Can there be a clinical interaction without any medical or psychological language? Can you, as a clinician, do away with clinical/psychological terms? Here is my response.

The idea of the post came from a clinician:

I like the idea of getting completely away from clinical terms, medical or psychological. And then there could be criteria – also in ordinary non-medical language – which explained what kind of difficulties the service offered helps with?

As a non-clinician, I can’t speak to the extent such a position makes sense clinically, but I can offer comment on the extent such a position makes sense linguistically. Before I start, I would like to reiterate my position on clinical communication, I think it should be as close to a ‘normal conversation’ as possible. In particular, it should do two things. First, clinicians should open the discursive space for me to speak to them. I should, hopefully, be put in a position of a narrator telling a ‘story’. Second, you should not only listen to me, you should acknowledge what I say and make sure I see it. In fact, I actually did write a scenario for my ideal consultation. I never postulated non-medical language use because, and that’s my private non-academic opinion, I would assume that a clinician who never uses, shall I say, professional language, is patronising. There is a fine line, I think, between being understandable and patronising; it’s likely to be in different places for different people, but for me it comes quickly.

The way I see it, there are two aspects of the fragment I quoted above. One is getting rid of the medical/psychological language altogether, the other doing away with professional language in clinician-patient interactions. I must admit that I find both ideas very difficult to deal with. So, let me first deal with the former and start by saying that I recommend that people actually should read ICD-10. It’s surprisingly ordinary stuff in the F volume. As I pointed out in the previous post, you have things like:

confidence, self-esteem, guilt, self-reproach, thoughts, indecisiveness, change in appetite, weight change, ability to concentrate.

This is hardly ‘medical stuff’ and, more generally, I think it’s quite difficult to pinpoint the ‘language of illness’ or ‘vocabulary of disease’. And you could multiply such vocabulary; what about ‘emotion’, ‘personality’, ‘suicide’, ‘paranoid’? Are they medical/psychological?

And, to stress the point, yes, you can identify all the terminology which is used in psychology and psychiatry. You can also identify other linguistic/discursive practices in the disciplines. But just because psychiatry or psychology use a particular word and in a particular way, it doesn’t mean that it becomes solely and exclusively ‘medical/psychological language’, once and forever. It’s worth remembering that there is huge overlap the language psychologists and other people use. I also don’t think the direction of travel of such linguistic practices can be simply assumed to go from psychology outside. Yes, it’s likely psych-people use certain words differently, give them different meanings, still they really can’t call dibbs on the word like, say, ‘personality’. People will still use the word, also, but not exclusively, in the meaning in which, roughly, psy-disciplines use it.

Moreover, I tend to bang on about using verbs. I would like to see a diagnostic manual written more narratively (very nebulous word), but such a shift is not about ‘medical’ or ‘psychological’ language at all. Or if it is, it is much more subtle and nuanced than is dreamt in the ‘non-medical language’ philosophy. Yet, interestingly, somehow no one in psychology and/or psychiatry is interested in changing nouns to verbs. No, we must not use the words they choose for us (yes, of course, it’s about power).

Now, I’m also not entirely certain what it means to put the criteria (I assume, wink, diagnostic criteria, except we shall call them something else) in ordinary language. What’s ordinary language? Commonsensically, it can be argued that The Sun, The Telegraph and The Guardian are all written in ‘ordinary’ language. Moreover, it is The Sun which reaches by far the most people in the trio, so should ‘the criteria’ be written in the language of The Sun? I somehow doubt the idea would have many takers, so what language should we write the criteria in? And so, we start flipping the empty signifier. From the ‘vocabulary of disease’ we go to the ‘ordinary language’, but there isn’t any ‘ordinary language’ to be used in writing medical and psychological stuff. And, to be honest, I think what the author of the fragment ‘really means’ is: ‘Let’s use the language my friends and I like.’.

But this question does have one significant consequence. Let me ask you this: If you give up on the notional ‘psychological language’, do you still practice psychology? For I’m not so certain. I’m no expert in the language of science, but I would imagine that a significant part of being a psychologist means being able to use, understand and partake in sets of (linguistic/discursive) practices other members of your community of practice use. The moment, I think, you give up on using, say, the word ‘personality’ and replace it with, say, ‘soul’, you stop being a psychologist. Obviously, it’s way more complex, still the principle is sound, I think. As a psychologist or psychiatrist, you cannot start explaining what’s happening to me in terms or ‘possession’ and tell me that a spirit has invaded and now inhabits my body. You cannot order exorcisms and sing chants as you cast spells on me. Why? Because ‘possession’ and ‘exorcism’ are not part of the community’s practices.

So, what’s left, if you simply stop using the medical/psychological language? Too be completely honest, I don’t know. But my guess is it’s chit-chat. If I see a psychiatrist/psychologist, I want her to describe me in terms of the current discourse-knowledge, and this account of what happens to me will initially be a hypothesis that will be challenged, until, hopefully jointly, s/he and I will come up with something useful for both of us. But that means using ‘medical/psychological language’, doesn’t it? There is no escape, is there?

And so, we come to the interaction. I sit down in front of a clinician, s/he (let’s hope) lets me speak, listens intently, then asks me a question or two, possibly asks my opinion, asks another question or two and then what do we do? How do you account for what’s happening to me without recourse to professional language? Will you just say that I am sad?  I really don’t need a shrink to tell me that, I already know it. What I need a shrink to do is offer a way out. And how do you offer a way out without falling back on the ‘medical/psychological language’? Even if you think that I need a job as part of the way out of my depression (that’s what men I spoke to said)!  How do you offer evidence for what you suggest? What is your reasoning based on? Are you going to say: People experiencing what you experience tend to benefit from…? Whether you believe that my depression comes from chemical imbalance or from a trauma I experienced, do we resist calling it something because you would like to give up on the language you don’t like? What if I do want to call it something? Shall I call it ‘you-know-what’?

And then there is something like chronic fatigue syndrome, regardless of what exactly it is. For me getting the CFS label was a small victory in my fight for the right to be ill. Yes, the right to be ill – there is a blog in it. So, I wallow in this medical/psychological language as it provides me with a framework to see what’s been happening to me. Is it possible to achieve that without this language? I don’t know, I can’t see it, but then no one tried it. Just like my ‘strabismus’ which depersonalises my squint (bloody hell, I hate this word), also my CFS has a very important function. It allows me to be ill! It allows me to stop wondering whether I’ve completely lost it and started imagining things.  And I wish all those who keep on criticising the use of medical and psychological language for once stopped to consider that it also offers something. Well, it offers me and, believe it or not, it’s quite an important consideration for me.

And here we come to the final point about the fragment. What really (like, really) struck me is that the little fragment is about the clinician and what the clinician likes. And I would like to say: bloody hell, it’s really not about you. I really don’t give two hoots about what you like or not, because your language should be useful for me, not you. And regardless of your likes or dislikes, you should follow me in how I speak. Not the other way round.

When I came to be interested in things psychological/psychiatric, I started by looking at how these disciplines and their representatives use language. I wrote, for example, about the language of the famous (or infamous, if you prefer) Beck Depression Inventory. And yes, I showed again that language matters (oh, the cliché!). But that doesn’t mean that language is everything. This incessant focus on the language used by psychiatry and psychology is just absurd. There is psychiatry and psychology beyond the language it uses, and psychiatrists and psychologists should not be trained in departments of linguistics! And the assumptions that the moment you will change the language, things will become nice, pink and fluffy are, I’m sorry to say, just silly. Yes, discourses inform the objects of which they speak, as Foucault teaches, but let’s not forget that there is the other part of the equation. They are also an emanation of the social condition. There is a dialectic tension between discourse and context, one impacting the other. And sometimes, just sometimes, you might want to consider thinking about the context and not only about discourse. For example, about the fact that helping people is not about the clinician and their comfort, but about the patient and their comfort.

And so, how about, you know, like once in a blue moon, worrying about me and not ‘the language’? For once, please, stop talking about ‘language’, and start talking about making ‘me’ better.