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A tyranny of nouns

Ben Hoban is a GP in Exeter

 

You may not have considered this before, but doctors are inordinately fond of nouns. We keep and curate mental lists of them: the seven causes of a particular presentation or the key features of this or that disease. We think about patterns of illness as though they are concrete things with their own independent existence, although we’d struggle to put acute pancreatitis or depression into a pathology jar. We talk about the different aspects of ourselves – organs, limbs, emotions – in the same way: all nouns. We may tell one patient that their bladder has an infection which can be treated with antibiotics, and another that their personality has mood instability which can be treated with anticonvulsants, as if we were rearranging the flaps in a children’s book to combine the astronaut’s head with the lumberjack’s trunk and the diver’s legs. All of this may seem obvious and unremarkable, but it testifies to a reductionist way of thinking about ourselves: the body is made of parts, which are made of cells, which in turn are made of molecules, and when we treat a patient, we think in terms of a molecule of medicine interacting with a molecule in a target cell, scaled up to the point where it has a therapeutic effect.

By and large, patients come to us not just with nouns, but with stories which include them but are driven along by verbs, words of action, backed up by adverbs, pronouns, and so on.

By and large, patients come to us not just with nouns, but with stories which include them but are driven along by verbs, words of action, backed up by adverbs, pronouns, and so on. Our professional ear filters these out or translates them into drier terms. Yes, Mrs Jones, I understand that your lungs feel like they’re full of treacle, but let’s stick to the facts: a week of cough with sputum but no blood, you said. Any chest pain? It’s practical: you can see why German still capitalizes its nouns.

On the odd occasion when patients lead with their nouns, though, it jarrs: It’s the pain, doc, it’s making my insomnia worse, and the anxiety’s really kicking off. Does this really tell us what we need to know? The instinctive response is to reach for more nouns: medication, therapy, a fit note. After a while it starts to feel just a little impersonal and repetitive, clichéd even. The reason is that nouns are good at communicating information, but not context. Back pain secondary to overuse is succinct but limited; you’ve been overdoing it in the garden and because your back isn’t used to all the movement, the muscles are tensing up to try to protect it and the nerves are listening out for anything that might be about to go wrong is far more meaningful.

There is also a danger that in talking about illness as a thing, we construe it as somehow foreign. I have a pain in my foot is a statement of location in the same way as I have a stone in my shoe, to which the obvious response is: get rid of it. By contrast, My foot hurts is a description of how a part of me is behaving, inviting the response: look after it. This is significant, in that virtually all the things that happen within the confines of our body are things that our body does. During an infection, fever, myalgia and all the other nouns on that particular list are simply the way our body responds to being invaded by a pathogen (yes, that one gets a noun). Even a gun-shot rarely kills directly: it is our own body that pumps blood out of the wound, sucks air into it or triggers a pro-inflammatory cascade that makes it swell. The same applies to the mind. Consider the following statements which are semantically equivalent and see which feels most meaningful: I have depression; I’m very sad; It’s as if I’ve lost something important to my sense of self.

The reason is that nouns are good at communicating information, but not context.

If we describe an illness primarily in terms of the nouns associated with it, we commit ourselves linguistically to making a diagnosis, the ultimate noun that fully captures the experience and hopefully unlocks the cure. This is a pretty fundamental part of our job, and if we run out of suitable diagnoses, we are free as a profession to develop new ones as needed. Constructs like Functional Neurological Disorder, Fibromyalgia and Post-Traumatic Stress Disorder, however, only work if we can provide a convincing explanation of what is actually going on under the bonnet, and for this we need verbs. The benefit of using verbs to describe rather than nouns to define an illness is that it works even without a diagnosis, encourages ownership and naturally invites action.

Of course, any consultation already involves the full spectrum of language, spoken and unspoken, and all of us have more than enough to be thinking about without analysing our sentence construction. If, however, you find yourself in a corner with a patient, and the focus is on things like the pain, the leg, the diagnosis, it might just be worth considering whether another way of speaking about the situation, expressed through actions, might help it to move on more smoothly. as needed. Constructs like Functional Neurological Disorder, Fibromyalgia and Post-Traumatic Stress Disorder, however, only work if we can provide a convincing explanation of what is actually going on under the bonnet, and for this we need verbs. The benefit of using verbs to describe rather than nouns to define an illness is that it works even without a diagnosis, encourages ownership and naturally invites action.

Of course, any consultation already involves the full spectrum of language, spoken and unspoken, and all of us have more than enough to be thinking about without analysing our sentence construction. If, however, you find yourself in a corner with a patient, and the focus is on things like the pain, the leg, the diagnosis, it might just be worth considering whether another way of speaking about the situation, expressed through actions, might help it to move on more smoothly.

Featured photo by Brett Jordan on Unsplash

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