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Review of  Medical Interpreting and Cross-cultural Communication

Reviewer: Simone C. Bacchini
Book Title: Medical Interpreting and Cross-cultural Communication
Book Author: Claudia V. Angelelli
Publisher: Cambridge University Press
Linguistic Field(s): Sociolinguistics
Anthropological Linguistics
Issue Number: 16.2756

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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

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

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

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

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

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

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.


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

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