Canadian Journal of Communication Vol 39 (2014)
©2014 Canadian Journal of Communication Corporation


Review

Yukari Seko
Ryerson University


bookExploring Health Communication: Language in Action. By Kevin Harvey & Nelya Koteyko. Routledge, 2013. 256 pp. ISBN 9780415597227.


Recent years have witnessed a burgeoning interest in analyzing discursive practices of contemporary medicine. As health increasingly becomes a contested sociopolitical issue, a discourse-based approach offers a promising means of revealing practical realities of health care, as well as taken-for-granted beliefs and practices embedded in health institutions. Exploring Health Communication is among these efforts to employ a discursive lens to analyze language in health, exploring how the concepts of health, illness, and well-being are shaped and reproduced both inside and outside clinical settings.

Targeting primarily students of advanced linguistics and similar disciplines, this book introduces a wide repertoire of research methods in broad brushstrokes, including critical discourse analysis, conversation analysis, narrative theory, discursive psychology, pragmatics, and systemic functional linguistics, to name a few. Each chapter contains tasks and activities for reflection, encouraging readers to engage in critical thinking about the topics presented. There are also commentaries on selected tasks at the back of the book, along with a glossary and a list of further readings, from which readers can further explore their area of interest.

The book is divided into three parts, as if tracing the evolution of communication from oral through to written and on to electronic communication. Part I, “Spoken Health Communication,” consists of three chapters organized around Elliot George Mishler’s (1984) classic distinction between “the voice of medicine,” representing a biomedical worldview, and “the voice of lifeworld,” reflecting everyday lived experience. The first two chapters feature practitioner-patient consultations, drawing attention to the professional’s enactment of authority. While the issue of the power asymmetry between doctors and patients has long been the focus of medical sociology (e.g., Mishler, 1984; Wodak, 1996; Gwyn, 2002), Kevin Harvey and Nelya Koteyko make a useful contribution by shedding light on a variety of health personnel besides physicians—nurses, pharmacists, physiotherapists, and even hospital chaplains—whose discursive practices reveal hitherto unexplored aspects of health communication. The voice of medicine represented in these two chapters is contrasted to patient narratives in Chapter 3, where the authors discuss how patients make sense of their experience by telling a story of their illness. It is worth noting that while fully recognizing the significance of listening to the patient’s voice, Harvey and Koteyko caution readers not to treat such lifeworld statements as if they display a coherent representation of a reality (p. 91). Calling for a critical evaluation of narrative approaches to health, they repeatedly emphasize that these two voices of medicine and the lifeworld are interpenetrating, rather than excluding one another.

Part II, “Written Health Communication,” reviews linguistic research into written documents constructed by health professionals and the media for patients and the general public. For the reviewer, Chapter 4 is the most intriguing among the three chapters in this part, where the authors delve into the patient case record. Here, readers again observe the tension between biomedical discourse and everyday life narratives, manifesting this time through the process in which a personal experience of “illness” is transformed into a written, fictional case of “disease.” Harvey and Koteyko contend that this transformational process allows excessive depersonalization of patients. By stripping the agency away from patients, the patient record obscures the personal and social context of the illness, while at the same time deflecting attention away from clinicians as agents of care. Readers are introduced to a range of linguistic devices, such as the passive voice and agent deletion, account makers, epigrammatic appraisals, and technological terminology, which together contribute to the pathologization of patients.

Chapter 5 examines print media’s representations of infectious disease outbreaks, with specific emphasis on metaphors in media and public health discourses. According to the authors, the use of the classical war metaphor weaves together journalists’ and health experts’ voices, and contributes to the shaping of infectious diseases (e.g., bird flu and SARS) as dreadful enemies to be eradicated. This strategic anthropomorphization can mobilize and justify political actions and, in turn, exculpate government from responsibility. Chapter 6 then presents an in-depth analysis of the patient information leaflet, which reveals an authoritarian tendency among writers that may hinder the accessibility of health information.

The final two chapters of this book in Part III, “Computer-Mediated Health Communication,” provide a brief overview of the emergent health communication practices on the Internet. In Chapter 7, Harvey and Koteyko explore online peer-support groups where members with similar concerns come together to share information, exchange advice, and overcome a sense of isolation. Their analytic focus is on advice-giving routines, where a linguistic approach proves effective in uncovering how members establish legitimacy through self-disclosure and provide reasonable advice in an anonymous online environment. This also indicates social norms of online interaction, according to which members construct their identities. While providing patients with a virtual agora, the Internet has also enabled health professionals to extend their reach beyond the hospital walls. Chapter 8 examines online coaching by medical professionals, who establish a credible expert persona through carefully crafted language strategies. This chapter also introduces corpus linguistics and quantitative methods, such as concordance analysis, as a potential methods for interrogating large amounts of textual data generated online.

A few areas of this book could use some further polishing. First, online-based health research cited in Part III requires some updating to reflect the changing cyber health landscape. With the rise of participatory social media, the public has come to play a larger role in knowledge dissemination and opinion making. Micro-blogging sites like Twitter are among rapidly growing platforms for health communication, where a text-mining method reveals promise in measuring the public reaction to disease outbreak (Chew & Eysenbach, 2010). In a related vein, it would be instructive to introduce some of the current visual/multimodal research that explores multimedia aspects of online health information (e.g., Thompson, 2012), especially as Harvey and Koteyko problematize the tendency among linguistic research to rely solely on text-based discourse (pp. 116–118). Finally, readers would benefit from a concluding chapter or an epilogue that draws together the multiplicity of topics and methods covered, and lays out the challenges and unanswered questions.

These quibbles aside, this book provides a valid entry point for newcomers to health communication. It should prove a constructive tool for students in linguistics, communication studies, and other language-related disciplines who are interested in language practice in health. Readers in applied health research, social work, and sociology of science and medicine would also find this book insightful, providing a helpful addition to their research.

References

Chew, Cynthia, & Eysenbach, Gunther. (2010). Pandemics in the age of Twitter: Content analysis of Tweets during the 2009 H1N1 outbreak. PLoS One, 5(11) URL: http://dx.doi.org/10.1371/journal.pone.0014118 .

Gwyn, Richard. (2002). Communicating Health and Illness. London: Sage.

Mishler, Elliot George. (1984). The discourse of medicine: Dialectics in medical interviews. Norwood, NJ: Ablex.

Thompson, Riki. (2012). Looking healthy: Visualizing mental health and illness online. Visual Communication, 11(4), 395–420. 

Wodak, Ruth. (1996). Disorders of discourse. London: Longman.



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