Why integrate linguistic analyses in narrative medicine? – speech by Theodora Tseligka

Between the 19th and the 21st of May in Porto (Portugal) took place the “Humanism in Surgery” Symposium. The last day was dedicated to The European Narrative Medicine Society (EUNAMES) Congress. We are happy to shere some of the speeches and slides of the participant.

Theodora Tseligka, University of Ioannina, Greece.

«Μονάχη έγνοια η γλώσσα μου, 
στις αμμουδιές του Ομήρου…»
Οδ. Ελύτης, βραβευμένος με Νόμπελ

My only care my language,
on Homer’s shores…
Od. Elytis, Nobel prize winner

It comes as a great surprise that among the 17 Sustainable Development Goals (SDG) designated by the United Nations (in 2015) in an effort to build safer and more resilient societies, language is not included as part of the 2030 Agenda [1]. When ‘Quality Education’, ‘Good Health and Wellbeing’ as well as ‘Partnerships’ are foregrounded, among others, as key pillars in promoting prosperity, it is hard to imagine how these can be effectively implemented without considering one of the key players at stake, i.e. language.  Eradicating inequalities, forming global networks and inclusive partnerships, and ensuring a sustainable healthcare ecosystem for all unavoidably entails the use of language, in all its forms and diversity, with all its nuances, exigencies, dimensions and its ‘surrounding’ contexts.

With respect to the healthcare setting, the pivotal role of language has long been recognized by relevant research from a wide array of disciplines, ranging from medical sociology, philosophy and communicative studies to linguistics and ethnomethodology.  Arguably, a popular approach to analysing language use in medicine talk has often been rather instrumental and addressed at developing specific communicative skills and strategies, e.g. ‘breaking bad news to patients’, ‘taking a patient’s medical history record’ along with studies of different medical genres, including case study presentations [2].  However, the emergence of Narrative Medicine, embedded within the broader field of Health Humanities [3], has accorded a rather prominent position to narrative discourse.  It is argued that the medical practice should be informed by an inclusive, empathetic and scientific approach in the analysis of the interactive clinical setting, consolidating a more holistic perspective of healthcare practice.  To this effect, emphasis is placed upon the authentic narratives disclosed by patients, caregivers and healthcare providers when discussing illness management, the therapeutic approach, the impact of the patient-provider encounter, etc. [4].  The assumption is that, in tandem with a more phenomenological perspective, “the influence of language…is unavoidable and provides the entrée to a patient’s world that is necessary for a relevant portrayal of illness or health.” [5] 

Narratives, a versatile and fluid concept, “has undertaken numerous and multi-dimensional understandings and meanings in healthcare”[6].  Mediated and enacted through language, medical narrations are at first sight representations of the teller’s subjective experiences and reality perceptions.  Microanalytic linguistic approaches (drawing typically on discourse analysis, interactional sociolinguistics, conversation analysis) bring to the fore the complexities, ambiguities and (un)certainties, portrayed by specific linguistic choices, such as metaphors and euphemisms.  As aptly noted by Demzjen [7] “Linguistic analysis relies on systematic, replicable and theoretically based methods of looking at what choices (e.g. in pronouns, metaphors, grammatical form, etc.) are made (consciously or not) in contrast with other choices that could have been made, how such choices pattern systematically, and what the implications might be”.  Based on a robust methodology and a variety of research tools, the form and structure of patients’ narratives particularly are at the center of linguistic study, uncovering how the language used achieves discourse goals, maintains or disrupts rapport, showcases communicative strategies, represents experiences and fulfills a variety of underlying functions [ibid].  Quite often, quantitative approaches with frequency word analyses of medical corpora and quantifiable data are employed, resembling the widely-established Evidence-based Medicine methodology.  

Yet, what needs to be stressed here is that the greatest gift that new theories of linguistic analyses come bearing to narrative medicine is to document that the analysis is not constrained to eliminating fragmented ambiguities and decoding hidden ‘objective’ truths, but rather to raise awareness of the wonderfully intricate nature of language permeating the whole human being.  Employing a more hermeneutically-based approach, Franz and Murphy [5] argue that the language interactions in clinical settings need to be addressed from “the elusive realm of interpretation”.  By tolerating ambiguity and embracing subjectivity, it is proposed that physician-patient encounters can benefit from allowing fully interpretative dialogic interactions and immersing in the interlocutor’s unique linguistic reality [ibid.].  Most notably, medical narratives are to be seen as dynamic interactive language practices, embedded within specific contextual settings, where the teller’s identity is (re-)enacted and (re-)enacting through language.  In that sense, narratives are viewed as “a context-shaping discourse activity” [8].  New knowledge and perceptions about health and illness are co-constructed within each encounter framed within a particular sociocultural context [9].  Patients, their families, healthcare providers and caregivers, all come to the medical setting endowed with a language background that they resort to (each from a unique intellectual and emotional stance) and negotiate in context so as to (re)construct their experiences, understand their interlocutor and reach intersubjectively a common consensus: healing in a time of illness. Let’s assist them in this process.

[1] United Nations: Sustainable Development Goals. https://www.un.org/sustainabledevelopment/sustainable-development-goals/ Accessed: 15/5/2022.

[2] Ferguson, G. (2012).  English for Medical Purposes.  In Paltridge, B. & Starfield, S. (eds.), The Handbook of English for Specific Purposes, pp.243-261. https://doi.org/10.1002/9781118339855.ch13

[3] Crawford, P., Brown, B., Baker, C., Tischler, V. & Abrams, B. (2015).  Health Humanities. London: Palgrave Macmillan. https://doi.org/10.1057/9781137282613_1

[4] Peeters, B. & Marini, M.G. (2018).  Narrative Medicine Across Languages and Cultures: Using Minimal English for Increased Comparability of Patients’ Narratives.  In Goddard, C. (ed.) Minimal English for a Global World Improved Communication Using Fewer Words, pp. 259-286.  London: Palgrave Macmillan. 

[5] Franz, B., Murphy, J.W. (2018).  Reconsidering the role of language in medicine. Philos Ethics Humanit Med 13, 5. https://doi.org/10.1186/s13010-018-0058-z

[6] Hurwitz B, Bates V. (2016).  The Roots and Ramifications of Narrative in Modern Medicine. In: Whitehead A, Woods A, Atkinson S, Macnaughton J, Richards J, (eds), The Edinburgh Companion to the Critical Medical Humanities, pp.559-576. Edinburgh: Edinburgh University Press.

[7] Demjen, S. (2020).  Applying linguistics in illness and healthcare settings.  London: Bloomsbury Academic.  

[8] de Fina, A. & Georgakopoulou, A. (2008). Introduction: Narrative analysis in the shift from texts to practices, 28, 3, 2008, pp. 275-281. https://doi.org/10.1515/TEXT.2008.013

[9] Magalhaes, S. (2022).  Looking behind the Veil: Why Narrative Matters in Times of Uncertainties.  In Marini, M.G. & McFarland, J. (eds.), Health Humanities for Quality of Care in Times of COVID-19, pp. 25-36.

The European Narrative Medicine Society was born from an idea of the Italian Society of Narrative Medicine (SIMeN), and  it is an association of non-profit researchers dedicated to the investigation of Medical Humanities and Humanities for Health in the medical, health care, social services.

The purpose of this European Society is to promote and strengthen dialogues, discussions on the present and the future of Medical Humanities and narrative medicine, for health professionals, researchers (both academics and non-academics), humanists, teachers and other professionals coming from every branch. All this with the aim to contribute to improve both the well-being of people who suffer from a physical condition or a mental illness, and the health workers, the caregivers, the social services and the citizenship.

VISIT THE EUNAMES PAGE TO LEARN MORE: https://www.medicinanarrativa.eu/eunames


We are always welcoming new members from around Europe and happy to broaden our host member community with people fro around the world. If you want to join us, please send a short profile to the above email and we will be in touch.

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