Abstract
The medical topic of the study is hepatitis A (jaundice). The data is taken from interpreted medical counselling sessions recorded in an advice centre (Ruhr-Area, Germany) in the 1980s, with male German doctors informing groups of (mainly female) Turkish adults on children’s diseases. While in German the illocutionary kernel of preventive health counselling is a piece of hypothetical advice, in Turkish that kernel is often transferred into instructions by the interpreter. Salient barriers to the Turkish clients’ reception are their own ideas and conceptions (functioning as an ‘inner scenario’) of how to deal with the elements of jaundice (pathogenesis, causes, way of infection, incubation period etc.); they are not in accordance with the German doctor’s medical knowledge and its semi-professional verbalization.—The doctor tries to bridge the intercultural and multilingual discordance by putting probing questions about the Turkish concept of nazar (evil eye) yet is only met with irony. It is hypothesized that the clients’ ideas and conceptions of jaundice could be changed by applying the Cultural Apparatus within the advice-giving discourse. Conclusions are drawn on how effective preventive healthcare may be achieved between doctors using German and migrant patients using their L1 Turkish.
I am highly grateful to Dr. Karl Theo von der Marwitz (Bochum at that time) for his help in collecting the data, to Anı Yılmaz (University of Hamburg) for her multilingual transcription work, to Dr. Safiye Genç (Akdeniz Üniversitesi, Antalya) for amending the Turkish-German translations and giving linguistic comments, and in particular to Ivika Rehbein-Ots and Jennifer Hartog for making suggestions and corrections regarding the English formulations. Needless to say, any remaining mistakes are solely my responsibility.
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Notes
- 1.
Immigrant societies, as is the German society, develop social multilingualism towards effective multilingual communication in the sense of a HELIX (s. Rehbein 2013), i.e. towards a realisation of superdiversity, if not only clients speak and understand the language of the agents (e.g. physicians, staff and personnel in hospitals and medical practices and other healthcare institutions), but if agents, too, speak and understand the community languages of the clients. At the present time, this development still requires interpreters for various languages. The communicative multilingual model suggested by Phillimore et al. (2018) which is based on a multidisciplinary exchange of multilingual abilities within an “eco system” would be of appreciated value for the HELIX-like development of an immigrant society towards multilingualism.
- 2.
The Hackney Community Centre in East London where the author recorded, transcribed and analysed legal-advice-giving sessions (cf. Rehbein 1980), was a similar centre.
- 3.
The paediatrician working as an assistant doctor in a hospital as well as the interpreter working as a school teacher were connected with the advice centre, and, in this way, were part of what is called today in the study by Phillimore et al. (2018) study an „eco system“ of multilingual superdiversity.
- 4.
An introduction into a quantitative approach on the basis of EXMARALDA transcriptions is given in Rehbein and Herkenrath (2012). The fundamental linguistic unit of counting in the EXMARALDA programme is the ‘utterance’. Utterances are automatically indicated in transcripts of a ‘partiture’-format, or ‘score’-format, by means of supralinear ‘segment numbers’.
- 5.
The linguistic action of interpreting, or transference, of a language A into language B can be categorized as a ‘reproducing action’ (‘reproduzierendes Handeln’), as it is a creative activity of its own (cf. Bührig and Rehbein 1996).
- 6.
For a description of form and function of the Communicative Apparatus of speaker-hearer-control in multilingual communication cf. in detail Rehbein and Romaniuk (2014).
- 7.
No reliable data of the clients’ L2-knowledge exist. But most of them have a passive or listening command of German as especially demonstrated in parts of excerpt (E6); some of them dispose even of an active or speaking command of German. Their abilities are certainly diversified due to their previous contact with German discourse.
- 8.
- 9.
Duman concludes that sometimes “wrong knowledge can be transformed into knowledge commonly affirmed as true. Hence [sometimes] wrong recommendations [of friendly laypersons] are preferred to correct professional ones. This is a big problem for Turkish doctors. It is […] very difficult for Turkish doctors to remove this wrong knowledge, to convince sick people and to convert it into the professional knowledge to be applied.” (Duman 2008, p. 358, author’s own translation).—The complete study including the data was published by Duman (2005) in Turkish.
- 10.
Rehbein defines ‘semi-professional speech’ as follows: “Since most of the doctor’s utterances [when these are verbalised to non-professional patients in everyday language – J.R.] contain traces of reference to his/her professional knowledge, I term this kind of agent discourse semi-professional speech.” (Rehbein 1994, p. 100).
- 11.
In her analyses of genetic counselling interviews, Hartog (1993) has drawn on the ethnomethodological concept of ‘lay knowledge’ which she confronts with the ‘expert knowledge’ and refers to Cicourel’s theory of the ‘belief system’ (e.g. Cicourel 1983, p. 235). The patients’ mental notions of ‘pseudo-professional knowledge’ and ‘everyday knowledge’ of diseases broached by Löning (1994) should also be taken into account in this respect. These kinds of ‘knowledge’ might act a part here, however, ideas and conceptions (Vorstellungen) of the clients are not “knowledge” in the strict sense, but are to be assigned to a different mental domain. – In a functional-pragmatic view of discourse, ‘knowledge’, ‘belief systems’ and ‘ideas and conceptions’ are separate areas of the Π-domain which, as a whole, is defined as the mental part of the space of action.
- 12.
- 13.
Both in preventive counselling and in informed consent, the physician anticipates awkward/risky incidents (: XY) in the future. But whereas in preventive counselling the awkward/risky incidents XY need not occur, if one avoids doing a detrimental action F or prepares a useful action G, i.e. if an action plan has been formed, in informed consent the awkward/risky incidents XY can occur even though one avoids doing F or prepares G. Hence, in informed consent only, anticipation is ‘risk communication’ (s. Meyer 2005; Meyer and Bührig 2014).
- 14.
For the analysis of speech actions and constellations akin to each other, in the case of advice, recommendation, suggestion, warning etc., cf. Rehbein (1977): §13.
- 15.
For empirical examples in the transcripts, cf. in excerpt (E4) utterances s639–s641; in (E3) s565–572 and in (E5) s674–s678. One can observe that, in discourse, an underlying if … then-construction is often realised by one or even a series of then-construction(s).
- 16.
- 17.
The verbal means of generalising which express the propositional acts of preventive counselling are often language specific, e.g. the man (one)-employment in German (cf. Bührig and Meyer 2003) or the habitual aspect (-r-aspect) in Turkish. Grammatically speaking, the categories of aspects vs. tense as well as of mode are of relevance here.
- 18.
Cf. footnote 10 above.—A doctor’s medical knowledge shows a twofold linguistic organisation: In doctor-doctor communication, medical-professional language is used, in doctor-patient communication semi-professional language is used by the doctor.
- 19.
Cf. here the analysis of the same setting in Rehbein (1985a, p. 355).
- 20.
Linguistic realisations of illocutions in empirical discourses have been studied in detail by Rehbein (1999a).
- 21.
Cf. fn. 10 for an explanation of the term ‘semi-professional’.
- 22.
Cf. fn. 5 on the definition of interpretation as ‘reproducing action’ (Bührig and Rehbein 1996).
- 23.
- 24.
Cf. footnote 9, Duman’s comment (Duman 2008, p. 358).
- 25.
What the elder son did precisely, could not be identified in the recording, therefore it is in parentheses.
- 26.
Reasons and/or causes are expressed in Turkish by means of the ablative case morpheme -den/-dan suffixed to nouns and participles; this construction seems to create difficulties in German for the interpreter’s reproduction (cf. s189). Maybe, for reasons of subsuming straightness, the interpreter elects one emotion (“For jealousy.” (“Kıskançlıktan.” in (s186)) but leaves out sadness and fear which are mentioned earlier in the discourse. In his answer (utterance s191), then, the doctor elaborates only on being “jealous” (“eifersüchtig”, cf. (s189)).
- 27.
Brünner (2005, pp. 313–336) uses the term ‘scenario’ in her analyses of teaching and learning discourses in the training of mining apprentices. The apprentices are taught action plans to be applied in typical situations of mining: “Those elements and structures of reality, the knowledge of which is a result from previous real experiences, enter the mental activities underlying the scenario. Scenarios, then, should depict what could happen and, therefore, make use of elements of reality which have been learnt to be possibly real.” (ibd., p. 314, author’s own translation). Crucial in this determination is that ‘scenarios’ are composed of fragments of experiences which enter into ‘ideas and conceptions’, and comprise action plans in potential situations of illness.
- 28.
The discourse position of the women’s utterances must be considered here as comments to the doctor’s utterances (cf. the partiture (: score) format of the transcript). The refutation uttered by FB and FF, in this case, occurs merely as hearer’s actions accompanying the interpreted doctor’s statement that the assumed relation is wrong. Insofar, the refutation seems to be nothing else than an affirmation of the doctor’s authority through repetition of his viewpoint, and especially of his illocution. By the way, this discourse format is often to be found in Turkish oral discourse.
- 29.
Cf. footnote 10 above for an explanation of ‘semi-professional speech’.
- 30.
Supposedly, the doctor uses the pattern of explanation here; for a detailed and groundbreaking analysis of this pattern in scientific talks, s. Hohenstein (2006).
- 31.
Cf. Johnen and Meyer (2007) for Turkish and Portuguese interpretations in doctor-patient talk.
- 32.
Also used in utterances (s580) and (s582), which have no counterparts in German.
- 33.
In Functional Pragmatics, one would state that diyor (s/he says), as it is employed in direct speech reports, changes its linguistic field, i.e. changes from a ‘combination of symbolic, operative and deictic procedures’ to a ‘para-operative procedure’ by merging into a single combined operative expression.
- 34.
According to Reisigl (1999, §4), both complex interjections can be analysed as “secondary interjections”, i.e. ‘para-expeditive procedures’ originating from a combination of symbolic procedures by field transposition. In speech formulae like these, social knowledge is stored in a general verbal form; that is why Ehlich and Rehbein (1977) termed speech formulae as ‘sentential knowledge structures’; Feilke (1996) discusses formulaic expressions in German under the term ‘Gemeinplatz’; for multiple speech formulae in Turkish migrants’ German discourse, s. Rehbein (1987).
- 35.
Cf. preceding footnote.
- 36.
FM’s story cannot be rendered and discussed here in detail.
- 37.
Turkish and German/English relative constructions are typologically very dissimilar (cf. Johanson 1999a; Aksu-Koç 1998; Erkman-Akerson 1993, 1998, etc.). The same is true of Turkish converbial constructions vs. German/English conjunctional constructions (s. e.g. Rehbein 1999b) or evidentiality/hearsay indicating mIş-constructions as in “çocuğunuzdan biri sarılık hasta da olmuşsa, diyor, […] o hastalık geçmiş olabilir, diyor.” (“If one of your children, he says, also gets jaundice, he says, […] that disease may have been transmitted, he says” (s644)).
- 38.
Bührig (1996) calls what the interpreter is doing here the linguistic action of ‘summarising’ (‘Zusammenfassen’) and classifies it under the category of ‘reformulating actions’.
- 39.
If nonetheless the clients may grasp the doctor’s descriptive list through their L2-German abilities, that could mean that they will change their form of perception (concerning the indications of jaundice) in the future—which means ‘anticipatory compliance’ and application of the ‘Cultural Apparatus’ (see below).
- 40.
In this respect, the ‘superdiversity model’ (s. Phillimore et al. 2018) according to which laypersons who speak family languages can be employed as community interpreters in an ‘eco-system’ has its limits or, rather, should be expanded to an additional professionalising education for the institutional contexts demanded for.
- 41.
- 42.
The idea of disconnectivity or fragmentation of discourse in consecutive interpretation was developed in Hartog (2017).
- 43.
Most of the clients have a passive or listening ability of German as especially parts of excerpt (E6) demonstrate; some of them even dispose of active or speaking ability of German.
- 44.
For a definition of ’cultural action’ cf. Rehbein 2012a, p.2763.
- 45.
- 46.
I cannot deepen the point here in the linguistic dimension. Cf. Aikhenvald (2010) for a universalistic view (including Turkish) of this basic linguistic dimension (of illocutionary force) in a variety of languages.
- 47.
- 48.
Cf. Sect. 5.2 above.
- 49.
One could say that “nazar” (“evil eye”) functions as an allegorical representation of a secret power.
- 50.
According to Bühler (1934), the ‘symbol field’ considers formal architectures and pragmatic functions of the lexical field of a language.
- 51.
Cf. Johanson (1999b) for an analytical overview of aspect in Turkic languages.
- 52.
In a pragmatic view, these formulae in Turkish as well as in English are to be analysed as ‘secondary interjections’, according to Reisigl (1999); cf. fn. 34.
- 53.
In a different social setting, varieties among Turkish women have been shown by Duman (1999) who published a study on women’s silence face to face to men whose addressing reproached them.
- 54.
In functional pragmatic theory, mental structures and processes, including structural types of knowledge, are subsumed under the roof concept of ‘Π-domain’ (cf. Rehbein 2017).
- 55.
Cf. Hartog (2017).
- 56.
For the morphematic realisation of the modes of prompting in discourse, cf. the discussion of excerpt (E5) above, end of section 5.8.
- 57.
Cf. Rehbein (2013) for a discussion of this concept.
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Rehbein, J. (2020). Multilingual Counselling in Preventive Healthcare. In: Hohenstein, C., Lévy-Tödter, M. (eds) Multilingual Healthcare. FOM-Edition(). Springer Gabler, Wiesbaden. https://doi.org/10.1007/978-3-658-27120-6_5
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