February 28th, 2006

ozarque figure

Linguistics; medical language; magical language....

Medical language is, for me, the crucial proof of the validity of the weak version of the Sapir-Whorf hypothesis (aka the linguistic relativity hypothesis). In "Framing Disease," by Charles E. Rosenberg and Janet Golden (pp. 179-192 of the July 15, 1992 issue of Hospital Practice), we find this statement on page 179: "In some ways disease does not exist until we have agreed that it does, by perceiving, naming, and responding to it." The authors note (on page 181) "a growing interest in the way disease definitions and hypothetical etiologies can serve as tools of social control, as labels for deviance, and as a rationale for the legitimization of status relationships." Exactly.

So long as menopause was just womenopause, a life stage every woman went through, it got no more medical attention than the "his-voice-is-changing" stage that every man goes through. Women did not die of it, were not crippled or incapacitated by it, saw no doctor for it, and went on about their business. It was turned into a disease by the medical industry, using a speech act that has two parts: the Incantation, and the Translation.

The Incantation is hypoestrogenemia. Shazam! Abracadabra! Every adult speaker of English instantly recognizes that as The Name Of A Disease, whether they can figure out its meaning or not. The Translation is estrogen deficiency. All really successful diseases and disorders undergo this double naming. They get an MDeitySpeak name -- for which ordinary people(called laypeople) will have to ask "What does that mean?" -- and a LaySpeak name that can be handed out in response to the question.

Now, with hypoestrogenemia, something is wrong with the woman. She deviates from normality because she is deficient. Her deficiency merits an eight-syllable Incantation whipped up from Greek roots. Instantly, an entire apparatus rises out of the bubbling cultural bog, bringing roles and scripts and a vocabulary. The woman "has" hypoestrogenemia; she needs medical treatment; her life is dramatically changed. This is only bootstrapping -- the menopausal state was already there -- but it is so close to being magic that it takes your breath away. We have seen it in action most recently in two areas: the creation of "perimenopause" -- a new disorder that is alleged to afflict women from about seven years before menopause until it actually begins; and, to my genuine amazement, "andropause" -- the alleged male version of menopause. I really did not think that "andropause" would fly.

We see the same process in connection with obesity (Incantation)/overweight (Translation), which revolves around excessive energy consumption (eating too much) and energy expenditure deficiency (not doing enough). Hunger is powerful, however. Doctors may encounter caloric restriction noncompliance (the patient won't stay on the diet) or demands for anorexigenic medications (diet pills) and be forced to move up to talking of hyperphagia (eating too much) and hypokinesis (not doing enough) in order to re-establish "status relationships."

I don't want to be misunderstood here. I have the deepest respect for those who, having observed a condition where people become gravely impaired and/or endangered, recognize the constellation of factors defining the condition and give it an acceptable name. They perform an indispensable service. As Rosenberg and Golden point out, until that naming is done the condition isn't "real" to health insurance companies, research funding agencies, inconvenienced family members, and so on. The problem is that the process of disease "discovery" is so much more easily and economically done by Invocation-and-Translation than by long years of dedicated labor in the research laboratory, that laypeople are defenseless against its abuse, and that multi-billion-dollar-a-year industries are highly motivating.

This is not a problem of science; this is a problem of language.