Linguistic theory and medical care: Sapir and Whorf join rounds in the ICU
It’s common sense that language and thought are closely related. For example, any politician knows the words one uses to describe something can profoundly affect how listeners understand and react to what they hear. Some think it goes deeper than that. An old theory of linguistics, the Sapir-Whorf hypothesis, has been batted around since the mid-20th century. This notion, named for Edward Sapir and his student, Benjamin Whorf, proposed that language actually controls thought, how we regard the world. Their argument was that we think using language, and thus the idiosyncrasies of our language determine how we think. The theory implies there are some things two native speakers of different languages cannot fully explain to each other or even completely understand. In its purer form the hypothesis is not that highly regarded these days among experts, but in its more rudimentary form the notion makes considerable sense to me. You can read more about the linguistic pros and cons of Sapir-Whorf many places, such as here, here, and here. Here is a nice PowerPoint presentation of its basic tenets. George Orwell’s 1984 is a powerful expression of the way whoever controls language can control thought. Today’s seemingly endless debates about “political correctness,” which generally seem silly to me, are getting at the same notion.
Yet language really does matter. I think that, over time, the words we physicians use to describe patients to each other, to interview patients and their families, and to explain treatments and therapies have importance far beyond the particular encounter. Our words have a cumulative impact on us, on our own attitudes and feelings. It is important to be empathetic and respectful not just because that is the correct way to behave to our patients, but also because it is the most caring way to nurture ourselves.
The intensive care unit is a place that can harden you. You hear it all around you in the language people use to describe patients and families. There can be a compulsion to sound hard-boiled and savvy. This easily degenerates into cynicism. Much has been written about the burn-out rate of people who work in the ICU environment. I think a portion of the burn-out relates to the language we use. After practicing critical care for 35 years I don’t think I’m in any danger anymore of experiencing burn-out. I also think one way we can at least partially inoculate ourselves against that possibility is to be careful of how we speak to each other, to our patients, and to their families.