A couple of days ago, my Twitter timeline sported a text called The Power of Words in Healthcare from the Society for Participatory Medicine. As ever, the list of 10 words is peppered with claims of power of language and of words, which, if you believe the article, can transform healthcare. I, on the other hand, despair when I read such things.

The text starts with a dramatic indictment of language:

Language has a magical influence on the lives we lead, with an impact on our thoughts, emotions, and/or actions. The words we use are one of the most potent ingredients in the science of language. Words have the power to heal, guide and motivate. They can confuse, mislead, and even hurt us. The intent of a spoken word can often be misinterpreted leading to an unintended consequence. The majority of our words are a result of habit and convenience. If we follow the ripple effect of our words to understand the emotions and/or behaviors they might potentially trigger, would it force us to pause, think and perhaps communicate differently?

I know it’s well-meant, I know it’s supposed to be helpful, but, I’m sorry, it’s nonsense. Which words have ‘magical power’, apart from ‘abracadabra’, that is? What impact on our thoughts and emotions have words like ‘cosine’, ‘continent’, ‘be’, or ‘lest’? What about ‘li’, ‘przy’, or ‘czwartek’? Exactly which words have magical healing power? And do you mean that if you say the right words you will cure cancer? Or just depression? Oh, please, do cure my CFS with the magic of your words!!! I’d better leave the paragraph here, before I get going for good.

But one thing I do agree with. Words are indeed an important part of what linguistics looks at. It might have something to do with the fact that if it weren’t for words, language might not exist, but, hey, let’s not be nit-picking here.

In my last post, I made the point that the slogan ‘language shapes attitudes’ is just about only patronising.  If language shapes attitudes, how on earth were the attitudes of those who point that out not shaped? It’s a statement of the elite protecting the uninformed mass from the language they decided was bad. Please, don’t protect me! But what really irritates me is statements like this:

Words have the power to transform healthcare and if you don’t speak their language, they won’t hear you.

Really? I detest this reference to ‘their language’ (here is my earlier post about it), as it implies that healthcare professionals have to dumb down in order to speak ‘our, the patients’, language’. Obviously, we cannot possibly follow the wondrous and sophisticated language you normally speak, as it just hovers above us. Even if we jumped, we couldn’t reach it.

But that’s just being patronising. Are you also suggesting that, say, the main problem of healthcare in the United States is language? Really? People are uninsured, while their health is subject to market forces and you worry about language?! That’s your priority?! What about access to the best healthcare? What about astronomical costs of American healthcare? Do you really think that a person who goes bankrupt because of saving their severely ill child will worry about words?! In which bloody universe, for pity’s sake?!

Anyway, that’s my rant. Let’s look at the words/phrases themselves:

• patient engagement
• patient journey
• patient-centric
• co-create
• compliance-adherence
• survivor
• fight
• caregiver
• Shared decision making
• negative

I read those words/phrases and in contrast to the author, I didn’t think they had any magic power over me.  In fact, on reading the phrases I thought exactly the opposite. I thought that they had been chosen precisely because they didn’t have any! They are simply a mix of stupidity and sugar-coating of reality. No one who was or is a patient would refer to what they are subject to in healthcare institutions as ‘patient journey’. The phrase is so idiotic that whoever invented it should be banned from speaking about healthcare! Anyone who was or is a patient knows that SDM, co-creation or patient engagement (whatever it is) is a distant aspiration, probably for both parties. And today healthcare professionals use such expression mostly to make themselves feel good.

I suspect people don’t like ‘compliance’ and ‘adherence’ because they are about medical gaze and medical power. References to fighting have long been disliked particularly by people ill with cancer. Words such as ‘survivor’ or ‘caregiver’, I suspect, were disliked because they reduce people into positions that might not be espoused by everyone. Magic power? Please!!

The only word I was somewhat surprised with was ‘negative’. I suspect, however, that it is to do with euphemising clinical communication. As I wrote in the last post, patients apparently don’t want to hear the hard news.

then I read the comments posted under the words and was gratified to see that they reflected my sentiments. Here is a quote on ‘patient journey’:

A 6 day trip to an exotic place that I’ve happily planned with an origin and destination is a journey. The multiple sclerosis I have or the cancer my husband got a few years ago—that’s not a journey!”

A comment on ‘adherence-compliance’:

Pick up a dictionary or a thesaurus to see how insulting these terms are! These words are synonymous with OBEDIENT, SUBSERVIENT, SUBMISSIVE, and PASSIVE. Non-adherence is equivalent with delinquency? Aren’t we in the 21^st century?!”

Do you really still think that those words have magic power of anyone? Unless, of course, it’s the magic power to irritate people!

Incidentally, it is very ironic  to see that the Society of Participatory Medicine still used the word ‘caregiver’ in reference to a person in the text, despite the fact that it was in the top ten disliked words! Why on earth do you want to find out which words to avoid only to ignore the results?!

Time for a comment. Words are important, language is important, I mean, I do beg your pardon: language matters. But it matters for a variety of reasons none of which is its magic power to ‘shape attitudes’. And I do wish all those well-meaning people stopped repeating this mantra. I also wish that, instead of making these grand claims about shaping the world, the language-warriors considered that some words should be changed because they are stupid, irritating, unhelpful (for a variety of reasons) and not because they mess with our minds making us unable to see the world. I really don’t think people will call their illness or treatment ‘patient journey’ and no matter how many hospitals and doctors will repeat that, people will not do it. And if they do, it will be because you will impose it on them, so they will, cursing you in the process.

Now, whenever I write against  simplistic claims about language shaping attitudes, I think I should suggest an alternative set of claims. So, slightly anxious, I’m going to have a go. Please forgive the oversimplification.

I think there are two levels at which ‘language matters’ claims should be considered. One is the linguistic form in a particular context. You can take research by Rose McCabe on the form of questions in medical interviews, by Elizabeth Stokoe on talk in suicidal crisis, or by Justyna Ziolkowska on discursive positions in psychiatric interviews, and see that, of course, the form of what is said in medical or quasi-medical contexts is significant. Yet, this level has nothing to do shaping attitudes etc., at least I don’t think people claim it.

The other level is one of discourse (some will say ‘order of discourse’), that is to say, the entire way of speaking, or a set of practices of speaking/writing about something, for example, mental illness, gender, nationality or whatever else. For example, men in depression whom I spoke to, inevitably located their experience in the dominant ‘discourse of masculinity’ and thereby constructed themselves as failed men. Their stories were full of self-deprecating, self-undermining, shame and embarrassment with their illness. Depression took their masculinity away.

The ‘dominant model of masculinity’ was an inevitable frame of reference for those men. In other words, no other discourse was available to them, even though there are other (sometimes marginal) discourses of masculinity. Indeed, there is research suggesting that therapy for men in depression should consist in making them aware of those non-dominant discourses of masculinity and in the process offering them an alternative in which to construct their experience.

I want to stress that I still don’t want to make any claims as to what people think. I just want to say that they have limited ways in which to tell their story. I still doubt that there is a simple and straightforward impact on their thinking.

Now, there are two problems with this level of ‘language matters’. First, it’s not about language, second, language doesn’t really matter. The moment we talk about discourse, we do not talk only about words, or even the entirety of the linguistic form (I so would like to see a campaign for active voice in medical discourse), we talk about much more. For example, who can say what to whom and in what sets of circumstances. How it can be said (the linguistic form) is only part of the issue. That, further, also means that it doesn’t really matter if you change one word for another.

Indeed, replacing the word ‘depression’ with something, say, less pathological, would change nothing for the men I talked to. This is because their stories were not only about depression, but the myriad of other expectations of what it means to be a man. Similarly, the continual change in psychiatric vocabulary has had little effect on how stigmatising mental illness is. This is because the ever-changing vocabulary is part of the entire discourse of psychiatry (or mental illness). Changing individual words doesn’t change the entire ‘way of speaking’ and so, it’s largely irrelevant in ‘shaping attitudes’.

Needless to say, this is more than likely to be a much oversimplified account of how ‘language matters’, much to be nuanced. Still, I think, it is roughly right. I also hope it makes it clear why the mantra ‘language shapes attitudes’ makes little sense, in the same way why opposing a word here or a word there is unlikely to make much difference.

Finally, I don’t believe that words heal or hurt (whatever either means). No, people heal or hurt others while communicating with them. It’s perhaps worth considering that as you get yourself off the hook, clinician, because you don’t use a ‘bad’ word.