Language and Health in Action

Carrie and Megan talk with Drs Lynnette Arnold and Anna I. Corwin about their new co-edited book (with Jennifer R Guzmán and Emily Avera), Language and Health in Action (ebook), along with two authors in the same volume, Drs Stephanie Keeney Parks and Abby Mack about their chapters "Autism Diagnostics as White Public Space in US Clinics" and "In the Spirit, in the Flesh: Performative Language, Embodiment, and Sustaining Recovery in Appalachia".

• Code Switch episode on Trump's culty language

Transcript

Carrie Gillon: Hi and welcome to the VocalFries podcast, the podcast about linguistic discrimination.

Megan: I'm Megan Figueroa.

Carrie: And I'm Carrie Gillon. Hey. 

Megan: Hey. Before I forget, related to this episode, I really wanted to plug a book by Patrick Radden Keefe about the Sacklers, which will be relevant later. The book is called Empire of Pain: The Secret History of the Sackler Dynasty. Yeah, it's so relevant to our episode.

Carrie: Good idea. Yeah, so the people will have multiple books to buy.

Megan: Yeah, exactly.

Carrie: We're going to talk about an episode of Code Switch from March, so it's almost a month ago now, but that's okay. What Trump's language has in common with cult language? 

Megan: Which is something I've often thought about on my own.

Carrie: Yeah, no, it's definitely very culty[?]. And obviously, his whole thing is culty.

Megan: Yes.

Carrie: To the point where I'm like, "How is this actually still holding on at this point?" He's not making any sense anymore.

Megan: No. I've heard some pieces, or I've seen some pieces where people are saying it's starting to crack for his followers. But

Carrie: Yeah, certainly some.

Megan: Yeah, especially his least Catholic or Christian followers recently.

Carrie: Well, yeah, more so his Catholic ones, but not even all of them.

Megan: It's true. Yeah, you never know what's going to make people finally start questioning things. I guess that's true of cults too.

Carrie: Yes. And often cults will stick around until someone dies. But sometimes they continue on after, like Scientology. So, who knows? I just don't think it can be JD Vance that continues on this cult. I just don't think he's got the juice.

Megan: He's not charismatic enough.

Carrie: He's anti-charisma.

Megan: Yes. 

Carrie: So wild. 

Megan: It does seem like he doesn't know how to interact with other humans very well.

Carrie: Right?

Megan: Yeah, there's something off. It's like...

Carrie: Yeah. And in a different way than whatever is off with Trump or whatever.

Megan: Right.

Carrie: Yeah. Okay. So they bring up the fact that President Trump has all his own kind of language: fake news, witch hunt, make America great again, his insults, Crooked Hillary, Sleepy Joe Biden, Ron DeSanctimonius[?], which still makes me laugh.

Megan: That's so funny.

Carrie: It's funny, even though it's not even any good. There's just something funny about how bad it is.

Megan: Yeah. Like low IQ Jasmine Crockett, always with a woman of color, of course. But yeah, low IQ, tagging that on to things.

Carrie: Yeah, it's almost always about Black women in particular.

Megan: Yeah, I think he said it once about AOC, possibly.

Carrie: Yeah, he probably did. But if you look, there's probably once in a while a Black man even, right? But it's mostly Black women[?]

Megan: Mostly Black women. Absolutely. 

Carrie: And then obviously, the super racist Pocahontas for Liz Warren. Cocaine Mitch, which also makes me laugh.

Megan: Mitch Macano? 

Carrie: I think so. I think it was, but it's like what?

Megan: Yeah.

Carrie: I don't remember now. I remember the name, but I don't remember why. And then also, he uses the Department of War for the Department of Defense. That feels less culty and more rebranding. But-

Megan: Gulf of America.

Carrie: Gulf of America, same thing. Yeah, they talked to Amanda Montel about it.

Megan: Oh[inaudible] yeah.

Carrie: Because she also has a podcast, Sounds Like a Cult...

Megan: Yep. 

Carrie: ...about that.

Megan: And we talked to her about her book, Cultish.

Carrie: Okay, so she argues that using emotionally charged buzzwords, acronyms, phrases is a technique that cult scholars call loaded language, right? So you have a strong emotional charge associated with these words or these phrases.

Megan: Yeah, absolutely.

Carrie: The emotional charge can come in a lot of flavors, right? It could be anger, it could be pride, it could be disgust, it could be righteousness, it could be fear, right?

Megan: Yeah.

Carrie: So if I say deep state, and you're part of the cult, it's probably going to trigger fear and disgust, I'm going to guess.

Megan: Yep.

Carrie: Although these days, they don't talk about it as much.

Megan: It's true.

Carrie: Because there isn't really anyone left.

Megan: Yeah.

Carrie: They fired everybody.

Megan: Yeah.

Carrie: Oh my God. Speaking of, did you see...

Megan: Kash Patel?

Carrie: Yeah, the Atlantic article on Kash Patel?

Megan: Oh yeah.

Carrie: I almost felt bad for him. Okay, so apparently, according to Amanda Montel, Jim Jones, the famous cult leader who murdered his entire flock, he would demonize the Bible by calling it the paper idol. I did not know this. Did you know this?

Megan: I have never heard that.

Carrie: No. And it's so weird, because he was a pastor, right?

Megan: He must have had his own writings then, right?

Carrie: I guess. I don't know. It's odd. So apparently, he would go up on stage at the pulpit, whatever, and he would rip the Bible up in front of everybody. And everyone would laugh.

Megan: Oh, that's so... okay, so that's feeling very culty, right? So you have the- yeah, the cult leader tells you something, and that's the reaction you're supposed to have.

Carrie: Yeah. And she also makes the connection to Trump, right? Because he's also very theatrical. And he expects people to laugh at certain things.

Megan: Yeah. Did you see the one where he was reading something, he said, "Corner store," and he's like, "Oh, who wrote this? What's a corner store?" And then the audience laughed. And I was like, I hope they're laughing because he's ridiculous. But it's like no, there's probably a room full of his supporters that are just laughing at him.

Carrie: It's hard to say in that case, because if I were there, no matter who it was, if they said that, I would laugh, because I'd be like, "What?"

Megan: Yeah, I know. What do you mean you've never had the word corner store.

Carrie: In New York, the normal term is bodega. 

Megan: Bodega, yeah.

Carrie: Maybe he really just didn't have that part of his active vocabulary when he was younger. And he's clearly[crosstalk]

Megan: Out of touch. 

Carrie: Well, no, not just out of touch, but I think his brain is melting. And so I think he's losing newer vocabulary. So I'm wondering if it's partially that. Yeah, he's out of touch, but there's no way he doesn't know what a bodega is, right?

Megan: Right. Well, he didn't say- it was specifically the terminology corner store.

Carrie: It was corner store. I know.

Megan: Yeah.

Carrie: And the reason why I thought about it is because there's all these regionalisms for corner stores, right?

Megan: Convenience store.

Carrie: Yeah. So I grew up with corner store, and I learned convenience store slightly later. And then I learned bodega even later than that. But I bet you there's other ones that I'm not thinking of.

Megan: Yeah.

Carrie: But anyway, he's just very strange. The groceries thing. He didn't know what groceries were.

Megan: Right. Didn't he think you have to show an ID at a certain point there too?

Carrie: Well, it was also that. But I think that predated the there's this new term groceries.

Megan: Oh, I know. Didn't he claim to come up with...See, that's culty, right? At a certain point, it's also, yeah, is it him losing his mind? But it's also, oh, he thinks he coins[?] things.

Carrie: Yeah. And I think it's a bit of both, right? I think it's a bit of him losing his mind. And also, he's just a narcissist. So yeah, he has power to create new words, which in some sense is kind of true. But in another sense, well yes, but not in this instance.

Megan: Yeah, no, you're right. It's about power, right? What's more power- wow, power like creating new words?

Carrie: So she argues that his language feels more like a marketing cult. And I definitely agree. He's a master marketer. Even [crosstalk]apprentice.

Megan: Like an[inaudible]

Carrie: No, I don't necessarily mean that. But if you go back to The Apprentice, he marketed himself as this brilliant businessman when he was like...

Megan: Not.

Carrie: Not a good businessman. But anyway, he marketed himself that way.

Megan: Putting his name on everything.

Carrie: Yeah. Which[?] happened around the same time as The Apprentice, is when he started putting his name on things that he didn't really have that much to do with.

Megan: The John F. Kennedy Memorial.

Carrie: The Donald Trump, the John F. Kennedy... 

Megan: Why does it remind me a little bit of Zoolander? It's just a really bad name for a building. It's like, what is the building that he has? 

Carrie: I don't remember. 

Megan: The school for kids who don't read good or something. I don't know.

Carrie: Something like that. But that still makes more sense[crosstalk] 

Megan: It does make more sense[inaudible]

Carrie: ... than having the name- the other name building. What? 

Megan: Right. I know. 

Carrie: Because you can't make this stuff up. Nobody would have tried to make a character like Trump.

Megan: Because it's unreal. It's like, you have to see it to believe it.

Carrie: She also says that he has a lot of thought-terminating clichés, which she's talked about with us.

Megan: Yeah.

Carrie: So it's these phrases, these little short phrases that get you to stop thinking about it. It is what it is. Stop thinking about it, right? So for him, it's like something is fake news.

Megan: Yeah, that's huge.

Carrie: One of the other things that she gets asked is, how is Make America Great Again different from Ronald Reagan's Morning in America or George W. Bush's Compassionate Conservative? Because those are also marketing phrases, right?

Megan: Yeah. Is it like Obama's Yes We Can?

Carrie: That would also be a marketing... Yeah.

Megan: Yeah. Okay.

Carrie: It's a different flavor.

Megan: Yeah.

Carrie: That's more like, "We can do new different things." Morning in America is just more, "Oh, it's a dawning of a new day." I guess it's a little bit closer to Obama's. Compassionate Conservative is, "We're going to have conservative values, but we're actually going to take care of each other." So it's a little bit, again, more unifying, more family sounding, at least. Make America Great Again is pure fascist, right? Because it's the same kind of thing that previous fascist dictators have done, right? So actually, Hitler literally said Make Germany Great Again in German.

Megan: I didn't realize that.

Carrie: According to Montel, anyway, which I think is probably true. And Make America Great Again, I think, also was said by the American Nazis back in the day. And Fascism is this looking to the past when things were great, things were better, and we were the shining empire. So it's always this sort of backwards-looking. Whereas Morning in America is more forward-looking.

Megan: Right. Which I don't agree with Reagan on things but- yeah.

Carrie: And it was still kind of a little bit icky, in my opinion. But it's not fascist.

Megan: No, you're right. Because if you look to the past, there's this inference that any progress made is not good.

Carrie: Yeah. So progressivism is always inherently bad, right? And progress is not always good. Right. Change is not always for the better. But also, things in the past aren't always better either.

Megan: Right, so like AI.

Carrie: Yes, AI is exactly what I was implying. Not all AI is bad, but come on, most of it is. So anyway, Trump is a...

Megan: A cult leader. 

Carrie: ... is very culty. He's definitely a cult leader. It'll be interesting to see as he gets worse in terms of his, to me, obvious dementia.

Megan: Right.

Carrie: How much this cult survives. Maybe they find a new leader, you know, like the Scientologists got a new leader, but maybe not.

Megan: They're already programmed to need a leader like that, right?

Carrie: Well, if you're in a cult, you definitely want to stay in the cult, right? Unless something pretty serious happens where you're like, "Wait."

Megan: Yeah, it's life-changing, right? It's like all of your beliefs are shattered if you leave. Like if it's not true.

Carrie: It's really hard to get out of a cult. People do. But it's usually something like there's two super incompatible beliefs you have to believe. And for some reason, you pick at it, you probe it, and you're just like, "Wait, I can't do this anymore." Like, so the people who left QAnon because it was too Christian for them. They were not Christian, and they had gotten into it through a non-Christian way. And then all the Christian stuff kept adding up, and they were like, "No, this doesn't make sense to me." So it can happen. It's just that on a large scale, it's hard to get everybody out.

Megan: Yeah. 

Carrie: Anyway.

Megan: It's fascinating.

Carrie: Yeah. Anyway, so let's turn to our episode and hope everyone's interested and buys the books.

Megan: Yeah, enjoy.

Carrie: Alright, so today we are very excited to have, I think, the most guests we've ever had at one time. So we have Dr. Lynnette Arnold, who's an Associate Professor in the Department of Anthropology at the University of Massachusetts Amherst. Dr. Anna I. Corwin, who is an Associate Professor and Chair of the Women's Spirituality Program at the California Institute of Integral Studies. Dr. Abby Mack, Assistant Professor, Department of Anthropology at the University of Kentucky. And Dr. Stephanie Keeney-Parks, who is the University of California Chancellor Postdoctoral Fellow at the Department of Anthropology, University of California, Los Angeles. So welcome.

Megan: Yeah, welcome everyone.

Carrie: And we have them here to talk about their book, Language and Health in Action.

Megan: It's like we've never done this before, y'all. 

Carrie: There's just too many people. 

Megan: I know. I'm just like, "Whose face am I going to look at?" It's fantastic, though. It's so lovely to be in community with you all this morning. It's been hard to be in the U.S. lately, so it's lovely to see you all here. Thank you. I appreciate it.

Lynnette[?]: Thanks for having us.

Carrie: Yeah. Okay, so we'll start with why did you want to write this book or these chapters, and why now?

Lynnette: So we wrote this book because in the field of medical and linguistic anthropology over the last 10 to 15 years, there's been a real resurgence in interest on work in language and health and their intersection. And this work has really demonstrated the profound importance of language and communication for health. As much anthropological work does, it shows in rich detail, in a range of different contexts, how different taken-for-granted communication processes and linguistic practices can really shape the nature and quality of medical care, and that can produce really uneven risks and consequences for human health. And so this work shows that language has a really profound real-world impact for health. But in order to understand this scholarship, you need specialized vocabulary and a lot of background knowledge, which makes the scholarship often not very accessible to people outside the fields of medical and linguistic anthropology. So at the same time as this kind of scholarship is on the rise, there has been increasing public interest in language and health, I think largely as an effect of the COVID-19 pandemic that made many people more aware of the connections between language practices and health in the world. For instance, all of these negative impacts of the racist and xenophobic naming of the virus that we saw, public debates about responses and treatments, the effects of lockdown and social distancing where people were having to do parts of their lives via communication technology that they previously had done in other ways.

So all this created a lot of public awareness about language and health. And as a result, I think many undergraduate students became very interested in this intersection, often taking it on as part of possible health careers, like in pre-med or other sort of health-related career trajectories. Institutions have also become interested in this work, I think, as a way to demonstrate the relevance of the humanities and the social sciences. So we've seen a rise in programs like social science and medicine or medical humanities in many institutions. And so there's more courses being offered at this intersection. But we still have this issue of scholarship that's not accessible. So the book really most immediately came out of hallway conversations between the editors of the volume at the Society for Linguistic Anthropology Conference and in other spaces. We all identified one another as people who were teaching courses on language and health and were asking one another, "What are you assigning to read?" Recognizing that there was this challenge of finding readings in this area that were workable for undergrads. So most immediately, the book came out of this need to provide readings for our interested undergraduate students that were accessible. To make this really profoundly important work available to people who might go on to become clinicians or nurses or work in public health or in other health-related areas. We also think about our students as voters and consumers of public health discourses. So we wanted people to have more of a savvy awareness of what those discourses can enact.

And then just recognizing that our students are people who will confront many health issues over their life course, right? Whether that's their own aging or caring for aging parents, raising children, just being human beings in bodies, right? And so for all of these reasons, we wanted our students to have access to this body of scholarship. And then by extension, making a book that's available for undergrads also means that this work is more accessible to interdisciplinary audiences. So I really think about this book as a project in linguistics communication that works to make this work on language more welcoming and invites more people into these conversations so they can learn about the impact of this research, they can apply it in their own lives, and perhaps even go on to contribute to this work in the future.

Megan: That's amazing. I was just thinking these students that you may be interfacing with came of age during COVID when they were in front of their computers at home. It's scary. I was scared. It was a really strange time, and I did think about mortality a lot, and I'm sure your students did as well. And so I'm interested, how did that kind of, if all of you had that where you were seeing students kind of showing up and having different questions for you during that time? Do you have any examples? Were they asking for more readings? What were they doing?

Anna: In my classrooms, I could say at that time. I'm Anna, this is Anna Corwin. I don't know if I need to say who I am so it's recognizable, but I'm now at CIIS where I teach graduate students. But at the time during COVID, I was teaching undergrads, and it certainly was a moment where it felt like that Wizard of Oz kind of curtain was lifted a little bit for students because there had been this idea, biomedicine has done it all. We're so lucky. We have all the technology. You go to the doctor. They can diagnose you. It's perfect. And they maybe hadn't, they were young enough, they hadn't had too much interface with medicine. And when they had, it had worked. And then suddenly there was this moment where the curtain was lifted, and these systems, like what wasn't working, the cracks in the systems, they began to actually have the possibility of seeing that biomedicine was not this simple thing that sort of was taken care of and had a little bow on it. You go to the doctor, you're fixed, you get your vaccine, it's done. But that adds social components, interactive components, but also structural power, structural- components of structural oppression. And it was a real crisis. I don't want to undermine that. But it was also an opportunity in the classroom to look, as we were moving through it, at what was happening as it was unfolding.

Lynnette: Yeah, and absolutely an opportunity to dig into what happens with language. I remember teaching methods classes around that time and having students walk around campus and do a linguistic landscape of signage related to social distancing and mask wearing, or analyzing emails from the chancellor about vaccine requirements or surges and those kinds of things. It was a real opportunity, as Anna was saying, to help students see the processes and the ways that language is so integral to the way that decisions are made and meaning is made in health contexts, and ways that guide our individual and collective actions.

Megan: And also, to not understate it, how language is weaponized, right? That's so real, especially during COVID and after. And now I'm hearing about how there are things called vaccine-neutral pediatrician offices, and I'm so scared. I think, Abby, you had an example. I think you were nodding along about how students interfaced with you after or during COVID.

Abby: Oh, I'm[?] certainly was amening everything that I had to say. But yeah, I was teaching a class that summer after we first went on the lockdown. And the class I was teaching as a graduate student at the time was called Anthropology of Deviance and Abnormality. So really, and as a linguistic and medical anthropologist, that class looked very different than it would have been traditionally taught. And we were spending a lot of time really thinking about how language functions to construct what we recognize as normal, as ordinary, how we think about health, how we articulate certain people as outsiders. And in the midst of all of this, the students who were showing up to Zoom with me every morning were navigating the uprisings in Los Angeles, the loss of their family members, new employment when they pick up jobs to help care for their family and become those essential workers at that time, even just the word essential workers or phrase, all of that was really present. And, I don't think it's gone away. The students who are freshmen now were 13, 14 and going through their coming of age in the midst of this time, this moment and confrontation with mortality at such a young age as well, I think has really shaped a lot of the- has had a profound impact on the ways that students are learning and thinking about their lives and their world. And I think about it all the time too. There's research that suggests that that kind of confrontation with mortality primes people to become more in-group thinking and suspicious of outsiders. And I think that that is something that we are also navigating now. And it matters for how we think about language and it matters for how we think about health and it matters for how we think about building community, which I think is at the center of all of these things. So I'm thinking about it a lot.

Carrie: Well, speaking of, what is health?

Abby: That's a good question, Carrie. What is health?

Anna: So a classic definition of health, one might see in like a dictionary is just the condition of being sound in body. Sometimes you'll see that it's against being sound in body, mind and spirit. It can refer to sort of well-being or thriving, but that's like pretty vague. And so health is also often defined by its opposite. For example, illness being the opposite of health or being outside of health. Illness in medical anthropology world is defined as something that is individual and subjective. It's an experience of feeling unwell. So that's illness. And then disease, which is distinct from that, refers to the pathological condition, a body that is sort of measured by a practitioner within a particular system. So it might be a biomedical system, but could be any other kind of system in which there are taxonomies. So this is a system created by people that has a culture that says, "Okay, like your unwellness can be named in this particular way." So already, I just want to sort of point out, language is part of health. It's not as if we often, like our undergrads, as we were talking about, often grew up with this idea like there's health and it's just objective and it happens. And then you go to and there's disease and it's taken care of. But it's already within a system of language.

And even that experience of illness is in a system, a social system. Like what is that feeling that you then interpret? Maybe it doesn't feel good, but how you understand it, that's also social. So there's health, then there's illness, then there's disease, which is within that system of taxonomies. We also have a third term that we talk about a bit in the book, or that we define, which is sickness, which refers to the way ill health can constitute a social problem. And we also then talk about stigma, where we have then social responses to ill health. So maybe social responses of shaming or blaming that can be associated with certain diseases or illnesses. We saw that in COVID sometimes. So did you wear your mask? How did you get it? Were you at a party? There's these things, again, social, interactional, linguistic, all the way down. And I want to also say, as linguistic and medical anthropologists, this perspective that we're bringing, it's all- we also try to sort of... Often when we talk about health, we center the human individual and we sort of, in an unquestioned way, as if the individual exists and isn't made through social interaction. But of course, health also is something, we have bacteria in us, we have whole colonies of things interacting within us at this micro scale. And then we also, as individual humans, interact.

And so there are these multiple scales of interaction. Over a lifetime, a human goes through developmental stages and these sustain injuries. We have social interactions, maybe we're stigmatized, whatever, these things happen. And that influences how even just we experience our bodies and our health or our illness. And then also, we've got, health is also constituted through these networks of social relations and kinship and friendships and many other people who might be interacting with a physician, who's interacting with someone who's developed new drugs, who then that influences our health systems. We also have food systems that are impacting our experiences of our own bodies. We have legislators who are influencing policies that are influencing how we experience our own bodies and interact around illness or health. And so in the book, we're taking health not as something that exists sort of unquestioned in an individual body, but as something that is social and multidimensional and existing at these multiple scales. We don't talk a lot about that tiny micro scale, but I think that's important, that bacterial scale. But we do look at these sort of familial- the scale of kinship, the scale of community, the scale of the nation stage, the scale of the ecosystem and these different levels of society and also structures of power, of course, that are all shaping health.

Megan: When you describe it that way, I'm seeing lots of points of like beauty, but also points of pressure that are very scary that play out. And you see that in your book?

Anna: Again, there's this way that like, we were talking about this, or I was talking a minute ago about the students during COVID sort of see the curtain going up and sort of seeing it. And there is this dual experience of like, "Holy shit, that's like- there's so much power and pain that's not necessary." It's painful. It's scary. But there's also beauty and hope. And also, we're just humans doing human stuff. And there's something just like gorgeous about that. Like the way we have made it is not the way it has to be or has always been or is everywhere. And that's, I think, one of the greatest beauties of it is that there is an otherwise that one can begin to see. But then seeing the thing itself can be a bit overwhelming.

Carrie: Yes. Yeah, the scale of it is definitely overwhelming for me. You already talked about a little bit, but maybe you want to flesh it out more. What is the relationship between language and health?

Lynnette: So the short answer to this question is it's multifaceted and complex. But that, of course, is not satisfying to anybody. And this was one of our main challenges in the book was how to bring across this multifaceted, complex relationship in a way that would make sense to undergraduates. And so that, I think, is really baked into the structure of the book and the way that we've organized the book. We explore the connections between language and health in five different sections, starting with what people will probably most immediately think of when you say language and health, and expanding out from there to things that may never have crossed their minds. So the first section is clinical interaction, so that we're looking at doctor-patient interaction, which is a thing that many people think of when you say language and health. So the kinds of unspoken rules about who can ask questions, what kinds of answers are valid, all those kinds of things that we see structuring doctor-patient interaction. That section also looks at medical socialization, how clinicians learn these kinds of things, and the ways that doctor-patient interaction is also shaped by intersecting identity categories like race, gender, and age in ways that often mobilize profoundly discriminatory stereotypes and beliefs.

And so it's very easy in doctor-patient communication to see how language has these very profound effects for health outcomes. Who gets listened to, who is dismissed, who is given access to certain kinds of care, and who is denied that access. So that's where the book starts. The next section looks at language access, which is another way of thinking about the relationship between language and health. Language here becomes a barrier for accessing care, especially for immigrant communities. And we introduce this section by saying that in reality in the world, multilingualism is the norm, right? But healthcare in many contexts has remained firmly monolingual. And so that's what produces the problem, right? So rather than locating the problem in the multilingual individual, the problem is in a monolingual system of healthcare provision. And so that creates this reliance on medical interpreters, an often unfunded mandate that means that family members, often children, are pressed into these kind of language-brokering, informal interpretation sorts of interactions that scholarship has written about. And so this way of thinking about language helps us to see that what's often understood as simply a linguistic issue is actually deeply embedded in structural inequality, economic injustice, some of the things that drive migration. So those are sort of where the starting points of where people might think if you say language and health, that might be immediately where their mind goes to.

But from there, the book goes to a third section, which talks about, we call it community and communicability. And the point of this section is to say, actually, a lot of really important health communication does not happen in clinical settings. It's happening outside of clinical settings, right? So we were talking about that with the pandemic and all of the kind of legislative and media and social media discourse around the pandemic that was actually very influential to impacting kind of the course and the trajectory of what unfolded over the course of the pandemic. Bio-communicability is the term that is used within the field to capture the way that knowledge about health is articulated, how these ideas then travel and get taken up and sort of what the consequences of that are. The goal of this is to try to understand why certain ideas become sticky, why certain people's words carry more weight while other people's are not, right? But we also, in this section, look at how kind of everyday people resist this by coming together in communities and in groups to try to amplify their messages and kind of tweak bio-communicability, right? Try to make a bio-communicable[?] intervention in these fields of power.

And I think in this particular moment with the rise of AI, which is really something that happened since we started working on this book, right? But we're in a moment of AI creating false facts and narratives and drowning out people's voices and I think having a hugely outsized effect on bio-communicability. So I think we really need the tools of bio-communicability now, I think, more than ever. The final two sections of the book, the fourth one, looks at language and environment. And as Anna was saying earlier, when we understand health as something that's not just held in the individual body, then we need scholarship that can help us think about how we make sense of our relationship with the natural world, with the social environment, and the impacts on health. And of course, language is crucial for that. And obviously, right? We're in climate change right now, which is having far-ranging consequences for health for many, many populations around the world. So again, a scale of analysis of language and health that also includes questions of environment and climate is really useful right now. And then finally, we get back to, I think, which is probably my favorite section of the book, which is called healing practices. And in this section, we're looking at the ways that language is really important for healing.

And we can see this in kind of a common example of, for instance, medical instructions of how to care for a wound site, right? That are then important for healing that wound. But it goes way beyond this, right? Language itself, in many models, is understood as a form of healing. We see this in psychotherapy and in many other kind of more spiritual modes of healing. But language is just fundamentally a tool for making meaning. So it's crucial for the ways that people individually come to terms with illness and collectively make sense of that and grapple with the consequences of that for their lives. So we're constantly using language to imbue these health-related experiences with meaning and then sort out ways to kind of persevere through that, right? Through language. So this way of thinking, I think, gets us back to this, where we started, right? With these really expansive understandings of language that we need for thinking about well-being and resistance, especially in this particular moment. So again, the relationship between language and health is multifaceted and there are things that we don't capture in the book, but the structure of these five units, I think, takes us from the smallest scale clinical interaction out into this larger world understanding of health and is a way of making that multifaceted and complex relationship digestible and accessible to our readers.

Megan: So Stephanie, I would love to get to you in your chapter. So why did you decide to write about your interaction with the white clinician?

Stephanie: It's a great example of how race and disability can be completed[?]. It's a great example of how quietly racism works in clinical spaces and how quickly those things happen. And it's an excellent example of language in a multitude of ways. Autism is a language-based disability, often considered that it's one of the forefronts of what clinicians and families and autistic people care about is language. And it's often foregrounded that verbal language in particular is ideal. And then you go further. Well, then is it white standard English that is the ideal? And if you're a Black child speaking white standard English, or are you capable of code switching or not? You have autism, you're probably not going to code switch, right? Because your social norms are also part of that diagnostic process. So I just think it's a really useful example to look at how health disparities can be created and maintained in these spaces even by really well-meaning clinicians. He didn't come to work that day hoping to racialize a little kid or create a health disparity. He came to work thinking he was teaching a group of graduate students how to diagnose autism. But his behavior and interactions with Dell[?] were such that, the outcome is the outcome. And so that's really important for people to come face-to-face with.

Megan: Yeah, so it's not just an instance of one individual doctor coming in. 

Stephanie: This is the norm. 

Megan: He's an example of norm and he's teaching others.

Stephanie: Yeah, so that day[?], and that's part of what's really important about this too, I foreground that there's like 50 graduate students in that room from a multitude of disciplines. And they all leave that room believing that this is okay. And that they've had a good interaction with a Black child because my son Dell, who's in the interaction, does have a great time on stage. He's happy and lovely and delightful and giggling the whole time. And they think this is all great and they're clapping for the clinician. But as an anthropologist and a mother of this child, I can see how problematically racialized this situation is. But then that's also part of the conversation. I have a very unique positionality that I get the opportunity to see these things and think about them for long periods of time where clinicians get milliseconds. These things happened in seconds. And then I got to think about them for the next 10 years and write about it, right? So racism is deeply embedded in this, in the way we talk and think about language. And disability is not extracted from that.

Megan: And that timeline you just gave just reminds me of how slow things work in medicine. Like new practices, new norms of things I've heard take time from the research to the actual implementation across specialists. For the listeners, if anyone else is watching the pit[?], I feel like we see instances of this all the time where there is a fat patient where one of the doctors in training had an interaction. And then a doctor came in and said, "Hey, I noticed your interaction was different and not in a good way with this patient." And we're coming into these things. So I wonder if they have some sort of linguistic anthropologists on scene or if they actually have people that know about these things coming in there. Because I think it's actually quite thoughtful about these situations. I don't know if any of you watched it. But I think a wider audience is definitely getting some insight into, "Oh, they didn't listen to the fat patient because he's fat." And[?] eating disorder with a Black woman, and I just saw how everyone was like, "That's so great because it's so underdiagnosed." It's going- we get it if you're a white woman, it's usually picked up on. It's not picked up on if you're a Black woman. So these kind of things, they're highlighting these things. And I wonder, just for the listeners, maybe you can apply that in your real life and think about how important language and health really is. I can't believe I'm the only one of six of us that has watched the video.

Carrie: Oh, no. I'm watching it.

Megan: Oh, you're watching it.

Carrie: Of course. We've talked about it. 

Megan: Yeah, that's true.

Carrie: Yeah, I think it's a very smart show and they do talk a lot of things with a lot more sensitivity than other medical shows have. That is for sure.

Megan: Yeah, no, it's like the most unrealistic thing is like, that's not how I- even like the way that I am and I look and I enter into rooms, I'm not treated that way with a lot of doctors. They're really quite good, a lot of them. And I'm like, "That's a shame because that has not been my experience."

Carrie: Let's dive into your experience, Stephanie. So what is the Autism Diagnostic Observation Schedule and why does it matter?

Stephanie: So the ADOS is commonly referred to, it's probably called the ADOS, but it is the Autism Observation, I'm going to get this upside down, sorry, Diagnostic Schedule, but it's commonly referred to as the gold standard for diagnosing autism. And my critique is not actually of the ADOS. You could insert any test in there that is subjective. And the important thing is this is a subjective test. There's no space in which somebody's, the point of view of the clinician is not a part of the diagnostic process, right? And we can see this, in any instance, a Black person walks in and they're like, "Oh, you're overweight, you must have diabetes, we should test you for sugar," right? Like they're immediate, like stereotypes that go along with diagnostic processes. And the same is true for an ADOS or it could be any number of the autism diagnostic tests, but this is just the one I happened to capture. And what also makes that incredibly important is that it is conflated with race in this case, where Dell's behavior in particular, when he doesn't code switch, is seen as being echolalic, which added a category to his diagnosis that he previously didn't have. His behavior is seen as inappropriate and disruptive, right? Which are kind of like dog whistles for little Black boys being naughty. And you're diagnosing Del's race as deviant, as non-normative, right? Rather than looking at who Dell is. And he does have autism, it's very clear, right? Like that's not the argument. The kid has autism, but what are you looking at that begets that? 

And he was using, the clinician in question was using a lot of Dell's linguistic ways of being as being non-normative. And they're completely normative in Black spaces. It's very normal to bring up rap lyrics or popular culture into everyday life in our conversations. In fact, we would think you're a little odd if you didn't. And so Dell doing that is culturally immediately appropriate for us. But for the white person in question, it was not. It was the naughty Black boy who was echolalic. Clearly he can't be normal. And even when he displayed so-called white ideas, he was talking about a country Western song. That was also immediately racialized as, "Oh, he must be talking about hip hop," which is also fascinating. So Dell couldn't either be Black, he was either too Black or not Black enough, right? He was being helped to be Black. It was just a really strange thing. And the clinician himself even wore some of that Blackness during his interaction, like putting on a fake Black accent[?] and talking about dropping the mic and hip hop this. And it's just a very odd situation, especially when we're measuring things like social norms in an autism diagnosis when the clinician is so out of pocket with his own social norms. It's just a strange kind of inflation of events, but also not atypical. 

Carrie: What is echolalic?

Stephanie: Echolalic is when, yeah, you parrot the sound, or you say something exact, or you may hear somebody make the same noise, the same phrase, and it's exact, even the intonation of it, right? Not just, "Hey-" Like Dell does[inaudible] then he's like, "Oh, I like Big Buds," when he answers a question, citing a rap lyric. That's not echolalic. But if he had gone[?] and sang the song exactly, you know what I mean? That might be echolalic, but we need more context for it, too, right? But it doesn't display echolalia, the behavior that he showed.

Megan: I was just wondering if tag questions or tag statements could possibly,  you know what I'm saying?

Stephanie: No.

Megan: If you say, "What I'm saying?" 

Stephanie: No, that's not echolalic.

Megan: Okay, yeah. But that wouldn't be misdiagnosed by someone, or confused. I was like[crosstalk]

Stephanie: [inaudible]diagnostic[?]processes[?]. And again, I just want to reiterate, I know the ADOS is front and center in this, accurate, but it can be any, and I mean any subjective test.

Carrie: Yes.

Stephanie: This is just the one I happened to catch.

Carrie: Yes.

Stephanie: Yeah, so my critique's not of the ADOS, but...

Carrie: No.

Stephanie: Of the [inaudible]. Yeah.

Carrie: I was mostly interested because echolalia, you bring it up, and the way that your kid is presenting it, supposedly, I'm like, well, "I do that too. Is that..." And people have told me, "Oh, what you're doing is echolalia," but now the way you're describing it, it's not. And so I'm relieved to know, not relieved, but just, I was always confused why people were calling it that, because I'm not echoing anything. I'm just responding with a song.

Stephanie: When you hear echolalia, you will know this is echolalia. I mean, it's very distinct and clear, because it's exact, and it's exact to be like, "Wow, that was really the same," right? It's very...

Carrie:  Interesting. 

Stephanie: In Linguistic anthropology, we would call this conversational sampling. That's the term we would use for this. In Black folks[inaudible] we would just be like, "Oh, that's dinner talk."[crosstalk]For us, it's regular.

Carrie: Anyway, that's certainly interesting.

Megan: Yeah. Thank you for sharing that. I'm just thinking about, they don't get doctors, they don't get linguistic training. This is not a thing. It's terrible. Especially pediatricians. I'm like, "You should know more about development, about- yeah." 

Stephanie[?]: Yeah, development is important. 

Megan: And even that's fraught. But you should know a little bit more than you do about language development and all that. But, yeah.

Carrie: Yeah. So, I mean, we are talking about the ADOS, but more broadly, how is whiteness playing a role in these kinds of interactions?

Stephanie: Yeah, for this in particular, it just leaves itself completely unmarked. And the clinician himself is teaching that it's not about culture, it's about response. It's how the patient responds. Well, I mean, we're anthropologists. We think everything is culturally shaped, every response. There's not a response you can really give that's not touched by this process. So, when he said that, that's when I was like, "Oh, we're in for something." My son's about to be in this situation, and he's definitely not going to be without culture. And the other things that were fascinating is the grad student- a grad student also asked, "Well, what do we do if we run into culture?" How do you run into culture? What is not running in, right? So, it becomes a wonderful way to teach what it means when whiteness is so completely unmarked in a space that you can't even understand that you're saying, hey, you're very clearly pointing out, right, if you run into culture, that just means non-whiteness.
What happens if we have to deal with non-white folks, right? Which is actually a great question in the context of that class if we had talked about it, right? But it's a fair question. What do we do with that? If you're a white clinician, you need to know. But they didn't have a great answer. The answer was, it's not about culture. It's about response, which is, and then we watched all the rest of the process unfold, in which it was all about culture. The whole diagnosis was about culture, including the clinician's behavior himself. And so, whiteness became- when you foreground that as not even existing, and that's just so normative in the air, then when a non-white person inhabits the space and displays behaviors that aren't aligned with that, they're immediately seen as atypical and non-normative and register in diagnostic processes, when that has real lifetime outcomes.

Megan: Oh, yeah. Tons of terrible speech-language diagnoses because of this.

Carrie: Oh, yeah.

Stephanie: Those are absolutely nefarious[?], yeah. 

Megan: I think I went to their ASHA conference at one point and cited, it was like, 92% of the field is white women. It is. 

Stephanie: Yes. 

Megan: It's striking. That is- yeah.

Stephanie: And when they don't understand, and that's, I think this is important because I think we all teach that one of the most important things we teach is that whiteness is a cultural process, as is any other thing. And so, students really are taken aback by that. It's many students' first time understanding that they are functioning in a space where it is just so normative that everything else is deviant from that, right? It deviates from that point.

Megan: We got to keep reminding them. We got to keep... It's not a bad reminder. It's needed for a lot of people, for sure. 

Lynnette: Yes, 100%. 

Megan: I feel like we have so much- because you're all so great. Okay, if we could switch a little bit and go to Abby and your chapter. How did you, or why did you want to write about Debra and her experience of divine deliverance from polysubstance use disorder? And what is that?

Abby: The chapter that I contributed is coming from a longitudinal collaborative ethnographic project that I've been a part of for the past five years with people in Central Appalachia who are recovering from substance use disorder through a variety of modalities, a variety of different treatment practices. One of those may be something like what happens in a clinic. We did work with people who were receiving things like buprenorphine, which is an opioid agonist and helps people to not have cravings for opioid use disorder. Other modalities include forms of faith-based recovery. In Central Appalachia, this is a region that has been constructed as having an opioid epidemic for the past two decades. It has been the site of the statistical epicenter for many years. It's no longer of opioid overdose in the country. That has shifted as fentanyl has spread across the country in different ways. And for many people, it's not just opioid use. Opioids themselves are accompanied by an extremely painful withdrawal process. And methamphetamine helps with that withdrawal. In time, many of the people that we worked with found themselves navigating a polysubstance use disorder, where they were experiencing multiple kinds of addiction. This is in a region that is also the site of many different kinds of exploitation and extraction, from coal mining companies to the cultural exploitation and extraction that we see someone like J.D. Vance doing, to other kinds of media representations of the region as well. 

And one of the biggest forms of exploitation that has been widely publicized has been what has occurred with Purdue Pharma, which was the company that created OxyContin and manipulated various pain scales, gave us that smiley face to sad face pain scale, used what Helena Hansen has called technologies of whiteness to create racially segmented markets, and then exploited the pain that people were experiencing through various kinds of labor exploitation as well to sell this drug, which is a big part of what created what we know of as this opioid epidemic, and resulted in cash clinics that were making a lot of money selling pain medications. And in time, some of those clinics transferred to treatment for opioid use disorder. And so there are layers of cultural and historical and structural kinds of traumas that are happening in this space that lead people to be sometimes skeptical of medical treatment. But I will say the clinicians that we work with are very good at recognizing that and have really formed a powerful ethic in treating that. And then you also have this region that I was working in, Central Appalachia, northeastern Tennessee, southwestern Virginia, southeastern Kentucky. It's also site to a huge cultural tradition of charismatic Christian practice. Cane Ridge Revival, Second Great Awakening, these huge moments that changed American Christianity. And faith is, we've been talking about meaning making and the ways that we build meaning around health. 

And faith is such a central cultural kind of form of building systems of meaning and belief and community and connection. And it's very powerful. And so Debra, who I worked with, is someone who had been navigating 15 years of polysubstance use disorder with intravenous use. And one of the clinicians I worked with would say, "Listen, I'll give a samurai sword to the first person in my clinic who goes five years without relapsing after that kind of use." Debra had tried other modalities of recovery. And the way that she tells her story is so powerful, and I won't do it justice here, but she found her way to attempt revival and fainted in the Holy Spirit, which means that she literally fainted and began speaking in tongues. And this experience happened again when she returned the next day. And she reported immediately after she did not experience cravings. She did not experience withdrawal. And she hasn't used again in 20 years, which is medically, when you know about what's going on with the brain, miraculous. And the chapter that I contributed is not so much about the deliverance itself. It's what comes after, right? And there's much more that I could have written about, about the ways that such an experience can radically shift a person's sense of self and creates a really profound connection with the divine, with God, right? That has translated into the ways that Debra lives her life every day and is part of her practice in worship spaces, but also in her everyday life. 

She has learned to maintain this relationship through language, through prayer, through the ways that she learns to kind of experience the pains in her body, the ongoing pains in her body. And so that really gave me an opportunity to think about, right, we talk about language as performative, not in an inauthentic way, but in a way that language is doing something in the world. And here it is doing something very profound with Debra in creating a very powerful relationship to God. And, for those in the listening audience who are not religious, you can think of it as the more than human that surrounds us in many different ways, or however people build connections or community. When I think about people who are suspicious of this, right, as many anthropologists have been in times past, increasingly we've come to think a little bit more about how we live in many different worlds. And my work with this article or chapter was really to try to think about how Debra is experiencing a world that is allowing her to create, or not create, engage and access language and meaning and practices and relationships that allow her to continue forward and really critically allow her to think about her past experiences and her past trauma in ways that aren't as stigmatizing as many of the models for addiction are in different treatment modalities, including things like the chronic relapsing brain disease model that is now used in clinical spaces.

Carrie: Yeah. So speaking of, how does the way we talk about drug addiction affect recovery?

Abby: Yeah. So I think there are lots of ways to dive into this and many anthropologists have thought about this. We can talk about the word addiction itself, which etymologically means to be bound, to be a slave to, and in a culture, broadly the U.S., right? This is very different in different parts of the U.S. That has its own kind of stigma when we are a hyper individualist culture that really prioritizes and privileges and values willpower. And when we look at the history of addiction recovery, we see different ways that willpower has operated as a motivator, but also a way to shame people. It's a problem of your will. It's a problem then of yourself. It's a problem of even your soul. That you cannot resist this substance or gambling or whatever it is. And in medical models in the nineties, they began to think about what we know about the brain, right? They didn't begin. This was building on lots of research over time. They started to talk about how what's happening in an addiction experience is dopamine response that is chemical. And as a result of that chemical process, you can expect that you will experience relapses and that this will be chronic. And as other anthropologists have written about, Angela Garcia, China Scherz, who is one of my coauthors, this chronic relapsing disease model has its impacts too, right? What happens when medically you could say, "Well, chronic really doesn't mean lifelong," but to a person in a clinical space or wherever they are hearing chronic suggests that this is something you will be living with for the rest of your life. And people adopt that, right? So even people who are 20 years in AA will say, "I'm an addict," even if they haven't relapsed, and this is not a critique of AA, although there are some valid critiques of that. What Debra has found in a faith-based model is it allows her to say, "I'm Debra. I am not an addict. I'm free from that. I am delivered." And that is really powerful in terms of meaning making processes that has really shaped her experience.

Megan: I got chills for Debra to be able to say, "I'm not an addict." I think that's so beautiful. I actually struggle with this. I'm like, "Do I call myself a depressed person because I have episodes sometimes?" I don't know. I still struggle with it. So it's for each person to be able to identify what's the best language for themselves around these things is so healing, or has the opportunity to be so healing. So that's really awesome.

Anna: I want to jump in and just both of these chapters are brilliant, Stephanie's and Abby's. And I want to just sort of bring us back to, we were talking at the very beginning, what's the connection with language and health? That's sort of a framing question in some ways of this book. And I think that these two stories, the research that these two have shared with us, show us that it's not only- there's all this important stuff where language communicates stuff and does stuff and creates meaning and all these things that we've been talking about. But also I think both of these show that language itself is a technology for directly, this is the performativity that Abby's getting at. It is that language itself can have direct effects. And that in Stephanie and some of Abby's examples and data, we get examples of language itself causing disease, causing sickness, causing direct experiences that wouldn't be happening if we weren't using that language, that the language itself has a direct impact. And also in this example that Abby's providing, language itself is the technology of healing. And so there's this power also that I think I want to make sure we capture that's just cool, language is cool. It's not just a sort of way in which other things travel, but it also is a thing in itself that creates experiences. And our- three of us here actually were mentored by Eleanor Ochs, who writes a lot about this, that language itself is experience and creates experiences and these things ride together. So kind of calling her in a little bit here.

Carrie: Language is cool. Yes.[crosstalk] If we learn nothing else from this- language is cool. Is there anything that we haven't asked you that you really wish that we had?

Lynnette: I guess one thing I would say is who should read this book? And I think everybody should read this book. But I do think for those of the listeners who are teaching classes, I think this is a book that lends itself to a range of different kinds of classes, right? So it could be in a medical anthropology class or linguistic anthropology class, but also in classes on a range of other different topics. There are chapters in this book related to themes about immigration, help me out you all, there's things related to gender, age, indigeneity, race, as Stephanie was talking about. So there are many themes that we teach when we teach language and that this book would lend itself, or a chapter of this book would lend itself, well to. So everybody should read this book. We've structured this book to be as welcoming to everybody as possible. Every chapter comes with bolded terms, clear definitions, a set of questions that can be used for individual or small or large group discussion. Each section has a little introduction that sort of sets the tone for what that section is about. So everybody should use this book because we want it to be accessible to as many people as possible. We're also super excited about a website that we're developing that's going to have more teaching materials, like, multimodal teaching materials. And we source those materials from teaching drafts of these chapters to three, now three separate sets of students in our classes. And so they've helped us to gather a range of multimodal, and authors have suggested as well, podcasts, documentaries, those kinds of things that can be used in conjunction with the chapters that will make them hopefully more engaging to teach as well. So everybody should read this book.

Carrie: Everybody should read this book. I think that's actually a really excellent place to end. So thank you for adding that. 

Megan: Yes. Well, we appreciate all of you. 

Carrie: Yes, we do. And we always leave our listeners with one final message. Don't be an asshole. 

Megan: Don't be an asshole. 

Carrie: The VocalFries podcast is produced by me, Carrie Gillon, theme music by Nick Granum. You can find us on Tumblr, Twitter, Facebook, and Instagram at VocalFriesPod. You can email us at VocalFriesPod@ gmail.com. And our website is VocalFriesPod.com.
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