From: Randall Eggert <randylinguistlist.org>
Subject: Review: Discourse Analysis: Pöchhacker & Shlesinger (2007)
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EDITORS: Pöchhacker, Franz and Shlesinger, MiriamTITLE: Healthcare InterpretingSUBTITLE: Discourse and InteractionSERIES: Benjamins Current Topics 9PUBLISHER: John BenjaminsYEAR: 2007
Laura Callahan, The City College of the City University of New York
SUMMARYThis volume was first published as a special issue of the journal _Interpreting:International Journal of Research and Practice in Interpreting_ (7:2, 2005),prior to which the papers had been presented at the Fourth Critical LinkConference (Stockholm, 2004). It contains an introduction, five articles, andfive book reviews. The articles cover various ''settings and specialties, fromgeneral medicine to pediatrics, psychiatry and speech therapy'' (p. 6). Languagepairs include ''Arabic, Dari, Farsi, Italian and Spanish in combination withDanish, Dutch, English and French'' (p. 6). As the editors inform us, the twocommon focal points are discourse-based analysis of interpreter-mediatedinteraction, which in turn forms part of the larger field of cross-culturalcommunication in healthcare settings (p. 2).
Franz Pöchhacker and Miriam Shlesinger. Introduction: Discourse-based researchon healthcare interpreting.Pöchhacker and Shlesinger describe the trajectory of healthcare interpreting, asboth practice and object of research, within the larger field of communityinterpreting as well as in other disciplines. As recognition of its importancehas grown since the mid 1990s, various theoretical approaches have been used tostudy this type of interaction. The editors highlight the influence of CeciliaWadensjo (cf. Wadensjo 1992, 1998), whose approach centers on dialogic discoursein triadic interaction. Pöchhacker and Shlesinger next offer brief reviews ofother important literature in healthcare interpreting, noting that the firstinvestigations came from researchers outside the field of interpreting studies.Having situated this volume's work within its broader historic andmethodological context, the editors conclude the Introduction with a descriptionof each of the five papers.
1. Yvan Leanza. Roles of community interpreters in pediatrics as seen byinterpreters, physicians and researchers.Leanza highlights the need for professional interpreters in order to avoid thelinguistic errors and subsequent misdiagnoses that may occur with ad-hocinterpreters. Noting the presence of cultural differences between thepediatricians and their patients and patients' parents, the author examineswhether the interpreter exercises linguistic skills only or also culturalknowledge. Reference is made to Jalbert's (1998) taxonomy, which shows a clineof involvement and hence, visibility, moving successively from the minimumpresence of the translator up to cultural informant, culture broker or culturalmediator, advocate, and finally, bilingual professional. Leanza examinesvideotaped preventive pediatric consultations in a clinic in Switzerland todetermine which role the interpreter plays. The languages used are French andAlbanian or Tamil. Stimulated recall interviews with the physicians were alsoconducted.
Critical incidents were the unit of analysis in the interpreter-mediatedinteractions, defined by the author as a sequence in the consultation in whichthe topic under discussion corresponded to the study interest, ''discourses abouteducational issues in a multicultural pediatric setting'' (p. 22). In regard tothe interpreter's role and Jalbert's taxonomy, Leanza finds that the healthcareprovider's dominance remains unchallenged, with interpreters having littlechance to advocate for patients, acting instead as agents of assimilation. Heproposes a new role typology as well as some training recommendations, includingrecognition of the need for healthcare providers to receive instruction onworking with interpreters. He promotes giving interpreters an official status,so that they may be ''acknowledged as professionals in their own right,'' and thusexperience less of a temptation to align themselves with the healthcare providerin order to demonstrate their superiority over fellow immigrants who happen tobe patients (p. 30).
2. Carmen Valero Garces. Doctor–patient consultations in dyadic and triadicexchanges.Valero Garces studied consultations with and without ad-hoc interpreters inMadrid, Spain and with trained interpreters in Minneapolis, U.S.A., usinginstitutional discourse analysis as her theoretical framework. The languagesinvolved were Spanish and Bulgarian or Arabic, and English and Spanish. Althoughin general the power imbalance inherent to the institutional context ismaintained, manifested by the doctor's dominance in dyads with the patient,there are some unexpected changes. These revolve around changes in theinteraction order, contribution types, and lexical choice.
In consultations with no interpreter or with an interpreter who lacksproficiency in the doctor's language, the doctor may adjust his or her syntacticconstructions and lexical choices, sometimes resulting in ungrammaticalutterances. The untrained interpreters may struggle to translate even simplifiedmedical terms. The author notes that there is less direct interaction betweendoctor and patient when an ad-hoc interpreter is present. A reduction in directinteraction between primary speakers in interpreter-mediated encounters has beencited by many investigators. But, as Valero Garces observes, this effect may begreater in the case of ad-hoc interpreters, due to the fact that many who assumethis role are relatives of the patient, who may feel more at liberty to addturns and speak for the patient without prior consultation.
3. Friedel Dubslaff and Bodil Martinsen. Exploring untrained interpreters' useof direct versus indirect speech.The authors analyzed four simulated medical interviews, focusing on direct vs.indirect speech, as measured by pronoun shifts and their interactionalfunctions. The languages involved are Danish and Arabic. The original purpose ofthe interviews, each of which followed the same scripted role-play, had been toevaluate the skills of four untrained Arabic interpreters who worked for aDanish interpreting agency. As Dubslaff and Martinsen and other authors in thisvolume point out, use of the direct mode (the first person) is widely consideredto be superior and more professional. Among the advantages cited is anenhancement of accuracy. Nevertheless, the indirect mode (the third person) hasbeen found to be more common among ''so-called natural interpreters or layinterpreters'' (p. 54).
In the corpus for this paper two of the interpreters used the direct style moreand two used the indirect style more. The authors posit that direct address isused to express solidarity with the monolingual participant with whom theinterpreter shares a dominant language, in this case the patient. Regardless ofwhether they spoke in the first or third person, all four of the interpreterspersonalized the indefinite pronoun ''one'' when interpreting the doctor's wordsto the patient. Dubslaff and Martinsen conclude that, contrary to receivedwisdom and standards in the profession, indirect speech may be necessary attimes, for example when use of the first person pronoun would result in anambiguous construction. They also observed problems caused by deficiencies inthe interpreters' medical knowledge, and for this reason recommend training inspecialized terminology.
4. Hanneke Bot. Dialogue interpreting as a specific case of reported speech.Bot's data come from psychotherapy sessions in the Netherlands in whichexperienced interpreters worked between Dari or Persian and Dutch. She maintainsthat indirect speech may not be so problematic as traditionally assumed, andthat, among other things, its use simply acknowledges the reality of thesituation: that of an interpreter-mediated dialogue in which a third party ofnecessity has a presence.
The author found that in many cases the interpreters did not actually change thefirst person pronoun; they merely prefaced their renditions of the primaryspeakers' (the therapist and patient) utterances with ''he says.'' Thus, ratherthan ''repeat'' they ''report'' (p. 96). Using perspective and mental space theory(Fauconnier 1985; Sanders 1994), Bot shows how interpreters make it clear tolisteners that their rendition of another person's utterances are not theinterpreters' own words. They do this by presenting it as reported speech,especially when there is a chance that the person to whom the message isdirected could be offended by its content.
5. Raffaela Merlini and Roberta Favaron. Examining the ''voice of interpreting''in speech pathology.Merlini and Favaron studied English-speaking speech pathologists' sessions withItalian-speaking immigrants in Australia. This type of encounter represents aspecial case in the field of healthcare interpreting, since the interpreter isresponsible for transmission of not only ''what is said [but also] what shouldhave been said'' by the patient, so that the speech pathologist can ''recognisethe extent and causes of the language impairment and provide appropriatefeedback'' (pp. 102-103). Hence the interpreter uses knowledge of the language inwhich the patient is speaking to provide the doctor with a normative modelagainst which to measure the patient's utterances.
The authors use two analytic categories from Mishler (1984), the ''voice of thelifeworld'' and the ''voice of medicine,'' and add a third, the ''voice ofinterpreting'' (p. 105). The exposition follows a conversation analyticperspective, focusing on items such as turn-taking and topic control, footing,divergent renditions, and prosody. Unlike in typical medical interviews, inwhich the doctor's voice dominates, in Merlini and Favaron's data theinterpreter is a ''powerful participant'', who self-selects as next speaker andperforms other functions that exceed the boundaries of the professional modeldictating an invisible presence. The authors conclude that ''strict adherence toa dry, formal, passive and detached interpreting style, though it might be inline with an idealized notion of professional conduct, is not always the bestway to serve one's clients, especially when their intention is to engage in afriendly and co-operative dialogue'' (p. 132).
Book ReviewsFive books of great relevance to the topic of the main volume are reviewed.
1. Carmen Valero Garces and Guzman Mancho Bares, eds.: _Traduccion einterpretacion en los servicios publicos: Nuevas necesidades para nuevasrealidades / Community Interpreting and Translating: New Needs for New Realities_.2. Carmen Valero Garces, ed. _Traduccion e interpretacion en los serviciospublicos. Contextualizacion, actualidad y futuro_. Reviewed by Holly Mikkelson
As Mikkelson explains, the first title is a CD of proceedings from the FifthInternational Conference on Translation and the First National Conference onTranslation and Interpretation in Public Services (Alcala de Henares, Spain,2002). The second title is a book that was compiled to provide an update andexpansion of community interpreting issues covered in the CD.
3. Bernd Meyer: _Dolmetschen im medizinischen Aufklärungsgespräch. Einediskursanalytische Untersuchung zur Wissensvermittlung im mehrsprachigenKrankenhaus_. Reviewed by Christina Schaffner
Meyer investigates doctor-patient communication interpreted by nurses orrelatives of the patient, using data from German hospitals. The patients andinterpreters share Portuguese as their first language, with the former havingacquired it in Portugal and the latter as a heritage language at home in Germany.
4. Claudia V. Angelelli: _Revisiting the interpreter's role. A study ofconference, court, and medical interpreters in Canada, Mexico, and the UnitedStates_.5. Claudia V. Angelelli: _Medical interpreting and cross-culturalcommunication_. Reviewed by Helen Slatyer
The first of these volumes reports on a quantitative study carried out in threecountries, and the second is an ethnographic study focusing on interpreters inone hospital in Northern California. Both examine the construct of theinterpreter's visibility or invisibility. Of special interest in the secondvolume are the interpreting services provided by telephone, and the implicationsthat this has for visibility and other concerns.
EVALUATIONThis volume offers a very coherent examination of healthcare interpreting in awide range of settings, and as such it will be of great use to students andinstructors in courses having to do with this profession. Its editing isimpeccable, and the presentation of data in each article is clear and easy tofollow. The book will also be of interest to scholars and practitioners in otherdisciplines, such as translation, discourse analysis, and linguistic minorities.Each of the papers contains authentic data as well as a wealth of theoreticalmodels, only a few of which have been cited here. The book reviews that closethe volume constitute another valuable resource for researchers.
The authors of all five papers challenge the idealized myth of neutrality thatdominates the Western medical profession, part and parcel of which is theassumption that the function of an interpreter in a medical encounter can orshould be confined to direct translation. Another common conclusion is theimportance of providing training for community interpreters, as well as for thehealthcare professionals who will work with them. As can be seen from thiscollection, both types of training are still fairly scarce worldwide. HealthcareInterpreting represents a step in the right direction, since it documents theneed with empirical evidence.
REFERENCESFauconnier, G. 1985. _Mental spaces: Aspects of meaning construction in naturallanguage_. Cambridge: Cambridge University Press.
Jalbert, M. 1998. Travailler avec un interprete en consultation psychiatrique._P.R.I.S.M.E_. 8(3), 94-111.
Mishler, E. G. 1984. _The discourse of medicine: Dialectics of medicalinterviews_. Norwood, NJ: Ablex.
Sanders, J. M. 1994. _Perspective in narrative discourse_. Ph.D. dissertation,Katholieke Universiteit Brabant, Tilburg.
Wadensjo, C. 1992. _Interpreting as interaction: On dialogue interpreting inimmigration hearings and medical encounters_. Linkoping: Linkoping University Press.
Wadensjo, C. 1998. _Interpreting as interaction_. London/New York: Longman.
ABOUT THE REVIEWERLaura Callahan is Assistant Professor of Hispanic Linguistics at the CityCollege, City University of New York (CUNY), and Research Fellow at the ResearchInstitute for the Study of Language in Urban Society (RISLUS), at the GraduateCenter, CUNY. Her research interests include intercultural communication,language and identity, and heritage language maintenance. She worked for severalyears as a health educator, medical assistant, and interpreter in a communityclinic in the San Francisco Bay Area, California, and is currently co-principalinvestigator of a project entitled Increasing the Effectiveness ofSpanish-Language Healthcare Materials: Documenting the Problem and Finding aSolution.