The Handbook of Discourse Analysis

Language and Medicine 475
Bourhis et al. 1989; Hadlow and Pitts 1991; Platt 1992). Scientific nomenclature has
thus, paradoxically, come to carry out the original function of euphemism.
2.2.3 Technical language and ordinary language
Some attention has been paid to the linguistic “gray area” in which the occupational
register of medicine overlaps with ordinary language (Hadlow and Pitts 1991;
Fleischman 1999; sporadically in the literature on doctor–patient communication).
Occupational registers provide an efficient code for the transfer of information among
specialists. Within knowledge communities, they provide a practical and convenient
shorthand for talking about complex matters specific to a field. They are largely
opaque outside the esoteric circle. A particularly slippery situation arises when
technical language passes for ordinary language, i.e. when words have meanings –
different meanings – in both dialects. Looking at psychological disorders the names
of which have entered common parlance (e.g. depression, hysteria, eating disorder,
obsession, “psychomatic” disorders generally), Hadlow and Pitts (1991) and Kirkmayer
(1988) find that patients and medical professionals have different understandings of
these terms. And in my own initial forays into medical literature, as a naive patient,
I was unaware, for example, that the euphemism “supportive care” was a technical
term (an umbrella term for a variety of actual therapies); it did not mean, as I had
imagined, that patients were to be treated with empathy and respect. Nor did I
realize that an “indolent” clinical course was a desirable thing to have. This latter
expression, like a nurse’s reference to Oliver Sacks’s “lazy muscle” that prompted a
mini-diatribe on descriptors (Sacks 1984: 46), illustrates medical language’s potential
for “guilt by association” (metonymic contamination), subtle slippages through which
characteristics of a disease or affected body part transfer to the sufferer as an individual
(see also Donnelly 1986 and section 4.3 below). One of the most striking
examples of the ambiguous gray area in which the esoteric dialect confronts the
exoteric dialect is the term “morbidity” – coin of the realm in medical discourse, the
affective charge of which is clearly more noxious in ordinary language.
2.2.4 “Illness language” and “disease language”
Medical language, as various observers have pointed out (McCullough 1989; Mintz
1992), is an abstract discourse about disease and organs; it is not about patients and
their experience of illness. In principle, McCullough argues, only patients can employ
illness language; physicians qua physicians have no other language at their disposal
than the abstract (because it is not about patients) language of disease (1989: 124). Those
who urge changes in physicians’ communicative practices, however, are less inclined to
accept that physicians’ “hands are tied” by the traditional orientation of medical language
(see Donnelly 1986, forthcoming, and section 2.3.2 below on case histories). One
wonders too whether physicians’ language changes when they “cross over” and become
patients? The “polyphonic” passages of Oliver Sacks’s (1984) narrative of his experience
of a severe leg injury shed interesting light on this question (see also Hahn 1985).
Mintz (1992) emphasizes the distancing function of medical language, an artifact of
its commitment to objectivity. The distance, he argues, develops not only out of poor
communication between physician and patient but also, and more importantly, as the