This post comes from frustration. I’m not entirely certain I should write it, but, hell, I am getting fed up with hitting the brick wall of….medicine. And so, I want to write about what the wall looks like.
In a way this post been long coming, but, recently, there was a tipping point. I want to show you two snippets from reviews I recently got (the ms was on clinical notes). Here is the first:
Clinical notes by their very nature are objective and summative.
To be completely honest, when I read this comment, I just despaired. I hoped that such a statement was so obviously false that it simply could not be written. This is because it’s not just untrue because I have written on clinical notes before, it’s untrue because it’s at odds with well over 200 years of linguistics, roughly since the concept of Weltanschauung was invented by Wilhelm von Humboldt. We are way beyond Humboldt in linguistics today and say confidently that there is no such thing as ‘objective’ language or text! And while I can just about understand that a reviewer in a top medical journal is not au fait with linguistic theory, I would hope that would have heard of, for example, Michel Foucault and that would give them pause to think before writing a sentence so stupid! And if not that, there are actually plenty of medics who around who already understand this no problem.
I also hoped that a review containing sentences like that would not be taken seriously. A sentence that shows such a complete absence of any reflection on clinical communication (whether spoken or written) is very hard to engage with. For me it’s akin to saying that the moon is made of cheese. One doesn’t legitimise nonsense by debating it, do we?
Alas, that was not to be. So, how do you argue with an utter fallacy, if, given that the review was sent to you, the editors must think that this is a serious review? In fact, the review was considered so serious that the paper was deemed unworthy of further consideration. Really?! I mean, really?!
Here is the other snippet, referring to the same paper, from a different review:
Some findings are presented as surprising, for example, that some notes are “stripped of any personal involvement”. However, given that notes do not intend to report on such aspects, this seems not to be such a surprising result.
I find this statement extraordinary (incidentally, the quote in the snippet is not a quote, but, hey….). It is also quite arrogant. The statement is so completely outside any understanding of language/discourse that my teeth ached. The reviewer, for example, seems to ignore that if communication between the doctor and the patient is constructed with completely absence of the medic, that’s actually something not only interesting, it is also quite significant. But in order to understand this, you must have a basic understanding both of what it means to communicate and what it means to analyse text. Of course, I accept that such a finding might not be of interest to medicine, but I really would like to see the argument.
There is more. The idea that medicine simply can say what is important or unimportant in the language of clinical notes is nonsense (this is what the snippet is about, isn’t it?). And just because a reviewer decides that notes are not intended to do something, the issue really doesn’t become irrelevant. It really doesn’t! To try an analogy, this is like saying that the fact a patient is constructed as stupid doesn’t matter, because the notes are not intended to write about patient stupidity. Or, it doesn’t matter that the notes are full spelling mistakes, because notes are not intended to be spelling guides. Sapienti sat.
Now, ever since I started being interested in medical/psychiatric issues, I’ve wanted to communicate with people about whom I wrote. I’ve thought that it’s better to tell shrinks about their communication rather than linguists. Yes, linguists are likely to understand better, but I’ve hoped that medics will be more interested. But it’s not only about my disappointment, I want to make two more general points.
The first thing is that I am really sick and tired of being reviewed by people who have no idea about qualitative research. And it’s not only about arrogance of such reviews, more importantly, it is about the integrity of the peer-review system.
Trying to talk to medicine (psychology is not much better) is like running into a brick wall. Time and again, I get reviews which suggest that the reviewers have absolutely no idea about qualitative research. They don’t even try to engage. But what really irritates me is that the editors seem to go along with them. Why bother for…. pity’s sake? Why even pretend?
I started writing this post yesterday, today, as it happened, Christiane Grünloh tweeted about asking reviewers whether they are able to make a judgement on qualitative stuff. It’s a very well-made point. The assumption that ‘anyone’ can comment on qualitative research is beyond irritating.
The second point I want to make is about medicine telling us, social scientists, what we can or cannot research or publish about. I might have mentioned before that I had already been diagnosed (3 times!) by my psychiatric or psychological audiences; a couple of psychiatrists in the audience of my papers explicitly told me that my research was harmful and I should cease and desist immediately; a number of audience members left loudly and angrily when I was speaking. I myself seem to be responsible for undermining the entirety of shrink-patient trust!
The assumption that medicine can tell me (and other social scientists, presumably) what can or cannot be researched is mind-boggling. By what right?! All that, needless to say, while at the same time professing undying interest in social scientific and discourse-analytic insight into matters medical, psychiatric or psychological. At what point do you begin to notice hypocrisy? When it comes over and kicks you?
It’s been 30 years of my research work this year. I started working on my doctorate 30 years ago, just about to the month. I can’t believe it’s been so long, I also can’t believe how many brick walls I have run into since. But, on the whole, I bear my academic scars with some pride.
And yet, it’s the first time I’m really disheartened. I’m tired fighting a fight which, ultimately, I cannot possibly win. Unless you recognise the problem, I cannot win. Yes, when up against the entire world, I really prefer to take the world’s side! I’m tired. If you, shrinks, think you have all the answers and you do such sterling work, who am I tell you you’re wrong? You’re so bloody brilliant, aren’t you?
I really don’t mind being told my research is crap (well, I do, but I can take it). But I would like to be judged fairly. I want to be judged by people who understand what I write about, without preconditions of what exactly I can or cannot write about. Otherwise, the whole thing makes no sense at all.