The Handbook of Discourse Analysis

Language and Medicine 493
(cf. Osherson and AmaraSingham 1981; Kirkmayer 1988), 31 his statement is a fortiori
apt. The pathology of language – as distinct from the language of pathology – is
when it inhibits changes in concepts and interferes with new ways of understanding
disease and treating illness.
NOTES
1 This is not to deny the existence of
literature on this topic prior to 1980.
Studies on the medical interview and
guides for teaching the conventions
of certain medical genres began to
appear in the 1960s. And among
studies on the relationship of
language to the “real world” of
medicine, two of the most
illuminating date from the 1970s
(Warner 1976; Cassell 1976). The
epigraph for this chapter, it will be
noted, is drawn from an essay dated
1923; its thesis remains valid threequarters
of a century later.
2 In this chapter I follow the
distinction, introduced by Eisenberg
(1977) and elaborated by Kleinman
(1988), between illness and disease.
“Illness” incorporates our human
perception and experience of states of
bodily or mental dysfunction, while
in “disease” the patient is abstracted
out of the pathology. In the western
biomedical tradition, doctors are
trained to treat disease. They do not
necessarily treat illness.
3 The task is rendered easier than a
comparable survey of the DA/EST
literature by virtue of the fact that
medical articles are always
accompanied by an abstract that
“tells all.” One need not read the
article to extract the “bottom line.”
The abstracts from language-oriented
fields, on the other hand, are often
crafted so as to draw the reader into
the article through a seductive
advertisement of topics to be
addressed and broader implications
of the study (this is an impression
based on extensive reading of the
literature; a quantitative comparison
has not been carried out.) Also, books
and monographs (which do not have
abstracts) are rare from the medical
camp, save for practical guides to
medical interviewing (Cassell 1985:
vol. 2; Platt 1992, 1995; Smith 1996).
4 Medical professionals who enter the
debate about medicine’s language all
tend to cite the same three “language
authorities”: Susan Sontag, Lakoff and
Johnson, and Benjamin Lee Whorf
(Sapir is occasionally thrown in for
good measure – or through guilt by
association; see n. 11).
5 The performative dimension of case
presentations and their formulaic
language prompt Ratzan’s (1992)
comparison of this genre to orally
composed song-poetry of the type
analyzed by Parry and Lord (see Lord
1960). While the process through
which medical students learn the
formulae of medicine’s tribal
language (see Klass 1984) may
bear similarities to oral poets’
apprenticeship in the art of formulaic
composition, the comparison falters
on the level of the functions of the
respective texts – poetic entertainment
vs. imparting clinically relevant
information about hospital patients
– which necessarily influence
their construction. Ethnographic
approaches to discourse, in particular,
emphasize the crucial role of situation