PETERSO N, C. 684
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998
Pe t e rso n p re se n t s co m p e llin g e xa m p le s o f t h e m ean in g an d th e con stru ction s of m ed ical sla n g in Rio d e Ja n eiro, a n d d escrib es th e n ew m ea n -in gs p h ysic ia n s c re a t e fo r (a n d c o m m u n ic a t e a b o u t ) t h e ir h e a lt h c a re syst e m t h ro u gh t h e ir u se o f m ed ica l sla n g. Bu t h e m a kes u n co n vin c-in g a t t e m p t s t o d iffe re n t ia t e h is st u d y fr o m o t h e rs (p a rt icu la rly a st u d y b y Go rd o n in Ca lifo r n ia ), a n d so m e t im e s m ove s t o o q u ickly b e -twe e n d e scrip tio n s o f m e ta p h o r, sla n g, ja rgo n , p rove r b s, p u n s, a n d jo ke s. Th is is a t o n c e a p le a sin g a n d p ro b le m a tic p a p e r, e sp e cia lly fo r a m e d ica l a n t h ro p o lo gist wit h lit t le fo rm a l so -cio lin gu istic tra in in g.
Pe t e r so n co n t r a st s su b st it u t ive, co m p a ra -tive, a n d in tera ctive exp la n a tio n s o f m eta p h o r, a n d m a ke s a co n vin cin g ca se fo r t h e u t ilit y o f th e th ird ca tego r y. He p resen ts o n ly a sketch o f th e Bra zilia n h ea lth system cr isis, b u t h e m a kes a p p r o p r ia t e a n d c o n vin c in g re fe re n c e s t o a co n text o f h o rro r a n d m o ra l ch a llen ge, a n d th e d evelo p m en t a n d u se o f m ed ica l sla n g to m a n -ifest a n d co n fro n t (o r wo rsen ) th a t co n text. On t h e o t h e r h a n d , h is a t t e m p t s t o c o m p a re h is stu d y with on e from Californ ia on h osp ital jokes (Go rd o n , 1983) a re le ss co n vin cin g. He co n t ra st s h is b ro a d e r wit h Go rd o n’s n a r rowe r fo -cu s, t h o u gh it is n o t cle a r t h a t Go rd o n so u gh t t o re p re se n t a n yt h in g o t h e r t h a n o n e sp e cific t yp e o f jo ke. He a lso cr it iq u e s Go rd o n’s a t t e n -t io n -t o ra p p o r -t a m o n g p r o fe ssio n a ls a n d d is-ta n ce fro m p a tien ts, p referrin g in stea d h is own a tten tio n to th e crea tio n o f m ea n in g. Bu t wh ile Peterson d oes atten d to m ean in g, h e also p o sits a m ech a n ism of socia l cr itiq u e th a t lin ks a con -t e x-t o f h o r r o r -t o -t h e c re a -t io n a n d u se o f p u n s b y d o ct o r s. So is it t h a t Pe t e r so n d islike s Go r -d o n’s la ck o f a t t e n t io n t o m e a n in g, o r is it t h a t Go rd o n e m p loys a d iffe re n t fu n ct io n a l m o d e l? Or b o t h ? Pe t e r so n la t e r e xp la in s t h a t h e p a ys m o st a tte n tio n to th e th ird o f h is th re e th e m e s (m e d ica l sp e cia lt y, p a t ie n t s, h e a lt h ca re se r v-ic e s) b e c a u se t h is is a n a re a m o re re le va n t t o t h e c r isis. He c h o o se s h is own e xa m p le s fo r wh a t , a s m u ch a s h ow, t h e y co m m u n ica t e. Fi-n a lly, Peterso Fi-n writes th a t Go rd o Fi-n d ra ws “cu ri-ou s con clu sion s.” Th is cr it iq u e se e m s t o m e t o rest la rgely o n a m isrep resen ta tio n o f th e wo rd ‘c la im ,’ a s e q u iva le n t t o t h e ve r b ‘t o d e m a n d ’ ra t h e r t h a n t h e a lso a c c e p t a b le ‘t o re q u ire’ (co n tra ry to Peterso n’s con clu sion , in th is la tter se n se co m a t o se p a t ie n t s ca n re a d ily cla im a t -ten tio n ).
Bu t u n d e r n e a t h t h is I a m c o n fu se d a b o u t t h e r o le o f t h is c r it iq u e in t h e a r t ic le it se lf: with ou t d efen d in g Go rd on I won d ered wh y Pe-cia n s, ju st a s t h e re a re fo r p a t ie n t s, b u t h a rd ly
a n y a t a ll fo r in stitu tio n s.
I wa s th erefo re in terested to see th a t Dr. Peterson focu ses, correctly I th in k, on th e b u rea u -c ra t iza t io n o f h e a lt h -c a re, a n d re a d s m u -c h o f Ca r io ca m e d ica l sla n g t o b e a re sp o n se t o t h is p rocess. Th e a ltern a tive th a t h a s b een exp lored e xt e n sive ly b y p h ysic ia n s a n d m e d ic a l so c ia l scie n t ist s o f a m o re Ma r xist b e n t is t h e ‘p ro le -ta ria n iza tio n’ o f p h ysicia n s, a p ro cess in wh ich p h ysicia n s in cre a sin gly fin d t h e m se lve s se r v-in g as em p loyees of d e facto p rofit-m akv-in g h o s-p it a ls a n d ‘m a n a ge d ca re’ co rs-p o ra t io n s. In t h e m id - 1980s jo u r n a ls su ch a s Th e In t ern a t ion a l Jou rn a l of Hea lt h Serv ices Resea rch we re in -fla m ed with a n gr y a n a lyses o f Ma rxist sch o la rs wh o re a d in t o t h is p r o c e ss t h e c o m m o d ific a t io n o f ‘c a re’ t h e c o n ve r sio n o f a h u m a n re la -t io n sh ip in -t o a re ifie d ‘-t h in g’ -t h a -t is p ro d u ce d , m e a su re d , wit h h e ld , o r so ld in a st r ic t ly e c o -n o m ic m o d el.
Dr. Pe t e rso n su gge st s, a s I re a d h im , t h a t a m o re n u a n ced view o f th e recen t h isto ry o f th e p o lit ica l e co n o m y o f h e a lt h ca re is n e ce ssa r y. Aft e r a ll, p h ysic ia n s h a ve lo n g wo rke d a s e m -p loye e s o f in st it u t io n s, a n d t h e y a re st ill fa r fro m b e in g t re a t e d a s h o u r ly wa ge la b o re r s. Ra th er, wh a t h a s ch a n ged in th e circu m sta n ces o f p h ysicia n wo rk is t h e e xt ra o rd in a r y le ve l o f b u re a u cra t iza t io n it h a s u n d e rgo n e, a t le a st in t h e Un it e d St a t e s a n d , a p p a re n t ly, in Bra zil. I d o n ot h a ve th e sp a ce in a b r ief co m m en ta ry to d e ve lo p t h is p o in t in d e t a il, b u t sin ce it is n o t th e exp licit focu s of Dr. Peterso n’s a rticle I wa n t t o d ra w a t t e n t io n t o t h e re le va n ce o f h is a rgu -m en t fo r a n o n go in g d eb a te in th e so cio lo gy o f m e d icin e. Wh ile h is Bra zilia n e xa m p le h a s fa s-c in a t in g d iffe re n s-c e s fr o m t h e U S s-c a se s wit h wh ich I a m m o st fa m ilia r, t h e re a re im p o r t a n t sim ila r it ie s t h a t m a ke h is a r t ic le a sign ific a n t co n trib u tio n to th is d eb a te a s well.
I sh o u ld a lso n o t e t h a t t h is co m m e n t a r y is b e in g wr it t e n wh ile I a m t ra ve lin g, a n d d o n o t h a ve a c c e ss t o t h e u su a l sc h o la r ly m a t e r ia ls th a t I wo u ld wa n t to co n su lt; I a p o lo gize to Dr. Peterso n a n d o th er a u th o rs if m y m em o ry fa ils m e a t o n e o r t wo p o in t s in m y d is c u s s io n o f th eir wo rk.
An t h rop ology Progra m Trin it y College Ha rt ford , CT, U SA.
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’.
