In this post, I want to take up (again) the issue of the so-called language of illness, this time presented as ‘vocabulary of disease’. Because I am referring to the Imperfect Cognitions blog again, with philosophers about, I am treading cautiously and with some trepidation.
I’m inspired to write this by another post on the blog. Christopher Mole makes an argument for dropping the vocabulary of disease in the case of autism. Yet, I don’t want to write about the argument itself, I want to take the author up on the issue of the ‘vocabulary of disease’. I don’t know what such vocabulary might be. And before I consider what Mole himself says, first I would like to consider the matter linguistically.
As it turns out, I have written about the ‘language of illness’ before. Do indulge me and read a fragment:
Just commonsensically, ‘we’ speak differently of the common cold, depression and terminal cancer. Needless to say, there are multiple social, cultural and psychological reasons why this is so. Moreover, apart from a huge variety of contexts in which we talk about such illnesses, as …we also have goals upon goals we want to achieve with such talk, from apologising for not putting the rubbish out, through reassurance all the way to expressing love and compassion. And these are stereotypical situations just for starters. What about getting a sympathy date, self-humiliating to get an audience to laugh, making a point in a lecture? Which of those communicative acts constitute the ‘language of illness’ beats me.
I understand, of course, that the fragment above refers to the whole language (whatever it might be), so, at least in principle, the author’s reference to vocabulary can narrow things down. Still, vocabulary is not only what you can find in a dictionary, but it is what people use, for various reasons, with multiple communicative/social goals. Words are used and their usage is considerably more complex than we might think. And here we come to the first issue. Does the author mean the vocabulary that he (and other important people) will just designate as ‘vocabulary of disease’ or does he mean something else? For if it is the former, I would like to see the list of words he doesn’t like. If something else, the ground is very slippery and it’s worth reminding ourselves that people medicalise all sorts of behaviours for all sorts of reasons.
For example, when I was little my mother used all sorts of medicalised arguments to get me to do things or prevent me from doing things. One such situation was when she baked a cake, I was forbidden from eating it when it was still warm as, apparently, it would lead to some catastrophic effects on my body, including death from intestinal volvulus (in Polish skręt kiszek). Of course, the ‘vocabulary of disease’ was predominantly used to save the cake, rather than make a claim about iatrogenic effects of warm-cake eating. There is no doubt, however, that the argument was, shall I say, disease-oriented. Incidentally, when, much later, I asked her about pizza which is meant to be eaten warm, I was told to shut up. I spared my mother information about apple crumble.
But there is more. I wonder where the limits of the vocabulary of disease are. In other words, while I understand that words such as ‘disease’ and, presumably, ‘symptoms’ or ‘diagnosis’ would all count, but what about ‘illness’. Or ‘suffering’, or perhaps ‘pain’. But let’s make things even more complicated: what about the following words/phrases:
confidence, self-esteem, guilt, self-reproach, thoughts, indecisiveness, change in appetite, weight change, ability to concentrate.
Some of you will have already noticed that I am taking words from the ICD-10’s diagnostic criteria for the depressive episode (F32-33). Do they count as ‘vocabulary of disease’? In other words, if I talk about losing confidence, do I use vocabulary of disease or not? And while I would like to suggest that, at best, it depends, we’re faced with a big problem. For if phrases taken straight from the ‘book of disease’ may well not count as ‘vocabulary of disease’, what does? I’m running out of options here.
Yes, we could come back to ‘important people’ or particular people using the ICD-10 vocabulary, but only in particular contexts when referring to particular people in a particular way. I’m sorry to say, we have just lost any ‘vocabulary of disease’.
But let’s see what Mole himself says. He suggests that:
The vocabulary of disease enables us to infer certain normative consequences on the basis of there being a condition that impairs human flourishing: from the presence of such a condition it allows us to infer that cure-seeking would be appropriate (and perhaps obligatory for those with a duty of care); and it allows us to infer that shortcomings attributable to this condition are mitigated.
I must admit I started despairing when I read it. This fragment suggests that the adjective ‘old’ in the statement
Your grandad is very old now, we must help him
may well count as part of vocabulary of disease. In fact, I somehow suspect that ‘Stannah stairlift’ might also count as part thereof, though I am not exactly certain what the disease is. Moreover, if I say that I would really like not to be shy like normal people, I will immediately be pathologised (by myself in this instance)! Though, in this case, I don’t even know which word is part of the bad vocabulary. And let’s remember that Mole explicitly talks about vocabulary, as if nothing else could be part of ‘diseasing’. In contrast, I started wondering….
I can’t remember in what situation, but I heard the following question
Do you ever work out?
asked of a man. In the context, the question was a clear, and quite nasty, reference to the (large) size of the man’s body, quite clearly pathologising it and rebuking the man. But does the question count as vocabulary of disease? Yes, it’s very easy to say: yes, it does. But I would like to know on what grounds. Which part of the five words can readily be counted as such vocabulary? In fact, the issue is the question asked in a particular context! Not the words – the act of communication rendered by them!
I hope I’ve laboured the point enough. It’s easy and very attractive to use phrases such as ‘vocabulary of disease’ or ‘language of illness’. But when you start unpicking them, it quite quickly becomes fairly clear that they are empty signifiers. Or, here is the optimistic take, that finding the signified is considerably more difficult than it would initially appear. My second point is that language, I honestly cannot remember how many times I’ve said it, doesn’t consist of words only. You know, we put words in statements, questions, promises or warnings. And those higher-order structures also carry meaning, just as the linguistic form which is used to speak/write them.
My final point is about the blog’s (and the article on the basis of which it is written) fairly unequivocal construction of vocabulary of disease as something negative. I really would like the question “Is it?” to be asked much more often. I have written before that medical language has its uses and can, in fact, be useful in various contexts. A blanket ‘ban’ on such language makes no sense at all, just like it doesn’t make sense to say that people should always use it. More generally, to repeat myself again, there are very few blanket rules in language use that can be sensibly and usefully imposed and enforced. Language will find a way.