The Cambridge Handbook of Communication Disorders examines the full range of developmental and acquired communication disorders and provides the most up-to-date and comprehensive guide to the epidemiology, aetiology and clinical features of these disorders.
EDITORS: McPherron, Paul. and Ramanathan, Vaidehi TITLE: Language, Body, and Health SERIES TITLE: Language and Social Processes [LSP] 2 PUBLISHER: De Gruyter Mouton YEAR: 2011
Simone C. Bacchini, Department of Social Sciences, The British Library, London, UK
In broad terms, the theme of this edited volume is the relationship between language and the human body. The term ‘body’ is used here in a very broad sense; it includes the healthy body and as well as the ailing one. It is concerned with language about and by individuals experiencing a host of body-related issues, such as visual impairment, organ transplants, chronic and terminal illnesses, and mental conditions. Contributions are also concerned with language about and by those near to those experiencing these issues, such as family members and carers. They draw on a number of methodologies, disciplinary perspectives, and theories. The analysed material comprises extant data as well as ethnographically gathered ones. To use the phrase coined by one of the editors (Ramanathan 2009), it is concerned with the ways in which bodies ‘get languaged.’ The authors of the contributions address various aspects of the terms in which body-related issues can be and are addressed. These include the social, the cultural, the communicative, and the emotional. Each contribution focuses on how, through language, “people with ailments or ‘unusual’ bodies’ get positioned and slotted in certain ways'' (p. 1). Importantly, the volume addresses the issue of how notions of ‘normalcy’ in relation to body-matters are constructed and reproduced and the ways in which, through language, ‘dysfunctional’ bodies are publicly framed or hidden from view.
Following an introductory chapter by the editors (pp. 1-14), the volume is divided into four sections. ''Bodies and communication'' (pp. 15-74) deals with ''abnormal'' or ''malfunctioning'' body-parts. “Bodies and cognitive ‘impairments’” (pp. 75-144) deals with conditions which affect cognition, such as Alzheimer’s disease and autism. ''Bodies and chronic ailments'' (pp. 145-171) contains essays on long-term or chronic conditions, such as diabetes and rheumatoid arthritis. The final section, ''Bodies and body performances'' (pp. 193-278), deals with ways in which culture and society structure ''body enactments and performances.''
Section one opens with an essay by David Bolt titled ''Community, controversy, and compromise: The language of visual impairment'' (pp. 15-36). With reference to visual impairment, Bolt addresses the various debates that have been taking place in recent decades within the disability community in relation to terminological typology. He begins with an overview of the ways terms such as ''blindness'' and ''the blind'' have been used unproblematically until the 1960s. The discussion is usefully positioned within current and well-established debates on ''ableist'' discourses on impairment but focuses on what Bolt terms ''ocularcentrism'' in language about visual impairment. The author highlights how the central role that vision is accorded among human experiences is reflected in the plethora of phrases, metaphors, and various language usages that equate unimpaired vision with full cognitive and experiential integrity. A consequence of this is that, in a language like English, the word ''blindness'' and its related concepts have almost exclusively negative connotations. This conclusion is supported by an examination of dictionary entries for terms and expressions related to blindness. Interestingly, Bold shows that of thirteen definitions of the adjective ''blind'' twelve are negative and only one pertains to actual visual impairment. However, even when not referring specifically to visual impairment, such usages clearly translate in negative evaluations of not only visual impairment but, crucially, of visually impaired individuals. Observations on how words derive their meanings ''from the company they keep'' and of the effect this has on people’s understanding and evaluation of real-world phenomena is not new. Yet, Bold highlights how this common linguistic encoding of vision-related phenomena is not only conducive to negative evaluations of visually-impaired people, it also distorts the reality of the full spectrum of visual impairment. The world of total darkness that such phrases and metaphors imply is rarely, if ever, the case. In this reviewer’s opinion, the analysis would benefit further from usage of large corpora, such as the Bank of English, to lend further support to the author’s claims. Furthermore, historical corpora could be used to give sounder grounding to claims relating to the stigma attached to blindness from a diachronic perspective. Use of the OED would perhaps offered better and more interesting results than the etymological notes found in the ''Encarta Wold English Dictionary,'' which Bold uses.
The author than offers a concise and useful overview of the debates on terminology which have been occurring since the inception of the disability movement in the 1970s. In particular, he discusses what has come to be known as the ''radical social model of disability,'' born out of a desire to contrast medical and essentialist views of disability. He concludes by discussing how recently, the radical social model has been critiqued but how this critique is adding diversity to the debate and having empowering effects.
Bold’s analysis illustrates very well how language clearly shapes our understanding of bodily phenomena. As noted, his observation that reality is not only reflected but also shaped by language is not new. However, by making the point with reference to the language of and about visual impairment the point comes across vividly. In his conclusions, the author states that his analysis does not intend to be prescriptive but that it aims to provide a rationale for making particular linguistic choices. This is particularly apparent in Bold’s critique of the National Federation of the Blind’s opposition to what has come to be known of ''person-first strategy.''
The second essay (pp. 37-53), by Paul McPherron, is titled: “Rebuilding the body: Biomedical discourse and the decision to perform a living donor organ transplant surgery.” It deals with the concurrent and often contrasting discourses of organ transplant of medicine (transplantation as a medical miracle), those of society (organ donation as a ''gift,'' signifying generosity and altruism, as exemplified by donations advertisements), and those of the patients and their families. Taking an ethnographic approach, the author concentrates on the discourse of living-donor transplant, based on his experience of donating part of his liver to his father. Using data derived from print and internet advertising, family discussions about transplant, and participant journals, the author shows that behind the medical discourse of organ donation lies a dominant ideology that, whilst framing donation as an act of generosity, simultaneously monetises it. McPherson’s analysis problematizes the prevailing notion of organ donation through metaphors of accounting. His data show how different from patients’ own metaphors and conceptualisations these images are. However, he demonstrates that questioning prevailing discourses of organ donation and transplant creates new spaces where new, fruitful and empowering discourses, more reflective of the patients’ experiences, can be generated.
The fourth chapter, which concludes section one, is by Vaidehi Ramanathan: “Reading ‘intentions’: Communication challenges for parents of children with autism and partial hearing'' (pp. 56-72). This ambitious essay attempts to probe whether the language we have for our bodies can adequately explain (or ''language,'' in the sense of ''give voice to'') accounts of ''subjectivity and the psychical inner space'' (p. 55). To answer this question, the author refers to Lacanian psychoanalytic thought as well as Bakhtinian Vygotskian ideas about inner speech and tries to explore how intentions operate at a pre-language level and to what extent such unconscious, pre-language intentions and verbalised language match. For parents and carers of children with autism and partial hearing, Ramanathan argues, an appreciation of the possible mismatches of pre-linguistic intentions and what gets ‘languaged’ is of crucial importance.
Ramanathan’s essays is based on two cases of autism and one of partial hearing. It is aimed at showing that, in such situations, communicative problems reside not so much in the children’s problems in reading other people’s intentions. They reside in the fact that the parents and carers of these children have to base the socialisation of the children on their (the parents’ and carers’) “readings of what the ‘normal’ world intends'' (p. 57). Although the essay does not provide definite answers, it highlights the problematic nature of communication in general and the ways this is heightened when what we take to be the ''normal,'' world, with it referents and ways of meaning, and the ''pathological'' meet.
Section two opens with a chapter by Boyd Davis: ''Intentional stance and Lucinda Greystone: Embodied memory in conversational reminiscence by a speaker with Alzheimer’s Disease'' (p. 75-104). This chapter focuses on the communicative challenges faced by individuals with a relatively common communicative impairment and those who care for them. The author argues that, in spite of changes in attitudes towards dementia of the Alzheimer’s type (DAT) and in models of care, negative attitudes and stigma towards DAT persist. Crucially, the author argues, such attitudes influence not only care outcomes but also people’s willingness to participate in screening programmes. Davis makes use of the concept of ''intentionality of insight,'' ''an awareness [on the part of DAT patients] of how other people might view their having dementia'' (p.76), two analyse two sets of repeated stories by a woman with DAT in conversation with students in training. By looking at repeated snapshots of conversation, the author shows how his informants manage to create and project a sense of self, with the interlocutor’s co-operation, by using small narrative fragments.
Chapter six (pp. 105-141), ''Body in autism: A view from social interaction'' by Olga Solomon, concludes the section. Similarly to the previous essay, this chapter focuses on social interaction in cognitively impaired individuals. Solomon’s analysis is multimodal; it relies on video-recorded daily (and mundane) interactions involving high functioning. The section discusses the ways in which affected individual operate in everyday life. In addition to addressing the embodied nature of autism, the chapter also argues for more ethnographic involvement in the study of autistic communication.
Part three, on ''bodies and chronic ailments'' is opened by Hanako Okada’s essay (pp. 145-170): ''Negotiating the invisible: Two women making sense of chronic illness through narrative.'' Taking a broadly narrative approach, the author analyses accounts by two women, one diagnosed with fybromalgia and chronic fatigue syndrome, the other with rheumatoid arthritis and a herniated disk. All of these ailments are, to a lesser or greater extent, ''invisible illnesses'' in the sense that (apart from disc herniation) they can go undiagnosed for a long time and their symptoms are very often invisible to the onlooker, even the medical professional. Okada uses Merleau-Ponty’s (1962) embodied phenomenology as a theoretical framework to investigate how these women narratively construe, negotiate, and communicate their conditions. Crucially, because of the aforementioned invisibility of these ailments, narrative becomes essential in reifying the conditions, lifting them, and the experiencing subject, out of obscurity.
Another chronic condition, Type 2 diabetes, is addressed in chapter eight, “Training your taste buds”: The language of success in diabetes ‘Self-efficacy’” (pp. 171-190), by Evan Davis, Knol, and Turner. The authors combine the instruments of discourse and narrative analysis to examine the language of patients who are successfully self-managing their condition and that can then be used to instruct and encourage newly diagnosed individuals to accept their condition and take ownership of their treatment regimens. According to the authors, such stories present the diabetic condition as one that is manageable, thus allowing patients to better cope with it. In addition, by narrativising their experiences, these ''successful'' patients are shown to ''discipline'' both the body and body breakdowns.
The final section of the book moves beyond the mainly North American setting with an essay by Busi and Sinfree Makoni titled: “The discursive construction of the female body in family planning pamphlets” (pp. 193-219). This section used a multimodal approach, by analysing both text and images in family planning pamphlets in pre and post-Colonial Zimbabwe. The authors’ analysis highlights the contradicting discourses and perceptions of the female body in the transition between the colonial and independent period. These differences in the conceptualisation of the female body, many of which persist to this day, have resulted in considerable tension between generations and between the sexes. The chapter also looks at the semiotics of film in female health and child reproduction.
The following chapter, “Blood talk: A discursive perspective on transcultural identity and mental health” (pp. 221-244), is by Matthew T. Prior. By looking at the language of a former Vietnamese refugee in the United States, the author examines how his informant draws on discourses of the body as both object and resource to construct a present a coherent and believable identity, as well as a rational self. Several ''strands of identity'' are addressed by the speaker: ethnicity, masculinity, and sexuality (same-sex orientation). Interestingly, the author shows how the topos of ''blood'' is invoked to harmonise potentially conflicting identities (Vietnamese, Chinese, Asian).
The following essay is by Fei Shui: “Body act: Contemporary Chinese body performance, critical narrative, and somatic writing” (pp. 245-266). This essay is unique in that it uses as data the performance genre of body art in China. The author analysed discourse around such performances (the ways in which they are documented, critiqued, talked about, and written). In so doing, he connects them with his idea of ''somatic writing'', defined as ''the alternative embodied practice and linguistic strategy to capture the evasive, the illicit, and the erotic'' (p. 245) in such performances. The author’s analysis shows how in these performances the body is eminently political in its interactions with the state, space, and the evolving organisation and prevailing ideology of Chinese society. The body is both object and subject and a living metaphor of the wider body-politic.
The last chapter in the volume is an essay by Tim McNamara: “Bodies and applied linguistics: The challenge of theory” (pp. 267-278). In it, the author consolidates and brings together the various themes addressed in the volume and suggest new avenues of research. He focuses on the relationship between applied research (in the form of applied linguistics) and theory. He advocates a bringing together of applied work and theory and highlights how not only theory can inform applied theory but also how applied research can in turn shape theoretical thinking. Body and language issues, the author argues, cross disciplines and they ought to be made as central as issues of language and race, ethnicity, and gender.
This volume is the second in a series that aims to contribute ''to the development of promising new approaches to the sociolinguistic, sociohistorical and linguistic anthropological study of social issues that centrally involve language'' (2012, Language and Social Processes series: aims and scope). The approach is thus broad and the volume under review fits very well in the series. One of the strengths of the volume is provided by the variety of academic background its contributors come from. The variety of expertises, outlooks, and theoretical perspectives truly allows the volume to appeal to different readerships. As stated by the editors (p. 1), the volume “seeks to contribute to and extend current investigations in applied sociolinguistics.” Because of its broad perspective and non-dogmatic approach, the volume will be of interest to different audiences. These include, but are certainly not limited to, applied linguists, sociolinguists, discourse analysts, health professionals, those working within the field of the medical humanities as well as those with an interest in disability issues. In addition, it is certainly refreshing to come across a work where a cross-disciplinary approach allows researchers space for intellectual and methodological cross-fertilisation and inter-disciplinary dialogue. Whilst scholarly works on the language – illness nexus are not lacking, what this volume offers is a broader perspective made possible by the idea of ''languaging the body,'' formulated by Ramathan in this and her previous work (2009). By ''languaging,'' the authors in this volume refer to various meaning-making processes (verbal and non-verbal; at the production and reception end of the communicative spectrum) using different modalities. The ''body,'' too, is understood in a non-restrictive manner and this understanding is therefore conducive to analysis of various aspects of the embodied experience, ranging from cognitive impairment to chronic illness. The already-mentioned ethnographic perspective that many of the essays have is particularly valuable, adding the value of the personal testimony to that of scholarly research.
At the same time, this broad approach can result, in places, in an apparent reduction in coherence. For example, from a methodological point of view, the various authors often employ different transcription conventions for their data. Although, as Riessman (2008) implies, transcriptions should not be fetishised, using different transcription methods within the same volume without providing transcription conventions can be confusing. Similarly, some of the authors employ terminology without proper definition. In Okada’s otherwise excellent paper, the term ''narrative'' appears to be used rather loosely, as a more or less synonym of ''story.'' Although not a major problem per se, in a volume that often makes reference to sociolinguistics, the reader is bound to expect ''narrative'' to reflect the rather strict Labovian model; the same applies to Evan Davies et al.’s paper, where reference is also made to ''discourse'' and ''discourse analysis'' rather ambiguously, as is the term ''agency'' (p. 179).
However, in this reviewer’s opinion, the aforementioned characteristics do not detract from the overall value of the research that this volume presents and encourages. But perhaps owing to the reviewer’s own background in sociolinguistic and discourse studies, it is felt that a certain harmonization at the editorial level would have made the final product more user-friendly.
In spite of the minor defects pointed out above, ''Language, Body, and Health'' is a valuable and needed book. Not only does it highlight the ways in which language (broadly understood) shapes and give visibility to embodied experience, but it also opens the way for new avenues of research from a variety of angles, or for the novel exploration of ''old'' problems in relation to the body in its various states. Usefully, each essay includes, together with list of references, a short annotated list of recommended readings for anyone interesting in knowing more about the background and methodology of each essay.
Riessman, Catherine. 2008. Narrative methods for the human sciences. London: Sage.
Language and Social Processes series: aims and scope. Available at: http://www.degruyter.com/view/serial/179211 (Accessed: 15 June 2012).
ABOUT THE REVIEWER:
ABOUT THE REVIEWER
I have recently defended my doctoral thesis on the linguistic encoding of
the experiences of physical pain and chronic illness through the
lexicogrammar of Italian. My research interests include sociolinguistic,
Systemic Functional Grammar and discourse analysis. As a result of my
doctoral research, I have developed and interest for health communication
and the use of language in medicine and medical settings. I am currently
researching the encoding of ‘affect’ in doctor-patient communication, with
particular attention to the role of the interpreter in situations when
medical professional and patient do not speak the same language.