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Book review: Stavros Assimakopoulos (ed.), Pragmatics at its Interfaces

Because the biological side of medicine is subject to quantification and therefore readily researchable, it is enormously overrepresented in medical research. Even within the field of psychiatry, research is dramatically skewed towards drug trials and physical measurement: non-government research is dominated by the pharmaceutical industry; and the biggest public funder of research, the National Institute of Mental Health, has committed itself to a decade of supporting neurobiological research to the almost complete exclusion of psychosocial studies. Almost no research funding is directed towards examining the interand intra-personal use of language that so characterises psychiatric disturbance. I therefore approached Medical Discourse in Professional, Academic and Popular Settings hoping that it may fill some of these gaps. This volume takes a range of approaches to discourse analysis, including corpus analysis of different genres of academic discourse, analysing evaluative language in clinical case studies, a systemic functional linguistic approach to the ethics of consent, ‘Metaphor Identification Procedure’ to examine cancer discourse, and cognitive linguistics applied to mindfulness. Unfortunately, my overall impression was that the authors used medical discourse as material to speculate about language more often than they applied their tools to help us physicians provide better assessment and care for our patients. One minor irritant was the overuse of acronyms, always clearly introduced, but nevertheless confusing to the non-linguist reader. Despite this and my other criticisms, the volume is not without useful information for the practicing physician. We are encouraged to look more carefully about the ethics of informed consent (Pilegaard, Chapter 5), and this chapter will be a useful resource for those wanting to improve the quality of consent documents. Similarly, Montalt and García-Izquierdo (Chapter 6) flesh out the importance of the use of written information in medicine. A casual inspection of a doctor’s waiting room will demonstrate the generally poor quality of currently available information. Of most interest to me as a psychiatrist was the discussion of the Clinical Case Report (Chapter 3), in which Salvador demonstrates that it does matter how we give a patient voice in our recounts of their presentations. For example, it is a habit of psychiatrists to describe patients as having denied some quality or behaviour, for example, he ‘denied smoking and alcoholism’. We tend not to notice the difference from simply reporting more neutrally that the patient ‘did not smoke or use excessive alcohol’ but it does matter. ‘Denied’ is the language of interrogation rather than medical communication, and nominalisation (‘smoking’, ‘alcoholism’) takes agency from the patient. We do this all the time in psychiatry and we need to be reminded of the inherent dangers. Unfortunately, whether through some level of awe about the medical profession or a misplaced form of politeness, too few linguists genuinely challenge the way in which doctors shape medical discourse, and in the end, I was not sufficiently challenged or changed by reading this book.