MEDICAL SLANG 685
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998 t e rso n ch o se t o m a ke t h e se so m e t im e s fo rce d
com p arison s rath er th an lettin g h is work ‘sp eak fo r it se lf?’ Is Go rd o n t h e o n ly a va ila b le re p re -se n t a t ive o f a su b st it u t ive vie w o f m e d ic a l m e t a p h o r s? I wo u ld h a ve like d t o h a ve re a d fe we r critiq u e s o f Go rd o n , a n d m o re e xte n sive a n a lysis, fo r e xa m p le , o f t h e sim ila r it y in im -a gery b etween th e em -a scu l-a tion of th e m ed ic-a l st a ff (e xp re sse d t h r o u gh t h e t e r m escu lh a m -b in a) a n d t h e e m a sc u la t io n o f p a t ie n t s (e x-p ressed th ro u gh th e term p oliescu lh am bad o).
I re gre t t h a t Pe t e rso n so m e t im e s u se s la n gu a ge to d ista n ce ra th e r th a n in fo rm th e re a d -e r. Wh a t , fo r -e xa m p l-e, is t h -e r-e a d -e r t o m a k-e o f th is sen ten ce: “Med ical slan g is th u s essen tially con n otative, to th e exten t th at th e sign ifican t el-em en t is th e u se of th e lin gu istic register p er se?” Is t h is t h e sa m e a s sa yin g, ‘Me d ica l sla n g b a si-ca lly h e lp s t o co n ve y n e w m e a n in gs, b a se d o n it s u se o f wo rd s a lre a d y in c irc u la t io n ?’ An d wh y u se t e rm s like ch ia sm a s, ca t a ch re sis, a n d p a ro n o m a stic tra n sfo rm a tio n o r p a ro n o m a stic in t e ra ct io n wit h o u t d e fin in g t h e m ? Th e se a re d isco n certin g p a rts o f a n a rticle th a t p a ys su ch clo se a tten tio n to wo rd s th em selves.
Wh ile t h e o p e n in g is a t o n c e fo rc e fu l a n d p la yfu l, I a m so r r y t h a t Pe t e r so n d o e s n o t fo l-low t h r o u gh wit h h is p r o m ise “t o ret u rn t o qu estion s raised by th e clav icle...”. Th e co n clu -sio n in vo kin g m e t a p h o r s o f ke ys a n d fu m e s m igh t h a ve b e e n m o re p owe r fu l h a d it re in fo rced m o re sp ecifica lly th e lin ks b etween eth -ica l ch a lle n ge, d a ily p ra ct ice, a n d p h ysicia n s’ p u n s.
Desp ite th ese criticism s, it is still a p lea su re to see (well, to rea d ) th is a tten tion p a id to wh a t (a n d h ow) we m e a n . Pe t e r so n o ffe r s m a n y id ea s fo r a d d itio n a l wo rk o n th e to p ic, in Bra zil a n d elsewh ere.
In st it u t o Fern a n d es Figu eira , Fiocru z , Rio d e Ja n eiro, Bra sil. Su ely Ferreira Desla n d es
Th e a r t icle ‘Tram biclín icas, p ilan t róp icos,a n d
m u la m b u la t órios: Me d ic a l sla n g in Rio d e Ja -n e ir o, Bra zil’, i-n ke e p i-n g wit h it s -n u m e r o u s m e t a p h o r ica l e xa m p le s is I.I.I (In q u isit ive, In -stiga tin g, a n d In d o cile, in th e b e st se n se o f th e wo rd ). I b e lie ve it a llows fo r t wo re a d in gs, wh ic h I d e sc r ib e b e low a n d in b o t h o f wh ic h (a s v ersion s) I se e p e r t in e n c e a n d le git im a c y. Th e fir st fo c u se s o n t h e sc ie n t ific c o n c a t e n a -tio n p ro p o se d b y th e stu d y. Th e se co n d b e gin s wit h t h e st u d y’s p r o p o sa l a s a st im u lu s fo r id ea s a n d d ia lo gu e.
A ‘clo sed’ readin g
Th e p a p e r b e gin s wit h a h yp ot h esist h a t co u ld b e su m m a r ize d , wit h u n a vo id a b le lo ss, a s fo l-lowin g: scie n t ific a n d d e o n t o lo gica l d isco u rs-e s, a lb rs-e it co n st it u t ivrs-e, a rrs-e in su fficirs-e n t t o rs-e x-p ress th e totality of m ed ical eth os. Accord in g to t h e a u t h o r, a n o t h e r se m a n t ic fie ld , ‘m e d ica l sla n g’, a d ifficu lt t e r m t o t ra n sla t e [in t o Po r -tu gu ese], is cap ab le of exp ressin g th is eth os in a less orth od ox an d m ore sen sitive way. From th e on set th e a u th or ch a llen ges th e fa m ilia r n otion th a t th is typ e o f m e ta p h o r ica l re co u rse is u se d t o m a in t a in a d ist a n ce b e t we e n p h ysicia n a n d p a tien t (a ro le p la yed b etter by m ed ica l ja rgo n ) or as a m ean s to relax from ten sion exp erien ced in t h e m e d ica l wo rk p ro ce ss (m o re co m m o n ly d e a lt wit h b y co n ve r sa t io n o n se x, fo o t b a ll, e t c.). Fin a lly, h e co n t e n d s t h a t ‘m e d ica l sla n g’ crea tes n ew m ea n in gs in th e rela tio n s b etween p h ysicia n s, b e t we e n p h ysicia n a n d p a t ie n t , in t h e a cq u isit io n o f n e w kn owle d ge, a n d in t h e p h ysicia n’s re la t io n sh ip t o t h e h e a lt h ca re sys-tem itself. He th u s assu m es th at m etap h ors will b e re a d n o t a s ‘su b stitu tio n’ o r ‘co m p a riso n’ o f m ea n in gs b u t a s crea tive ‘in tera ctio n’.
PETERSO N, C. 686
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998
Th e m ed ica l eth os is situ a ted in a con text of p a ra d igm a tic tra n sitio n a n d rewritten in a sce-n a rio o f “d ep rofession aliz ation” a n d “h yp ercri-sis” in t h e Bra zilia n h e a lt h syst e m . Th e a u t h o r t h u s p e rce ive s t h e ch a lle n ge ra ise d a s fo llows by Bo u rd ieu (1996:24) [tra n sla ted h ere fro m th e Po rtu gu e se ve rsio n in to En glish ]: “(...) lin gu is-tic com p eten ce p er se, d efin ed abstractly, ou tsid e of everyth in g to w h ich it ow es th e social con d i-t ion s of ii-t s p rod u ci-t ion , a i-t i-t em p i-t s i-t o d ea l w ii-t h d iscou rse in a ll it s con ju n ct u ra l sin gu la rit y. In fact, as lon g as lin gu ists ign ore th e con stitu tiv e lim its of th eir scien ce, th ey h ave n o oth er alter-n ative bu t to seek d esp erately ialter-n laalter-n gu age w h at is in scribed in th e social relation s w ith in w h ich it fu n ction s, or to p erform sociology (w ith ou t re-aliz in g it), th at is, ru n n in g th e risk of d iscover-in g iscover-in gram m ar itself w h at sp on tan eou s sociol-ogy im p orted u n con sciou sly for itself.”
Still, in th is a rticle, th e ‘socia l con d ition s for t h e p ro d u ct io n’ o f ‘m e d ica l sla n g’ ca n a lso b e re a d a s a b a c kd r o p o r fra m e fo r t h e m a n y e x-a m p le s q u o t e d . Wh x-a t x-a re t h e re lx-a t io n s (e t h icx-a l a n d so c io e c o n o c u lt u r a l) in t h is b r o a d sc e n a r io o f h yp e rc r isis t h a t a llow fo r t h e e m e r -ge n c e a n d p e r sist e n c e o f t ra m b iclín ica s, p i-lan tróp icos, an d Em brom ed s? Are th ey th e sa m e a s th o se th a t tra ce th e m e a n in g o f th e m u lam -b u la t órios? Are t h e y t h e sa m e a s t h o se sh e d -d in g ligh t o n t h e a ct o f la b e lin g p o o r p a t ie n t s a s m u la m b os o r est rop ícios? To d e m a rc a t e a ve r y b ro a d b a ckd ro p p rovid e s a sa fe, ye t n o n -sp ecific, a n ch or.
In fa ct, th e a rticle n eith er p ro m ises n o r a n -n ou -n ces su ch a-n exercise, a role p rop er to a so-ciological or h istorical an alysis. How, th en , d oes on e situ ate th e m ed ical eth os, wh ich on e m igh t su p p ose h as ch an ged over th ese last 20 years of o b se r va t io n ? Or m o re d ire ct ly, wh a t d o t h e se m a n y m e t a p h o r ica l e xa m p le s ‘m e a n’ [q u erem d iz er, lit e ra lly “wa n t t o sa y” in Po r t u gu e se – Tra n sla to r’s n o te] fro m th e p o in t o f view o f th is m e d ica l e t h o s? Wh a t is ‘re ve a le d ’ in t h is e t h o s wh en th e p h ysician u ses th e m etap h ors JEC(for “Je su s is ca llin g”), DPP(“le a ve h e r fo r t h e n e xt sh ift”) t o d e sign a t e re fu sa l t o t re a t so m e p a -t ie n -t s o r wh e n o -t h e rs a re re fe rre d -t o a s t ru bu -fu , p im b a , m u la m b o, est rop ício?Th e jo c o se t e r m s, a cco rd in g t o t h e a u t h o r, a re a sso cia t e d wit h d isc r im in a t io n o f a n e t h n ic (fo r b la c ks), a esth etic (for th e ob ese), or socioecon om ic n a -tu re (fo r th e p o o r), o r e ve n with th e se ve rity o f th e clin ica l sta te (p oliescu lh am bad os). In a d d i-t io n , b a se d o n su c h vivid e xa m p le s, wh a i-t c a n b e sa id a b ou t th e p h ysicia n p h ysicia n rela tio n -sh ip it se lf? D o e s c a llin g a m e d ic a l st u d e n t a ‘b u llh e a d ’ (a n u gly lit t le fish t h a t live s in t h e d e e p e st, d a rke st rive r b o tto m ) a llow o n e to in
-fer th a t m ed ica l tra in in g h a s a very stron g h ier-a rch icier-a l sen se o r th ier-a t th e stu d en t go es th ro u gh a r it u a l m o m e n t o f in it ia t io n (a “r it e o f p a s-sa ge”) o f wh ich h u m ilia t io n is a p a r t ? To t re a t p a tie n ts th ro u gh a h e a lth ca re p la n ca lle d Em -brom edd esign a tes a very d ifferen t rela tion sh ip b e t we e n t h e p h ysicia n a n d t h e h e a lt h ca re in -stitu tio n th a n th o se in vo lved in th e lo gic o f th e
Pafú n ciop la n .
In t h e a r t ic le , t h e n u m e r o u s e xa m p le s a re p re se n t t o ge t h e r wit h a ra w r ich n e ss, b e a r in g im p licit relation s with d ifferen t m ean in gs (b o th a ttrib u te d a n d so cia lly e xp e rie n ce d ), co m p ris-in g a vivid a n d ris-in st iga t ris-in g m o sa ic . Th e t e xt m igh t p e r h a p s b e n e fit fr o m a le ss d e scr ip t ive st a n c e , wit h in fe re n t ia l h yp o t h e se s e n c o m p a ssin g t h e n a r r a t ive a n d d ist in gu ish in g b e -tween th e o rigin s o f th e va rio u s term s.
Wo u ld it b e in c o r re c t t o im a gin e t h a t t h e m e d ica l e t h o s is a ct u a lize d in m u lt ip le fa ce t s, ga in in g sp e c ific it y in it s va r io u s in st it u t io n a l cu ltu res (th e em ergen cy wa rd , m a tern ity wa rd , o u t p a t ie n t clin ic, e t c.)? In t h e p u b lic se ct o r a s co m p a re d t o t h e p r iva t e ? Ba se d o n p re va ilin g wo r kin g c o n d it io n s? Ba se d o n h ie ra rc h ic a l con d ition s?
A se co n d e xp e cta tio n wo u ld b e th a t o f p e r-c e ivin g h o w “m e d ir-c a l sla n g”, in t h e fo r m o f p roverb s, p u n s, jokes, an d jests, u sin g m etap h or-ica l in t e ra ct io n , cre a t e s n e w m e a n in gs fo r t h e p h ysicia n -p a tien t rela tio n sh ip, m ed ica l kn owl-e d gowl-e , a n d h owl-e a lt h c a rowl-e in st it u t io n s. In a n owl-e x-ce r p t fro m p a ge 14 o f t h e m a n u scr ip t : “(...) In th e case of Carioca m ed ical slan g, it w ou ld be as if ca llin g t h e p a t ien t a m u la m b o cou ld b e re-d u cere-d to a literal tran slation ’raggere-d , p oor, an re-d black ’ sk irtin g th e in teraction s of th e m etap h or w it h t h e p h ysicia n’s ow n socioecon om ic a n d cu lt u ra l w orld (a ccord in g t o t h e in t era ct iv e v iew , m et a p h or d oes n ot m erely ex p ress a n ex -ist in g m ea n in g; on t h e con t ra ry, it crea t es n ew m ea n in g). Th u s, t h e m et a p h or m u la m b o d oes n ot m erely ex p ress socia l ex clu sion , it h elp s t o crea t e it .” In a n o t h e r e xce r p t , fro m p a ge 16 o f t h e m a n u sc r ip t : “Mu la m b u la t ó r io is a p u n form ed by m u la m b o, m ean in g ‘rag’, in corp orat-ed in t o t h e Port u gu ese la n gu a ge from Qu im -b o n d o, a Ba n t u la n gu a ge, a n d u sed h ere m etap h orically as ‘beggar’, p lu s a m b u la tó rio, or ‘ou t p a t ien t d ep a rt m en t ’. An in t era ct iv e in t er-p ret a t ion of t h is er-p u n /m et a er-p h or su ggest s t h a t su ch a n ou t p a t ien t clin ic n ot on ly t rea t s t h e
MEDICAL SLANG 687
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998 is on e th in g, wh ile to crea te exclu sion is a n oth
e r. Or is t h e re a m e d ia t io n b e t we e n e n u n cia t -in g a n d c o n st it u t -in g re a lit y? By e n u n c ia t -in g d o es o n e n o t en u n cia te wh a t is a lrea d y co n sti-t u sti-t e d , a lb e isti-t ssti-t ill n o sti-t re ve a le d o r visib le ? Wh a sti-t re la t io n sh ip d o e s t h e a u t h o r se e b e t we e n t h e wo rd a n d t h e t h in g,t h e“sym b olic effica cy of con stitu tin g reality”? Th is wo u ld b e a rich fie ld fo r fu r t h e r e xp lo ra t io n b y Pe t e r so n’s t a le n t , sin ce it is th e p a p er’s cen tra l h yp o th esis.
An ‘o pen’ readin g
Th e p a p e r is b a se d o n a p rop osa lwh ich co u ld b e su m m e d u p a s fo llows, wit h t h e a d va n t a ge o f a d d in g a n o t h e r re a d in g t o it : t h e sc ie n t ific a n d d eo n to lo gica l d isco u rses, a lth o u gh co n sti-t u sti-t ive, a re n o sti-t su fficie n sti-t sti-t o e xp re ss sti-t h e sti-t o sti-t a listi-t y o f m e d ic a l e t h o s. Ac c o rd in g t o t h e p r o p o sa l, a n oth er sem a n tic field (a m on gst oth ers n ot cit -e d ), t h a t o f ‘m -e d ic a l sla n g’, is c a p a b l-e o f -e x-p ressin g th is eth os in a less or th o d ox a n d m o re se n sit ive wa y, wh ile a lso se r vin g a s o n e o f it s fie ld s fo r cre a t in g n e w m e a n in gs. Th a t is, t h is e t h o s is e xp re sse d in t h e re la t io n s b e t we e n p h ysic ia n s t h e m se lve s, p h ysic ia n s a n d p a -tien ts, in th e a cq u isitio n o f n ew clin ica l kn owl-e d gowl-e, a n d in th owl-e rowl-e la tio n sh ip to th owl-e h owl-e a lth sys-tem itself.
Ba se d o n t h is in ve st iga t ive wa ge r, t h e irre d u c ib le c o n flic t b e t we e n t h e c o n t e xt o f m e d -ica l ‘d e p ro fe ssio n a liza tio n’; th e d ism a n tlin g o f h e a lt h ca re se r vice s a n d t h e h e a lt h ‘u t o p ia’ (in t h e se n se o f a gu id in g se t o f id e a ls); la ck o f re -so u rc e s; a n d a ggra va t io n o f -so c ia l in iq u it ie s, fa r fro m c o n st it u t in g a m e re b a ck d rop, h olo-gra m m a t ica llyp e r m e a t e s t h e d a ily ro u t in e o f t h e se p ro fe ssio n a ls a n d t h e m e d ica l e t h o s. It s field of sp ecificity for ea ch con crete socia l rela t io n sh ip (p h ysicia n p h ysicia n , p h ysicia n p a -t ie n -t , in -t h e a cq u isi-t io n o f n e w clin ica l kn owle d gowle , a n d vis à vis t h owle h owle a lt h c a rowle syst owle m it se lf ) n e e d s t o b e d e t a ile d in a p p ro p ria t e st u d -ie s a n d in a cre a tive wa y, to d ra w o u t d a ily life, e xp e r ie n ce d circu m st a n ce s, a n d t h e m a rks o f u se , a s d e sc r ib e d b y Ce r t a u (1994:82), [t ra n s-la te d fro m th e Po rtu gu e se ve rsio n in to En glish – T. n .] “(...)th e w ays by w h ich u ten sils, p roverbs, or oth er d iscou rses are m ark ed by u ses; p resen t-in g for an alysis th e m ark s of acts or p rocesses of en u n ciation (...) in a broad er w ay, th u s in d icatin g a social h istoricity icatin w h ich rep resen tation -al system s or con stru ctive p roced u res n o lon ger ap p ear m erely as n orm ative fram es, bu t as tools th at can be m an ip u lated by u sers”.
Th e co n stitu tio n o f n e w m e a n in gs th u s o c-c u r s in a m e t a p h o r ic-c a l fie ld , o f lin gu ist ic-c e x-c h a n ge s, a s in a fie ld o f so x-c ia l e xx-c h a n ge s, o f
c o n flic t , o f t h e se a rc h fo r p re st ige a n d le git -im iza t io n a m o n gst p e e r s. In o t h e r wo rd s, t h e d isco u rses p ro d u ced by p h ysicia n s fo r p a tien ts a n d h e a lt h ca re in st it u t io n s o ccu r in d iffe re n t co n texts o f exp erien ces a n d b a sed o n a lo gic o f rela tio n sh ip b etween sym b o lic fo rces.
Wh e n t h e p a p e r wo r ks so b e a u t ifu lly wit h t h e m e t a p h o r “Th e ICU is a t ort u re room”, it give s u s a clu e fo r u n d e rst a n d in g t h e cre a t io n o f n e w m e a n in gs, wh e re b y in t h e sym b o lic b in o m ia l ‘to rtu re ro o m / ICU’, to rtu re a d d s m ea in in g to th e ICU, wh ile th e ICU a d d s a ‘th era p eu t ic’ d im e n sio n t o t o r t u re. Is a re ve a lin g re p re -sen ta tio n a l d im en sio n o f th is eth o s in sin u a ted (th e n eed for torm en t an d its legitim acy as th er-a p y in ‘e xt re m e’ cer-a se s)? Wh e n t h e p h ysicier-a n ca lls p u b lic o u t p a t ie n t clin ics m u la m b u la t ó-rios, is h e n o t a t t e m p t in g t o p u sh t h e id e a o f
m u lam bosa wa y from h is own self-im a ge? After a ll, b y ‘t re a t in g’m u lam bos, a n d fa ce d wit h t h e a b so lu t e in a b ilit y t o c h a n ge t h e ir so c ia l a n d h u m a n re a lit y, wo u ld su ch p roxim it y n o t t u r n h im in t o a m u la m b o, t o o ? As t h e a u t h o r su g-gests, th ese a re clavicles/ little keys in a sym b ol-ic a rch eology a s rol-ich a s it is n ecessa r y: va lu a b le su b sid ie s fo r a d iscu ssio n o n t re n d s in h e a lt h eth ics.
BOURDIEU, P., 1996. A Econ om ia d as Trocas Lin gü ís-ticas. Sã o Pa u lo : Ed u sp.
CERTEAU, M., 1994. A In ven ção d o Cotid ian o. As Artes d e Fazer. Petró p o lis: Vozes.
Lan gu age , s o c ial c o n te xt, an d ‘e tym o lo gic al co n scio usn ess’
Befo re m a kin g m y co m m en ts, I sh ou ld sa y th a t I a m n e it h e r a lin gu ist n o r a sp e cia list in jo ke s a n d p u n s. Th u s, wh ile m y o b se r va t io n s re fle ct m y t ra in in g in so c ia l a n t h r o p o lo gy, t h e y m a y re fle c t m o re o f a c o m m o n se n sic a l vie w. Th e y sh ou ld th u s b e rea d a s su ch . Ch ristop h er Peter-so n h a s p u b lish e d a n in te re stin g a r ticle o n th e sla n g, p u n s, a n d jo ke s u se d d a ily b y Ca r io c a p h ysicia n s. Th e su b ject, a s fa r a s I kn ow, h a s re-ce ive d lit t le a t t e n t io n in Bra zil. Th e a rt icle h a s th e en o rm o u s d isa d va n ta ge o f b ein g written in En glish , wh ich h in d e r s d iscu ssio n o f a t h e m e wh ich is lin ked to wh a t a re so often u n tra n sla
t-Sérgio Ca rra ra
