The use of language in interactions between doctor and patient is a subject close to my heart. So it was a particular pleasure when a newly published book, The Language of Illness (Liberties Press,€19.99), arrived in the post.
Written by Prof Fergus Shanahan, emeritus professor of medicine at University College Cork and a noted gastroenterologist, it examines illness stories to see if we can gain a better understanding of the words we use to describe illness. Written for the lay reader, the book sets out to identify ways in which language may act as a barrier in illness, and proposes practical ways to dismantle these barriers.
Prof Shanahan says: “Since our thoughts, judgments, decisions and actions are shaped by our language, it is curious why [we] so many spend so little time considering the words [we] use. Sooner or later, we will all be called to play a role in someone’s illness story. The way we play that role, the words we use or don’t use, may alleviate or accentuate the suffering of that illness. The language of illness is simple and honest, it’s time to consider the language we use.”
In a chapter on illness words, he identifies hope, suffering, loss, fear, anger and denial as key, while also throwing degradation, shame, loneliness, disbelief, gain, trust and humour into the mix. These are the words patients use to tell us about their experiences and concerns when illness strikes.
As a university lecturer in narrative-based medicine, I have had the privilege of helping medical students understand the importance of listening to, and valuing, a patient’s story. So it is wonderful to have the issue of language brought into the mainstream by a distinguished Irish physician, as he explains how well- intentioned medics sometimes fail to provide a better caring experience for their patients. The reason? According to Shanahan, it is because doctors and patients speak different languages.
Doctors use “disease words”, he says, while patients speak “illness language”. Illness is the lived experience of disease, which is often a million miles away from the disease terms that must be learned by the tyro in medical school. Somewhere along the line, however, the twain largely fail to meet – and barriers arise.
The final chapter brings us right up to date by looking at the language of pandemics and plagues. Pandemics change the way people speak. Behind the language lies people's stories. Often they are all that's left when the all-consuming wave of contagion finally fades. Shanahan wonders if the Covid-19 pandemic will fade from our conscious as quickly as the 1918-19 flu pandemic. "Collective amnesia" is President Michael D Higgins description of how the devastating influenza outbreak quickly receded from national consciousness.
“One of the lessons from 1918-1919 is the need to hear patients’ voices in contemporary accounts so that the scale of human suffering is not forgotten. What was it really like? How did it feel?,” Shanahan writes. He predicts that while the individual stories and losses of Covid-19 will be remembered, collectively, society will again develop post -pandemic amnesia.
While literary figures often refer to disease as a great leveller, Shanahan sees Covid as a great “revealer” of societal inequities, poor leadership and unpreparedness. The poor have suffered disproportionately. And binary language does not work when describing how humans relate to microbes. He disputes the argument put forward by politicians and others that Covid-19 poses a binary choice between public health and the economy.
Peter Medawar has described viruses as "bad news wrapped in protein". Shanahan asks, who is in control – mankind or microbe? Neither it turns out – a symbiotic co-existence, rather than victor and vanquished, describes the relationship best.
The author invokes pop star Madonna, while offering a rewrite of her lyrics:
“You know that we are living in a microbial world,
And I’m a microbial girl.”