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Review of Medical Interpreting and Cross-cultural Communication
Date: Mon, 19 Sep 2005 18:12:39 +0100 From: Simon C. Bacchini Subject: Medical Interpreting and Cross-cultural Communication
AUTHOR: Angelelli, Claudia V. TITLE: Medical Interpreting and Cross-cultural Communication PUBLISHER: Cambridge University Press YEAR: 2004
Simon C. Bacchini, Department of Linguistics, Queen Mary, University of London, PhD research student in linguistics.
Claudia V. Angelelli's book is a study of medical interpreting in a Northern California hospital. To carry out her research, the author adopted an ethnographic approach and for a period of almost two years she shadowed a team of interpreters who work for the hospital, California Hope (not the real name). All interpreting was done from English into Spanish and vice-versa.
Angelelli's stated aim was to problematize the role of the medical interpreter. In particular, she wanted to challenge the idea that the interpreter -- in particular the medical interpreter - can be invisible, a simple carrier of meaning from language A to B. in addition, the other myth to be dispelled is the one that places the interpreter and the practice of interpreting in a social vacuum.
For Angelelli, the interpreter's invisibility is 'a myth' and the fact that it is presented as both a fact and an ideal is a cause for concern. The concern, Angelelli argues, is both theoretical and at the level of practice. In Angelelli's opinion, for the field of interpreting to advance, one needs an underlying theory; but 'a theory based on a myth [that of the interpreter's invisibility] is not a substantial theory' (p. 3).
The other concern is at the level of practice. It is 'about the ways in which the belief system of invisibility impacts on the lives of those who rely on interpreters for their daily communicative needs [...] as well as the interpreters themselves and the healthcare providers' (p.3).
It is these concerns that prompted the author to question the role and the very existence of the invisible interpreter and to explore, on the other hand, his or her visibility. Angelelli's ethnographic immersion in the world of interpreted interactions at California Hope (CH) resulted in several hours of recorded material, both of face to face as well as over the phone 'interpretative communicative events' (ICEs) between patients and health-care practitioners (HCPs). Through a careful analysis of these interactions, many of which appear in the book, Angelelli shows how interpreters become visible by showing agency.
The author contributes to making interpreters visible by including a chapter in which synthesis of interviews with the interpreters she shadowed and recorded is given, as well as of an interview with the manager of the interpreting department at CH. Interestingly, during these interviews many interpreters described their role using metaphors, which Angelelli discusses in her final chapter where she also gives us her conclusions and illustrates the theoretical and practical implications of her findings.
'Medical Interpreting and Cross-cultural Communication' is an ambitious work. As the author herself states, it is aimed at a variety of readers, 'researchers, policy makers, interpreter-educators, practitioners, students of interpreting, healthcare professionals, and communication specialists' (p. 5).
With such a varied readership in mind, the risk is always that of disappointing one or more of the intended target audiences by, for example, concentrating on theoretical aspect while neglecting more practical points, or vice versa. Another possible risk, in this kind of work, is that of falling into the trap of an easy prescriptivism by giving lists of dos and don'ts. And so forth. Angelelli, a professional linguist with vast experience in both academic research and translation and interpreting, mostly avoids this pitfall.
The book is well planned. From the outset, she states her aims and concerns, as well as the gaps in the current literature that the book is intended to fill. Angelelli recognises that researchers have begun to address the notion of the interpreter's neutrality and invisibility. Her goal was to expand on previous research by studying a large number of interactions over an extended period of time. Hence the choice of an ethnographic approach.
As noted, one of the author's main aim was to question the interpreter's invisibility. Participation in a large number of ICEs led her to propose a new model of medical interpreting, one where the interpreter is all but invisible, a mere facilitator. Angelelli argues that the visibility of interpreters manifests itself when they do one or more of the following (p. 11): 1) introduce or position the self as a party to the ICE, thus becoming co-participants and co-constructors; 2) set communication rules (for example, turn-taking) and control of the traffic of information; 3) paraphrase or explain terms or concepts; 4) slide the message up and down the register scale; 5) filter information; 6) align with one of the parties; 7) replace one of the parties to the ICE.
When an interpreter does one or more of the above, 'agency' manifests itself. In chapter 6, Angelelli shows interpreters doing just that, in various degrees. 'Agency' here, is located in discourse moves, rather than in specific lexicogrammatical choices. The more an interpreter controls the traffic flow (instead of following it), the more he or she shows agency. Another way identified by the Angelelli as a means of showing agency is by showing awareness of differences in register.
The manifestation of much of this type of agency depends -- as the author acknowledges -- on the institutional setting in which the ICE takes place. Courtroom interpreting, for example, poses many more restrictions on the kind of discursive actions an interpreter can take, thus imposing -- in a way -- a role of conveyor of the linguistic message.
In addition, Angelelli alerts us to the fact that interpreting does not take place in a social vacuum. All the parties involved in the ICE have socio-economic and cultural backgrounds, and thy take place within institutions (the hospital, for example) that operate with a certain set of norm, most of which are assumed to be shared knowledge.
And here the author shows how interpreting in a medical setting involves a lot of cross-cultural brokerage and that there is much more than language that needs translating in an ICE. Parties in an ICE in a medical setting often come to the interaction with different expectations and different sets of socio-cultural norms. What constitutes appropriate behaviour in a doctor, for example (degree of formality vs. informality, directness, etc.) can vary considerably across cultures. The interpreter is thus responsible for the success (and, potentially, the failure) of the interaction by operating simultaneously on various levels of translation: the linguistic, the cultural, and the personal.
It is in this arena that interpreters display their abilities, demonstrate their visibility, and exercise their agency. As noted, in Ch. 6 the author provides many examples of this. They clearly show various degrees of visibility and agency on the part of the interpreters. In some cases, interpreters even take the lead in the encounter. They begin a line of questioning of their own initiative and even reprimand patients when they are not complying with the health practitioner's instructions.
Crucially, Angelelli shows examples of what motivates an interpreter's display of agency. This could be the perception of a possible misunderstanding, often caused by the perceived imbalance between the educational level of the patient and that of the health care practitioner.
In those cases where the author shows that the display of agency is caused by the interpreter's wish to tone down a statement by the HCP or by the patient, it could have been helpful to have referred to notions of politeness and face (Brown and Levinson, 1987) as a way of explaining some of the discursive move by the interpreters. This, in my opinion, would have added explanatory power to Angelelli's argument. The medical encounter provides fertile ground for the generation of face-threatening acts (with potentially devastating effects). It could have been interesting to have looked at the possible 'face-saving by proxy' that might occur in this kind of interactions.
As mentioned, the author conducted interviews with all the interpreters she shadowed asking them clarifications about particular occurrences and also about the perception of their own role. The former was a very useful tool for clarifying the reasons behind some of the interpreters' choices. In linguistic investigations, it is quite easy for the linguist to read too much in the talk of the informants. This particular aspect of her ethnographic approach allowed the author to avoid that pitfall, simultaneously adding scholarly rigour and giving interpreters a voice or more visibility, one is tempted to say. Particularly interesting is the part where interpreters use metaphors to describe their own role. And so we have the interpreter as bridge-builder, diamond connoisseur, and miner. Perhaps here, some reference to Lakoff and Johnson (1980) would have not gone amiss. This might have helped clarify what the participants' own, possibly sub-conscious theories of translation might be. In this respect, it would have been interesting to conduct interviews with at least some of the patients and some HCPs to shed light on their ideas of the interpreter's role in the medical encounter. This, however, would have certainly added another burden on Angelelli's already heavy task of data collection and analysis, and perhaps is more suited for a multi-authored work.
Overall, this is a very useful and readable work. In it, the author sheds light on the complexities of cross-cultural medical interpreting, and shows convincingly that -- at least in this kind of interpreting -- the notion of an invisible interpreter is no more than a myth, and a potentially dangerous one at that. This is applied linguistics with the 'applied' part very much in the author's mind and it will certainly prove useful to the categories in the intended readership mentioned above.
Importantly, Angelelli's clearly explained methodology makes it possible for other researchers to replicate the study (perhaps on a smaller scale), thus exploring the issues further, addressing other questions or the same ones while taking into consideration other theoretical orientations (an investigation the interpersonal metafunction from the point of view of Systemic Functional Linguistics would be one of my preferences).
Brown, P. and Levinson, S. (1987). Politeness. Cambridge: Cambridge University Press.
Lakoff, G. and Johnson, M. (1980). Metaphors We Live by. Chicago: University of Chicago Press.
ABOUT THE REVIEWER:
ABOUT THE REVIEWER
After a Mater's in General Linguistics and Comparative Philology at the University of Oxford, I began a PhD in Linguistics at Queen Mary, University of London. The aim of my project is to investigate the linguistic expression of physical pain. I am looking at issues such as the grammatical encoding of pain, the expression of evaluation, subjectivity, affect and agency. The analysis is carried out on an original corpus of interviews with Italian women suffering from autoimmune diseases, such as Lupus and Rheumatoid Arthritis. The theoretical framework of my work is functional (drawing in particular on Halliday's Systemic Functional Grammar) with insights from sciolinguistics and discourse analysis. My other interests are sociolinguistics, Italian linguistics, discourse analyisis, and language variation.