How we talk about disease and illness

Director of the Undergraduate Medical Programme at UCC Dr Deirdre Bennett reviews Prof Fergus Shanahan’s book, which focuses on how we talk about disease and illness, with a view to assessing its suitability for medical students, and finds it is highly relevant to medical doctors, as well as a broader audience

In the midst of a global pandemic, health and disease have dominated the airwaves and daily conversation. Coronavirus has brought with it a new lexicon; pods and bubbles, physical distancing and cocooning, numbers and flattening the curve. New words that are shaping public understanding and everyday behaviour. There could be no better time to publish a book exploring how we talk about disease and illness. Prof Fergus Shanahan’s The Language of Illness is a sweeping tour de force on the topic. Prof Shanahan is Emeritus Professor of Medicine at University College Cork and Foundation Director of the Science Foundation Ireland-funded APC Microbiome Ireland.

Literary culture
In a thought-provoking and engaging book, pitched at ‘anyone who cares about caring’, he has drawn on his experience as a physician and father to a seriously ill son. He combines a rich selection of literature, from Donne and Shakespeare to Joyce and Heaney, with cultural references, anecdote and experience to reflect on how language used shapes doctor-patient interactions, patient and carer experiences, public health, and health systems management. Calling for a careful consideration of the words we use in all avenues of medicine, the book provides pause for thought for all of those immersed in the culture of medicine.

Contrasting positions and outcomes
In the opening chapters, the contrasting positions of doctor and patient in the consultation are sharply drawn. The doctor confident in a routine situation, the patient vulnerable in a crisis. The disease-speak of doctors creates distance from patients while the illness words of patients, suffering, fear, and hope, are all but absent from medical textbooks.

Prof Shanahan goes on to consider how words and the way we use them can influence patient outcomes for better or worse. Skilful communication with patients can create revealing moments or epiphanies, it can shape patients’ answers to questions, and alter patients’ understanding and decision-making. Words can stigmatise, apportion blame, and position patients as failures or social outcasts. Creation of new diseases, or non-diseases, from normal variants and the use of neat labels for medically unexplained symptoms can both lead to over investigation and mistreatment.

Beyond words
Prof Shanahan also considers non-verbal communication; body language, dress, touch and presence, each communicating as much, and sometimes more, than anything that is said.

Obfuscating gobbledegook
Extending his argument to the arenas of public health and health systems management, Prof Shanahan discusses how language can manipulate public opinion and hinder understanding of public health messages and health policy. He posits that health systems management is full of obfuscating gobbledegook intending to give the illusion of deliberative action.

The final chapter considers the current ‘pandemic parlance’, including the words chosen by politicians to mete out blame, to influence public behaviour and to put the best possible spin on a bad situation.

For medical students and doctors-in-training The Language of Illness provides the kind of wisdom normally gleaned over the length of a medical career. For those involved in the education of future doctors, it lays down a challenge; to examine the way we model and teach the use of language, to consider how we can engender better understanding of illness and to reflect what we really mean when we talk about empathy and caring.

The Language of Illness has a message for everyone in medicine, from the freshly minted student to the hard-bitten professor.

Patients and carers will also find much to resonate with their experiences in this book, along with insights into the origins and impacts of the communication failures they may have experienced with even the best-intentioned doctors.

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