Have they made you cry?
The article about how language belittles or blames continues to make rounds on Twitter (I’ve written about it here). Language can do nothing of the sort, obviously, language generally doesn’t do anything. People, including doctors, use language to do all sorts of unpleasant things, yet, more and more people are buying the need to change the language. I would like to introduce some linguistics into the debate.
What irritates me about these screams of wonder is the thoughtless blanking of any context. Who says things, to whom, when, what for, all these things are unimportant for the authors and commentators. This is a view of language that has nothing to do with how language works, still, the simplicity of the message, like, don’t say the word ‘deny’, is a winner. And somehow, it’s very easy to believe that when you change ‘taking history’ into, say, ‘engaging in dialogue’ your doctor will miraculously turn into a medical wonder. Silly? Yes, it is.
In this post, I want focus again on the problem that a medic can use all the right words and still belittle and invalidate. So, let me come back to the one sentence that almost reduced me to tears (yes, me, a grown man, highly articulate, highly educated, being able to stand up for myself).
It’s all to do with my chronic fatigue syndrome. Even though the infection was gone, the pain and fatigue were not. In fact, they were getting more intense. At the time, I was a fairly serious runner (about 40-50K a week) and all of a sudden, I just couldn’t run anymore. a short 5K would result in me not being able to recover for a couple days. I was in pain, I was in distress, so I went to see my GP. What I heard was striking. It was all normal. After infections, people experience fatigue, nothing to worry about, that’s just the way it is. I can’t remember how many times I saw a doctor at the time and I can’t remember how many times I heard it. But that wasn’t the bad bit. The bit that almost reduced me to tears was this:
Why are you looking for an illness?
It’s an innocent question, isn’t it? No problem words, no belittling or invalidating language, is there? And yet, I had never (or ever since) felt so undermined or invalidated. In a second, I understood all those stories of patients feeling destroyed by a doctor’s off-the-cuff remark. Thankfully, instead bursting in tears, I heard myself say:
You will never say this again to me. Never again.
I could barely contain myself. What followed was a very unpleasant conversation with the medic. For the first time, my GP saw pure anger in me, barely contained aggression, kept in check by social norms. Yes, I wanted to punch before headbutting him, wiping his idiotic well-studied pained expression off his face.
And here you have a conundrum. Where was the belittling or invalidating language? Which words should my GP have not uttered in order not to make me shake with anger? I’ll raise the stakes. At that time, I could not give a flying…..about this or that word my GP used. For at that time going to see the GP felt like going to battle. Every time I was psyching myself up to make sure that I was able to argue, to get heard. And I can still feel the tight stomach in the waiting room.
No, it’s not only about the CFS. I can also still feel the anger when three nurses, one after another, within the space of a few minutes, walked into my doctor’s surgery, without knocking, when I was discussing the possibility of having cancer with him. As I was trying to contain myself and not to succumb to fear, my privacy, my right to cry privately, was simply taken away from me. They behaved like I didn’t exist but I am apparently supposed to ponder the phrase ‘taking history’. I cannot even begin to respond to the two authors feeling great about themselves as they discover that ‘language matters’, as I talk to the doctor’s side because it is their computer which is now the centrepiece of their consultation room.
As more and more medics ‘discover language’, they somehow miss things like that. You know, the idea of engaging with the patient, acknowledging me as a partner. Not as a provider of stories, a source of ‘constructive’ information or patient opinion and feedback, which you will first authorise and then ignore.
My story, my experience, is evidence.
I once said to my GP.
We have to disagree on that.
He responded, looking at his computer screen. He also showed what he thought of our relationship, but, so much more importantly, he used only the medically approved vocabulary. The two authors want me to worry about their discovery of language, as if this were more important. What about your attitude, your communication, or, more generally, what kind of doctor you are? Aren’t these way more important than whether you write this word or another?
And here is the crux of the matter. References to language mostly serve to obscure the many issues you have and we, patients, have with you. Speaking to an unhelpful, impolite, belittling, obnoxious, disrespectful doctor is not at all about what words they use. It’s much more about how they behave, what they do, what they say, how they say it. But, it seems, doctors are different from the rest of us. Most of us, regular adults, don’t need to be trained in linguistics or read articles on vocabulary to know what it means to be kind, polite, considerate, even empathetic. You know, like normal people. Doctors apparently need training in normal social graces. Go figure.
Let me finish with a final story. When I was an intern in the psychiatry clinic of the Jagiellonian University in Krakow, I heard many stories about a famous professor of psychiatry and his unique way of speaking to his patients. And so, patients reporting delusions would apparently hear something like:
What kind of fucking nonsense is that? (For those of you who speak Polish, it was “A co mi tu pan/i będzie pierdolić?”).
Unacceptable, I hear a chorus of voices, insulting and offensive. Except that, so the stories invariably went, he said it in a way that not only were his patients not offended, but they loved him. He was a very popular shrink and had many patients, whom, so the legend goes, he was able to help.
The moral of this story is, inevitably, that language is contextual. And what appears to be ‘unacceptable language’, in the context of a particular encounter and a particular clinical relationship, can be warm, bonding and friendly. To repeat, ad nauseam, there isn’t a word which cannot be used both as a weapon and as an olive branch, given the right context. That’s precisely why it makes no point at all to promote some words and ban others. They all can move in mysterious ways.
Daily we are being persuaded that language matters (and yes, it does, a little). That if doctors change some of the vocabulary they use, somehow, we’ll all be better off. Daily, we are being told that language influences our thinking. So, really, if Brexit had been called Paradise, there wouldn’t have been a single person voting no. And because of this ‘language matters’ nonsense, daily, we don’t discuss clinical relationships, clinical communication. We don’t discuss respect, kindness, empathy.
So, please, please, stop worrying what word your doctor uttered, worry whether they respect you. It doesn’t matter, really, if they said another word you don’t like, ask yourself whether they listen to you. Is your stomach turned in knots when you walk into the surgery, do you feel helpless when you go home? Was the visit another time he or she made you cry? All that is significantly more important than a few words they don’t even think about.