Page 268 - Handbooks of Applied Linguistics Communication Competence Language and Communication Problems Practical Solutions

246 Celia Roberts

backgrounds. This may be the explanation but there are other reasons to do with
“professional culture”, individual differences, etc. which may account for dif-
ferences (Auer and Kern 2000).
It is important to bear these arguments in mind when discussing the litera-
ture on health beliefs from medical anthropology. The significance of this ap-
proach in professional–patient consultations lies in the potential for misunder-
standings when different explanatory models of illness, which patients bring to
the encounter, clash with the diagnosis and explanation of the disease from the
professional’s perspective. Much of the early medical anthropology literature
focused on non-western health beliefs and more recent studies have used this
perspective to examine issues of cultural diversity in western healthcare settings
(Kleinman 1988; Helman 1994), and in relation to mental illness (Rack 1991).
These health beliefs may affect how the body is conceptualized, what is re-
garded as healthy and what causes disease and appropriate responses to it.
Studies by medical anthropologists have also discussed different ways in which
patients from different cultural backgrounds may present their symptoms, some
highlighting objective signs and others the emotional or psychological aspects
(Helman 1994). Another aspect of the cultural and linguistic relativity of health
beliefs concerns pain and how it is responded to and expressed. Healthcare be-
liefs are also affected by different experiences of healthcare systems and this
may affect practical issues such as adherence to treatment (Henley and Schott
1999). The culturally specific beliefs that patients bring to a consultation enter
into the discourse of the encounter and cannot be ignored in a narrowly lin-
guistic analysis. However, medical anthropology has not focused on the discur-
sive and interactional aspects of the consultation (but see Manderson and Allo-
tey 2003 for an exception). So, illuminating though this literature is, it tends to
conceive of health beliefs as static sets of assumptions rather than active dis-
courses which may be called up or not and which are mediated through different
styles of self presentation. In contrast to much of the anthropological literature,
recent studies in the UK suggest that patients from diverse backgrounds tend to
use western medical models in their consultations with mainstream health pro-
fessionals (Bhopal 1986).
Rather than fixed health beliefs, it is the discourse styles of relating to, and
representing illness to the health professional that tend to make cultural issues
relevant in the consultation (Anderson, Elfert and Lai 1989). As Pauwels (1991,
1994) indicates in her discussion of training health workers in Australia, broad
differences in health beliefs were more readily available for comment than dis-
course and rhetorical features. So there is a tendency to focus on beliefs because
they are easier to talk about than on ways of talking and interacting which are
more hidden and require more technical understanding.