A tyranny of nouns

[摘要] You may not have considered this before, but doctors are inordinately fond of nouns. We keep and curate mental lists of them: the seven causes of a particular presentation or the key features of this or that disease. We think about patterns of illness as though they are concrete things with their own independent existence, although we’d struggle to put acute pancreatitis or depression into a pathology jar.We talk about the different aspects of ourselves — organs, limbs, emotions — in the same way: all nouns. We may tell one patient that their bladder has an infection that can be treated with antibiotics, and another that their personality has mood instability that can be treated with anticonvulsants, as if we were rearranging the flaps in a children’s book to combine the astronaut’s head with the lumberjack’s trunk and the diver’s legs.All of this may seem obvious and unremarkable, but it testifies to a reductionist way of thinking about ourselves: the body, like a machine, is made of components that malfunction and wear out, and as with a machine they can be fixed, replaced, or removed; but there is nothing else, no ghost in the machine, no whole that is more than just the sum of its parts.NOUNS ARE GOOD AT COMMUNICATING INFORMATION, BUT NOT CONTEXT By and large, patients come to us not just with nouns, but also with stories: these include nouns, but are driven along by verbs — words of action, backed up by adverbs, pronouns, and so on. Our professional ear filters these out or translates them into drier terms. Yes, Mrs Jones, I understand that your lungs feel like they’re full of treacle, but let’s stick to the facts: a week of cough with sputum but no blood, you said. Any chest pain? It’s practical: you can see why German still capitalises its nouns.On the odd occasion when patients lead with their nouns, though, it jars: ‘It’s the pain, doc, it’s making my insomnia worse, and the anxiety’s really kicking off.’ Does this really tell us what we need to know? The instinctive response is to reach for more nouns: medication, therapy, a fit note. After a while it starts to feel just a little impersonal and repetitive, clichéd even. The reason is that nouns are good at communicating information, but not context. Back pain secondary to overuse is succinct but limited: ‘You’ve been overdoing it in the garden and because your back isn’t used to all the movement, the muscles are tensing up to try to protect it and the nerves are listening out for anything that might be about to go wrong’ is far more meaningful.

[学科分类] 卫生学