About a decade ago, Welsh doctor and academic Nefyn Williams wrote an editorial about one of his patients asking him whether the damage to his painful knees, which had been diagnosed as degenerative change, was wear and tear. Williams highlighted how poor this choice of words was in his editorial “Words that harm: words that heal”.
In his view, wear and tear, as well as degenerative change designated a passive, helpless state in which the patient could but wait for the damage to increase and spread, engulfed in a gloomy prognosis of ensuing pain and disability. Yet this was not the inevitable future for the patient.
There is hope for osteoarthritis patients, as roughly one-third go on to reverse some of the damage. Williams warned that “the words we use to describe illness are very important”, and indeed a wealth of studies indicate that our perceived understanding of a potential illness greatly influences both the outcome of the illness and our way of coping with it.
Fast-forward to early last month, when young New Zealanders were encouraged in a 1News article to head to Eden Park stadium for their dot. The GotYaDot campaign is a Māori-led initiative encouraging youth to get vaccinated against Covid-19, in a bid to connect the dots and protect everyone in the community.
Initiated by musician Pere Wihongi, from Te Tai Tokerau, the Ira Dot (ira being the Māori word for “dot”) was born, following Wihongi’s observation that the word vaccine needed to be replaced by something more positive. Wihongi explains that vaccine was “language that ha[d] become triggering”.
The campaign went on to achieve massive success. Here is another indication of just how powerful the spin of words can be. While vaccines and jabs are reminiscent, for some, of painful mandate debates and of piercing needles coming forcefully at you, who could be scared of a harmless dot?
From inevitable cartilage damage to repackaging of painful vaccines, medical discourse is particularly apt in revealing the power of language in shaping our view of reality. Specifically, medicine is laden with two linguistic strategies: metaphors, just like the ones I have discussed above, and distancing strategies.
In a previous article, I described metaphors related to Covid-19. It turns out metaphors are everywhere in medicine, not just in connection to Covid-19. This is because illness and disease make us uncomfortable, and we resort to metaphors and euphemisms to avoid openly discussing them. Secondly, metaphors offer excellent bypasses for medical jargon unfamiliar to most patients.
Another strategy used in medical settings is distancing. In a bid to appear more objective, doctors use distancing language: The CT scan shows an unusual growth. But the CT scan did not perform or interpret itself. Distancing has the unfortunate consequence of placing patients in the background and the disease on centre stage: the tumour has returned.
What’s really odd is that not only does the wording used by doctors affect the patients and their outcomes, but it also seems to conversely reshape the physician’s own view of the patient – often seen as a passive passenger, merely experiencing what is happening to them, the wear and tear, with little ownership or control over it.
Williams was really on to something: words can harm, and they can heal. The language used does matter, and nowhere is the evidence of the tight relationship between body and mind more compelling than within the realm of medicine.