and behavior.

For example, consider the examination frameas evidence in the pediatrician's running reportof he r procedures and findings for the benefit ofthe video audience. Although the motherinterrupts with questions at many points in theexamination, she does not do so when thepediatrician is reporting her findings in what wehave called reporting register. 2 Her silencecontributes to the maintenance of this frame.Furthermore, on the three of seventeen occa-sions of reporting register when the mother doesoffer a contribution, she does so in keeping withthe physician's style: He r utterances have acomparable clipped styIe.

The Homonymy of Behaviors

Activities which appear the same on thesurface can have very different meanings andconsequences for the participants if they are

understood as associated with different frames.For example, the pediatrician examines variousparts of the child's body in accordance withwhat she describes at the start as a "standardpediatric evaluation." At times she asks themother for information relevant to the child's

condition, still adhering to the sequence of fociof attention prescribed by the pediatric evalua-tion. At one point, the mother asks about a skincondition behind the child's right ear, causingthe doctor to examine that part of Jody's body.What on the surface appears to be the sameactivity-examining the chi ld- is really verydifferent. In the first case the doctor is adheringto a preset sequence of procedures in theexamination, and in the second she is interrupt-ing that sequence to focus on something else,following which she will have to recover herplace in the standard sequence.

Conflicting Frames

Each frame entails ways of behaving thatpotentially conflict with the demands of otherframes. For example, consulting with themother entails not only interrupting the exami-nation sequence but also taking extra time toanswer her questions, and this means that thechild will ge t more restless aJ;ld more difficult tomanage as the examination proceeds. Reportingfindings to the video audience may upset themother, necessitating ,more explanation in theconsultation frame. Perhaps that is the reasonthe pediatrician frequently explains to themother what she is doing and finding and why.

Another example will illustrate that thedemands associated with the consultation framecan conflict with those of the examinationframe, and that these frames and associateddemands are seen in linguistic evidence, in thiscase by contrasting the pediatrician's discourseto the mother in the examination setting with herreport to the staff of the Child DevelopmentCenter about the same problem. Having recentlylearned that Jody has an arteriovenous malfor-mation in her brain, the mother asks the doctorduring the exanlination how dangerous thiscondition is. The doctor responds in a way thatbalances the demands of several frames:

Mother: I often worry about the danger involved t o o . ~ Doctor: L Yes.

cause she's well I mean like right now,

. . . uh . . . in her present c o n d i t i o n . ~ Doctor: L mhm

2 The notion of "reporting register" accounts for asimilar phenomenon described by Cicourel (1975) in ananalysis of a medical interview.


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Mother: I've often wondered about how dangerousthey they are to her right now.

Doctor: We:ll . . . urn . . . the only danger would be from bleeding.. . . Fr6m them. If there was any rupture, or anythinglike that. Which CAN happen. . . . urn. . . that wouldbe the dange[r.

Mother: mhmDoctor: . . . F6r that. But they're rom n6tgoing to be something that will get worseas time goes on.

Mother: Oh I see.Doctor: But they'r e just there. Okay?

The mother's question invoked the consultation The pediatrician blunts the effect of theframe, requiring the doctor to give the mother information she imparts by using circumlocuthe information requested based on her medical tions and repetitions; pausing and hesitating; andknowledge, plus take into account the effect on minimizing the significant danger of the arterithe mother of the information that the child's ovenous malformation by using the wordlife is in danger. However, the considerable "only" ("only danger"), by using the conditime that would normally be required for such a tional tense ("that would be the danger"), andtask is limited because of the conflicting by stressing what sounds positive, that they're

demands of the examination frame: the child is not going to get worse. She further creates a"o n hold" for the exam to proceed. (Notice that reassuring effect by smiling, nodding and usingit is the admirable sensitivity of this doctor that a soothing tone of voice. In reviewing themakes her aware of the needs of both frames. videotape with us several years after the taping,According to this mother, many doctors have the pediatrician was surprised to see that she hadinformed her in matter-of-fact tones of poten expressed the prognosis in this way, andtially devastating information about her child's furthermore that the mother seemed to becondition, without showing any sign of aware reassured by what was in fact distressingness that such information will have emotional information. The reason she did so, we suggest,impact on the parent. In our terms, such doctors is that she was responding to the immediate andacknowledge only one frame-examination-in conflicting demands of the two frames she wasorder to avoid the demands of conflicting operating in: consulting with the mother in theframes - consultation and social encounter. Ob context of the examination.serving the burden on this pediatrician, who Evidence that this doctor indeed felt greatsuccessfully balances the demands of multiple concern for the seriousness of the child'sframes, makes i t easy to understand why others condition is seen in her report to the staffmight avoid this). regarding the same issue:

Doctor: . uh: I' m not sure how much counseling has been d6ne,. WIth these parents, . . . around .. the issue. . . of

the a-v malformation. Mother asked me questions, . . .about the operability, inoperability of it, . . . u:m. . . which I was not able to answer. She was told itwas inoperable, and I had to say well yes some of themare and some of them aren't . . . . And I think that thisis a a an important point. Because I don't knowwhether the possibility of sudden death,intracranial hemorrhage, if any of this has ever beendiscussed with these parents.

Here the pediatrician speaks faster, with fluency possible event, gives the impression that evenand without hesitation or circumlocution. Her more dangers are present than those listed.tone of voice conveys a sense of urgency and Thus the demands on the pediatrician associgrave concern. Whereas the construction used ated with consultation with the mother; thosewith the mother, "only danger", seemed to associated with examining the child and reportminimize the danger, the listing intonation used ing her findings to the video audience; and thosewith the staff ("sudden death, intracranial associated with managing the interaction as ahemorrhage"), which actually refer to a single social encounter are potentially in conflict and


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result in competing demands on the doctor'scognitive and social capacities.

KNOWLEDGE SCHEMAS IN THEPEDIATRIC INTERACTION

Just as ways of talking (that is, of expressingand establishing footing) at any point ininteraction reflect the operation of multipleframes, similarly, what individuals choose tosay in an interaction grows out of multipleknowledge schemas regarding the issues underdiscussion, the participants, the setting, and soon. We have seen that conflicts can arise whenparticipants are oriented toward different interactive frames, or have different expectationsassociated with frames. Topics that the motherintroduces in the consultation frame sometimesinterfere with the doctor's conducting theexamination, and time the doctor spends examining Jody in areas in which she has had noproblems does not help the mother in terms ofwhat prompted her to take Jody to the ChildDevelopment Center: a concern that she was

regressing rather than improving in skills.Similarly, when participants have differentschemas, the result can be confusion and talkingat cross-purposes, and, frequently, the triggering of switches in interactive frames. We willdemonstrate this with examples from the

pediatrician's and mother's discussions of anumber of issues related to the child's healthand her cerebral palsy.

Mismatched Schemas

Before examining Jody, the pediatricianconducts a medical interview in which she fillsout a form by asking the mother a series ofquestions about lody's health history andcurrent health condition. After receiving negative answers to a series of questions concerningsuch potential conditions as bowel problems,bronchitis, pneumonia and ear infections, thepediatrician summarizes her perception of theinformation the mother has just given her.However, the mother does not concur with thisparaphrase:

Doctor: Okay. And so her general overall health has been good.Mother: . . . . . [sighs] Not really. . . . . . . uh: . . . back

. . uh . . . after she had her last seizure, . . . uh . . .uh . . . it was pretty cold during this .. that t ime. . .a:nd uh . . . it seemed that she just didn't have much

Doctor:energY'l

mmMother: . . and she uh. . . her uh. . . . . . motor abilities at

the time didn't seem . . . very good. . . . She keptbumping into walls, . . . and falling, and . . . uh

The mother's schema for health is a comprehensive one, including the child's total physical

well-being. The child's motor abilities have notbeen good; therefore her health has not beengood. In contrast, the pediatrician does notconsider motor abilities to be included in aschema of health. Moreover, the pediatricianhas a schema for cerebral palsy (cp): she knowswhat a child with cp can be expected to do ornot do, i.e., what is "normal" for a child withcpo In contrast,. as emerged in discussion duringa staff meeting, the mother has little experiencewith other cp children, so she can only compareIody's condition and development to those ofnon-cp children.

Throughout our tapes of interaction betweenJody's mother and the pediatrician, questions

are asked and much talk is generated becauseof

unreconciled differences between the mother'sand doctor's knowledge schemas regardinghealth and cerebral palsy, resulting from thedoctor's experience and training and the mother's differing experience and personal involvement.

Mismatches based on the cp schema account

for numerous interruptions of the examinationframe by the mother invoking the consultation

frame. For example, as briefly mentionedearlier, the mother interrupts the doctor'sexamination to ask about a skin eruption behindthe child's ear. The mother goes on to askwhether there is a connection between thecerebral palsy and the skin condition becauseboth afflict lody's right side. The doctorexplains that there is no connection. Themother's schema for cp does not include theknowledge that it would not cause drying andbreaking of skin. Rather, for her, the skincondition and the cp become linked in a"right-sided weakness" schema.

Similar knowledge schema mismatches account for extensive demands on the pediatrician

to switch from the examination to the consultation frame. When lady sleeps, her breathingsounds noisy, as if she were gasping for air. Themother is very concerned that the child mightnot be getting enough oxygen. When the doctorfinishes examining the child's throat and moveson to examine her ears, the mother takes theopportunity to interrupt and state her concern.


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214

SOCIAL PSYCHOLOGYThe doctor halts the ex a . . ' . QUARTERL Ymother and SWitches to t ~ l ~ a t l o n , t ~ m s to the therefore J 'explaining that the 1 onsultatIon frame, " f l " od y s breathing sounds " "

cp also affects the % ~ ~ f e : ~ ~ ~ e ~ : ~ ~ : ~ ~ 7 is h ~ ~ ~ g t r ~ ~ ~ : V ~ ; ~ a ~ : n ~ ~ s not m e ~ ~ ~ : t s:::Doctor: Iody?M h . . . . I want to look .

ot er: !h is problem that that sh e ~ ~ your e ~ s . . . . ]ody?Interfering with h b . s , . . . . IS not .Child: /H 11 / er reathlng IS it?

Doctor: N o ~ 0 [spoken into OPhthalm'oscope]Mother: I t 'Doctor: Just appears that way?

Yes. It's very i t 's 'fl6 . ' . ' " really 't ' l' kM PPY you know and tha t' s h . '" 1 S 1 e

other: She worries me at n' ht W Y It SOunds the way it is.Doctor: Yes Ig .

Mother: Because uh . . . When she'sher so she doesn't asleep I keep checking on

Doctor: 1Mother: As you know the important

thinking she's no t breathi 11 keepDoctor: As you know t h e ' , ng pr?per!y. [spoken While chuckling]

" ' Impor tant thIng IS that she d6eshave dIffIculty with the Use o f her muscles'Mother:

lDoctor: So she has difficulty with the use of he r m u s : s mas far .as the ,muscles o f he r chest, that are used ~ i ~ h ' .b ~ e a t h t n g . y ~ n o w as well as the drooling, the musclesWIth swallowIng, and all that so all her muscles

Mother: [Is there some exercise

Ito strengthen or help that/.

The mother's schemas for health and cerebralThese schemas are not easily altered. Thepalsy do not give her the expectation that the

pediatrician's assurance that Jody is not havingchild's breathing should sound noisy. Rather, trouble breathing goes on for some time, yet thefor her, noisy breathing is "wheezing" which mother brings it up again when the doctor isfits into a schema for ill health: Noisy breathing listening to lody's chest through a stethoscope.is associated with difficulty breathing. In fact, Again the doctor shifts from the examinationthe parents, in the initial medical interview at frame to the consultation frame to reassure herthe Child Development Center, characterize at length that the child is not having troubleJody as having difficulty breathing, and this is breathing, that these sounds are "normal" for ae n t ~ r e d into the written record of the interview. child with cp.

Doctor: Now I want you to listen, lody. We're going to listento you breathe. Can you? Look at me. Ca n you go likethis? [inhales] Good. Dh you know how to do all this.You've been to a lot of doctors. [lady inhales] Good.Good. Once . . . good. Okay. Once more. Dh you have alot of extra noise on this side. Go ahead. Do it oncemore. Once more.

~ M o t h e r : [That's the particular noise she makes whenshe sleeps. [chuckle]

Doctor: Once more. Yeah I hear all that. One more. On e more.[laughs] Once more. Okay. That's good. She has verycoarse breath sounds urn. . . and you can hear a lo t ofthe noises you hear when she breathes you can hear whenyou listen. Bu t there's nothing that'sl

~ M o t h e r : That's the kindof noise I hear when she's sleeping at night.

LYes)Doctor:Yes. There's nothing really as far as a pneumonia isconcerned or as far as any urn anything here. There'sno wheezing urn which would suggest a tightness or a


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constriction of the thing. There 's no wheezing at all.What it is is mainly very coarse due to the .the wide open kind of flopping.

Nonetheless, during the session in which thestaff report their findings to the parents, whenthe pediatrician makes her report, the motheragain voices her concern that the child is havingtrouble breathing and refers to the sound ofJody's breathing as "wheezing." At this pointthe doctor adamantly reasserts that there is nowheezing. What for the mother is a generaldescriptive term for the sound of noisy breathingis for the doctor a technical term denoting acondition by which the throat passages areconstricted.

As we have argued elsewhere (Tannen andWallat, 1986), an understanding of the mother'sschemas accounts for the resilience of herconcern about the child's breathing, despite thedoctor's repeated and lengthy reassurances. Our

point here is that it is the mismatch inschemas - both the mother's association ofnoisy breathing with difficulty breathing, plusthe doctor's dissociation of these two conditionsand her emphasis on the medical definition of"wheezing" (irrelevant to the mother). Thusthere is a mismatch in expectations about whatcounts as adequate reassurance that causes themother to ask questions, which requires thedoctor to shift frames from examination toconsultation.

SUMMARY AND CONCLUSION

We have used the term frame to refer to theanthropological/sociological notion of a frame,as developed by Bateson and Goffman, and asGumperz (1982) uses the term "speech activity." It refers to participants' sense of what isbeing done, and reflects Goffman's notion offooting: the alignment participants take up tothemselves and others in the situation. We usethe term schema to refer to patterns ofknowledge such as those discussed in cognitivepsychology and artificial intelligence. These arepatterns of expectations and assumptions aboutthe world, its inhabitants and objects.

We have shown how frames and schemastogether account for interaction in a pediatricinterview/examination, and how linguistic cues,or ways of talking, evidence and signal the

shifting frames and schemas. An understandingof frames accounts for the exceedingly complex,indeed burdensome nature of the pediatrician'stask in examining a child in the mother'spresence. An understanding of schemas accounts for many of the doctor's lengthyexplanations, as well as the mother's apparentdiscomfort and hedging when her schemas lead

her to contradict those of the doctor. Moreover,and most significantly, it is the mismatch ofschemas that frequently occasions the mother'srecurrent questions which, in their tum, requirethe doctor' to interrupt the examination frameand switch to a consultation frame.

The usefulness of such an analysis for thoseconcerned with medical interaction is significant. On a global level, this approach begins toanswer the call by physicians (for exampleBrody, 1980, and Lipp, 1980) for deeperunderstanding of the use of language in order toimprove services in their profession. On a locallevel, the pediatrician, on hearing our analysis,was pleased to see a theoretical basis forwhat she had instinctively sensed. Indeed, shehad developed the method in her private practice

of having parents observe examinations, paperin hand, from behind a one-way mirror, ratherthan examining children in the parents' presence.

The significance of the study, however, goesbeyond the disciplinary limits of medicalsettings. There is every reason to believe thatframes and schemas operate in similar ways inall face-to-face interaction, although the particular frames and schemas will necessarily differin different settings. We may also expect, andmust further investigate, individual and socialdifferences both in frames and schemas and inthe linguistic as well as nonverbal cues andmarkers by which they are identified andcreated.

APPENDIX

Transcription Conventions

[Brackets linking two lines show overlap:Two voices heard at once

Reversed-flap brackets show latching)lN o pause

between lines/words/ in slashes reflect uncertain transcription/?/ indicates inaudible words? indicates rising intonation, not grammatical question. indicates falling intonation, not grammatical sen

tence: following vowels indicates elongation of sound

.. Two dots indicate brief pause, less than half second. . . three dots indicate pause of at least half second;more dots indicate longer pauses

~ Arrow at left highlights key line in exampleArrow at right means talk continues withoutj n t e r r u p t i o n ~

on succeeding lines of text" Accent mark indIcates primary stressCAPS indicate emphatic stress


12/12

216SOCIAL PSYCHOL()G)' QUART l i ) ~ !

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