Recorded on April 9, 2026, this Authors Meet Critics panel features the book Incommunicable: Toward Communicative Justice in Health and Medicine, by Charles Briggs, the Alan Dundes Distinguished Professor and Distinguished Professor of Anthropology at UC Berkeley, co-director and graduate advisor of the UCB-UCSF Joint PhD Program in Medical Anthropology, and co-director of the Berkeley Center for Social Medicine.

Professor Briggs was joined in conversation by Elinor Ochs, Distinguished Research Professor of Anthropology at UCLA, and Eric Snoey, Department of Emergency Medicine, Alameda Health System at Highland Hospital and Clinical Professor in Emergency Medicine at the UCSF School of Medicine. Armando Lara-Millán, Associate Professor in the Department of Sociology, moderated.

The panel was co-sponsored by the UC Berkeley Department of Anthropology, the UC Berkeley School of Public Health, the Berkeley Center for Social Medicine, and the Center for Science, Technology, Medicine & Society.

About the Book

In Incommunicable, Charles L. Briggs examines the long-standing presumptions that medical discourse translates easily across geographic, racial, and class boundaries. Bringing linguistic and medical anthropology into conversation with Black and decolonial theory, he theorizes the failure in health communication as incommunicability, which negatively affects all patients, doctors, and healthcare providers. Briggs draws on W. E. B. Du Bois and the work of three philosopher-physicians — John Locke, Frantz Fanon, and Georges Canguilhem — to show how cultural models of communication and health have historically racialized people of color as being incapable of communicating rationally and understanding biomedical concepts.

He outlines incommunicability through a study of COVID-19 discourse, in which health professionals defined the disease based on scientific medical knowledge in ways that reduced varieties of nonprofessional knowledge about COVID-19 to “misinformation” and “conspiracy theories.” This dismissal of nonprofessional knowledge led to a failure of communication that eroded trust in medical expertise. Building on efforts by social movements and coalitions of health professionals and patients to craft more just and equitable futures, Briggs helps imagine health systems and healthcare discourses beyond the oppressive weight of communicability and the stigma of incommunicability.

Podcast and Transcript

Watch the panel above or on YouTube. Or listen to the audio recording via the Matrix Podcast below (or on Apple Podcasts).

(intro music)

[MARION FOURCADE]

Hi, everyone. My name is Marion Fourcade. I am the director of Social Science Matrix.

So we are very pleased today to have an Authors Meet Critics panel on the book Incommunicable: Toward Communicative Justice in Health and Medicine by Charles Briggs, who is Distinguished Professor of Anthropology here at UC Berkeley. The book explores the deep-seated inequalities in how medical knowledge is shared and whose voices are heard, advocating for a new framework of communicative justice within the worlds of health and medicine. And we are extremely lucky to have a panel that brings together outstanding social scientists and a veteran emergency medicine practitioner from Oakland’s public hospital.

So the format of this panel will be a little bit more conversational than usual, which I am sure will do us good because we’re sort of used to the sort of stiff, you know, presentations after one another. But, you know, that might be\u2014 hopefully, we will have more of a conversational format. Today’s event is part of our Authors Meet Critics series, and it is co-sponsored by the Berkeley Center for Social Medicine, the School of Public Health, the Center for Science, Technology, Medicine, and Society, and the UC Berkeley Department of Anthropology.

Now, as you know, before I turn it over to our panelists, let me briefly mention our upcoming events for the rest of the spring here at Social Science Matrix. We’ve had a very busy few days with three events in a row, so next week we’re taking a bit of a break, and then our next event is going to be on April 21, with Simone Zhang from NYU, presenting on scoring algorithms in the criminal justice system. Then we will have two book panels on books by Berkeley author Cristina Mora and Tianna Paschel on April 29th and on May 5th, computer scientist Benjamin Recht.

Now let me go back and introduce our moderator, Armando Lara-Millán. Armando is an associate professor in the departments of sociology.

Uh, he earned his PhD from Northwestern University and is a former Robert Wood Johnson Foundation scholar. His first book, titled Redistributing the Poor, came out in 2021, an ethnography-based political economy of American public hospitals and county jails. The book won the American Sociological Association’s 2022 Distinguished Scholarly Book Award and spawned articles in several top sociology journals.

Armando is now at work on two major projects. The first examines runaway US healthcare spending, arguing that rising costs are driven not by skill-intensive sectors, but by institutions, knowledge, cultures, and rent-seeking. And then the second book—not just one— another one right away.

The Firm That Predicted the Future argues that five dynamics long mistaken for permanent features of globalization: cheap Chinese labor, high growth tech, cheap energy, falling corporate taxes, and performative monetary policy were historically contingent and are now rapid-rapidly unwinding, offering a framework for making sense of our supposed polycrisis. So without further ado, let me now turn it over to Armando.

[ARMANDO]

Thank you, Marion. I didn’t know you were going to go into all that future work. I appreciate that.

I’m really excited today. I’ve been looking forward to this all semester. It’s a pleasure to be on this panel with Charles, who I’ve been a big fan of for my entire career.

Charles Briggs is the Alan Dundes Distinguished Professor of Anthropology at the University of California, Berkeley here. He’s the co-director of the UCB-UCSF Joint PhD program in Medical Anthropology. He’s written many books, including The Wood Carvers of Córdova, New Mexico; Learning How to Ask, which I still assign; Competence in Performance: Voices of Modernity; Making Health Public; Stories in the Time of Cholera, and Tell Me Why My Children Died; Unlearning: Rethinking Poetics, Pandemics, and the Politics of Knowledge; and now, Incommunicable.

He’s received many awards and honors, including being elected in 2023 as the Fellow of the American Academy of Arts and Sciences. So thank you, Professor Briggs. Elinor Ochs, um- Primary among Professor Ochs’ many research interests is the role of language and culture in lifespan human development and learning across social groups.

Her work with children and the caregivers in Samoa, as well as her collaborative work with anthropologists, B. Schieffelin, helped to develop the field of inquiry known as language socialization. Most recently, Professor Ochs has taken on the direction of the UCLA Center on Everyday Lives of Families, a Sloan Center on Working Families that examines how members of the middle-class working families create a home life through culturally and situationally organized social interactions. Eric Snoey, for the past 35 years, Dr. Snoey has been an emergency medicine physician and core faculty at Highland Hospital just down the road, a teaching and safety net hospital in Oakland, California.

His expertise, his areas of expertise include cardiovascular emergency, the application of point-of-care ultrasound and medical education. More recently, Dr. Snoey has begun to focus more on macro issues and threats to the delivery of emergency health care, ER overcrowding, the problem of over-testing and defensive medicine, budget cuts, predicted workforce shortages, algorithmic triage and AI, and the challenges of end-of-life care. Wow, I would love to talk about all those things.

He has written a series of highly recommended op-eds about some of these issues in the Los Angeles Times. So thank you for joining us, Doctor.

[ERIC SNOEY]

Of course.

[ARMANDO]

Yeah, I appreciate it. Now I’ll pass it over to Charles.

[CHARLES BRIGGS]

Thank you. Well, I was honored to be invited by the Social Science Matrix to discuss Incommunicable. I’m delighted that one of the scholars I admire most, Elinor Ochs is participating.

Finding that my very academic text will be discussed by a practicing physician, emergency medicine physician, Eric Snoey is absolutely perfect, and I thank you, Armando, for moderating. Matrix program manager Sarah Harrington, I thank her for her care in organizing discussion, and communications specialist Chuck Kapelke for generating more emails than I think I’ve ever received for any other event at Berkeley. I must admit, though, that the book talk is my least favorite genre.

Why? Well, first, it feels a little too close to self-marketing, which I absolutely detest. Second of all, I almost never look back at my previous work.

I’m always, you know, looking at what’s coming on the new project that I’m excited about. Finally, how do you summarize a long, complex argument in a short talk? And then as well, my real interest today lies in listening to our distinguished panelists and to all of you.

But Matrix asked me to talk about the book, so I’m pleased to oblige. So, with apologies to Derrida, what I want to do is tell an origin story, an account of how the book came about. So when I met our new anthropology colleague, Randeep Hothi, when he came to Berkeley as a UC President’s Postdoctoral Fellow…

And footnote, the UC President’s Postdoctoral Fellowship program is threatened and one of the most important resources at Berkeley. It’s worth defending. Dr. Hothi mentioned that his mentor at Chicago told him, “Go talk to Briggs.

He’s a wild man. He’s quite undisciplined.” Now, I— when I think about disciplines, I tend to eschew un- or inter- in favor of trans-, which suggests on the one hand that one needs to learn different sub-disciplines or disciplines so well that you know their presuppositions, their methodologies, and that then you can critically engage them in such a way as to potentially dislodge them to come up with new formulations and more creative work.

So for the past four decades, I’ve dug in deeply in fields of inquiry sitting on language on the one hand, and medicine and health on the other. In anthropology, medical and linguistic anthropologists generally inhabit entirely separate analytic frameworks, research practices, curricula, professional organizations, and journals. You can have people who write about the same topic, and there is, from linguistic and medical anthropology, and there’s not a single overlap in their bibliographies.

It’s quite astounding. One strategy, so the wildness in me prompts me to try to break down these walls. One strategy has been ethnographic, including four decades of collaboration, with the Venezuelan indigenous people.

I was there when devastating epidemics of cholera and bat-transmitted rabies emerged. After assisting and stopping the deaths and improving health conditions, Dr. Clara Mantini-Briggs and I asked why diseases that can be so easily controlled and prevented kill so many. We suggested that the co-production of linguistic and medical inequities was crucial.

Now, I will say that friends sometimes tell me they don’t like having me around because whenever I show up, there’s another epidemic. But I knew that through all of this work that something was really missing here. I long wanted to write a theoretical treatise that would rethink the fundamental premises of work on health, medicine, language, and communication.

But I couldn’t force myself to do it because I was sensing that I was still reproducing foundational truths. And, you know, when I don’t feel comfortable pushing ahead with a project, I say, “All right, time to stop and look for a different way to think and write.” So two things helped me with this impasse.

One started with a critical rethinking of European ideologies– Euro-American ideologies of language. So Richard Bauman and I analyzed John Locke’s foundational assertion that language is a separate domain or province, and that its core is communicability. That is, ideally providing a transparent, economical, and stable mechanism for transferring ideas.

Indexicality and performance threaten language by linking it to bodies, affect, and context. The essay constituted a nosology of pathologies of communicability, a diagnosis of their causes, and a program for expunging features that impede perfect communicability, thus creating the linguistic, social, and political order that he tried to promulgate. Locke lodged communicability in whiteness and patriarchy by casting white European, non-disabled elite men as As perfect communicable models.

So women, a few little residual category here, women, working classes, and all the people of Asia and the Americas, he was a stockholder in a slaveholding corporation, so he kind of left Africa out of the map there, were denied the possibility of becoming fully rational, modern, and communicatively competent. So starting in 2005, I analyzed how communicability projected ideological constructions of the circulation of discourse, but also of pathogens. But I had not yet ruptured the foundational separation of language and medicine.

I was trying to put them together, not realizing that I had started off on the wrong foot. Now, I knew that Locke was trained as a physician, but it was Roger Woolhouse’s new biography that made me realize how deeply Locke’s medical training and practice shaped his views on language. So Woolhouse writes that seeing patients with key early modern physician Thomas Sydenham, quote, “completely transformed Locke’s thinking not only about medicine, but about knowledge in general.”” And crafting, therefore, a regime of communicability that became the clinical, atheoretical, observational practice of medicine, which Foucault, of course, called the clinical gaze, and configuring Locke’s claim to have constructed an atheoretical, anti-philosophical approach to language.

A politics of usefulness, to cite Ahmed, enabled Locke to fashion narrow views of language, communication, medicine, health, property, politics, things like that, from the racialized odds and ends of colonialism and turn them into key embodiments of whiteness and markers of modern subjectivity. But Black feminist thought was more crucial here. Hortense Spillers connected slavery’s violent anti-Black legacy as reducing Black flesh to objects whose violent treatment is justified.

She characterizes enslavement as, quote, “a descent into the loss of communicative force.” You could guess why when I reread that, my radar started up. The Denise Silva’s work on enlightenment demands for transparency was also crucial here.

But Savannah Shange uses Spillers in analyzing how gentrification, race, social death, and the afterlives of slavery shape the politics of race and multiculturalism in a San Francisco high school. She suggested that, quote, “Black girl flesh spills forth” in excess of the discourses that attempt to locate it, to know it, to translate its non-communicability.” Another little radar, uh, going off here.

So Shange traces how race enters into the materiality of voices and flesh via complaints that Black girls spoke too loud and too often. Drawing on the work on ethnographic refusal by Audra Simpson and John Jackson. But I, I needed a concept that resonated with Glissant’s right to opacity, the right to refuse to accede to the dominant power’s demand for what he called reductive transparency.

Now, I had long joined other linguistic anthropologists in tracing how racialization and racism require denials of the markers of dominant forms of communicability and the imposition of stigmatized language varieties, usually entirely imaginary, on racialized subjects. Work on linguistic inequity by Jane Hill and others, and work on raciolinguistics, the racing of language, and the languaging of race by Alim, Flores, Rosa, and others, suggested how communicability was relationally defined by projecting the communicative failure of racialized others. But I was left with the feeling that there was a theoretical impasse that was still remaining.

Communicability was still the ontological starting point. Its opposite was still defined as an absence that shored up the hegemony of the communicable dominant. So linking inequities of language in medicine brought me back to a precursor to, I think, one of the most crucial precursors to the study of doctor-patient interaction.

Now, you know who I’m talking about, right? Frantz Fanon. Fanon anticipated work by Miyako Inoue and students of raciolinguistics when he analyzed pidgin, a denigrating register that colonial physicians used to imagine how they believed, inaccurately, that their patients actually spoke.

So to quote him, “Consulting physicians know this. Twenty Europeans come and go. Please have a seat.

Now, what’s the trouble? What can I do for you today? In comes a Black man or an Arab.

Sit down, old fellow. Not feeling good? Well, where is it hurting?

“When it’s not, you not good?” Now, the French edition shows how Fanon anticipated the tu-vous distinction that became important in sociolinguistics as physicians used the formal pronoun with white patients and the familiar subordinate tu with non-whites. Pidgin thus constitutes a racist poetics wherein textualization of formal features saturates the lexical, grammatical, and intonational features with signs of the addressees, not the speakers, but the addressees’ projected communicable incompetence.

Much like contemporary protocols for teaching physicians to communicate better with their patients, Fanon parodically replayed his colleagues’ rationalizations. Quote, or double quotes, “Speaking to Black people in this way is an attempt to reach down to them, to make them feel at ease, to make oneself understood, and to reassure them. Unquote.

Nevertheless, Fanon limited the value of his analyses by suggesting that it did not apply to a non-colonial society. There, he said, “The attitude of the sick man in the presence of the medical practitioner is one of confidence. The patient trusts the doctor.”

Unquote. So developing a notion of what I came to call incommunicability became the eureka moment that enabled me to finally sit down and write this book. It seemed to capture the crucial insight coming from Fanon and Sangari that incommunicability is not a byproduct of communicable failure, but is actively produced by heterogeneous sets of ideologies and practices.

Starting with incommunicability enabled me to dislodge the seemingly universal and primordial position of communicability. The Lockean illusion of communicability, of transparency in Glissant and Silva’s quite different formulations, is manufactured. as a byproduct of incommunicability, right?

So we’re defining communicability vis-à-vis looking at how incommunicability is produced. Now, Locke claimed that the need for his essay was prompted by communicative failure, and the book, once again, provides a nosology of incommunicable pathologies. Shange pushes us ethnographically to analyze how being pushed into a denigrated space of incommunicability can prompt racialized people to inhabit incommunicability, opening up critical perspectives with quite different degrees of explicitness of dominant communicabilities and the ideologies, practices, and infrastructures that hold them in place, refusing communicability’s positioning as the primordial grounds for defining and evaluating subjects, subjectivities, and identities.

Now, an interlude in the book presents four fascinating cases in which people deemed to be incommunicable on the basis of race or sexuality confront profound health inequities by creatively and critically inhabiting spaces of biomedical incommunicability. Then finally, starting with incommunicability enabled me to make the crucial, I think, theoretical move of rejecting communicability as the taken-for-granted starting point, using incommunicability as an alternative analytic. Rather than positing a binary between communicability and its opposite, I tried to turn the tables by repositioning communicability within incommunicability, thereby dislodging communicability from ideological dominance and keeping the racializing force of incommunicability in view.

Now, at this point, I felt a sense of exhilaration and urgency and a strong desire to rethink texts that I had found to be foundational, particularly the work of W.E.B. Du Bois, Georges Canguilhem, and then to see if I could tackle some areas that always struck me as examples of institutions that quintessentially promise entry into communicability, especially for stigmatized populations, even as they constitute factories for the production of incommunicable subjects. One chapter begins—to, begins, I want to emphasize this— begins to explore how the vast literature on doctor-patient interaction and communication promises to create healthier futures by teaching providers and patients alike how to excise incommunicability within clinical settings. Focusing on how medical and communicative inequities are produced in the clinic, I suggest how the centrality of the utilitarian focus of Locke’s foundation for language and medicine might be replaced by a commitment to building communicative justice in health.

I’m very much looking forward to Dr. Snoey’s reactions to this chapter, particularly since I’m thinking strongly about coming up with a systematic collaborative research project that would push this a little further. Having seen up close in Eastern Venezuela how health education can offer a biomedical that promises to offer biomedical enlightenment and modernity comes at the cost of requiring participants to embrace denigrating stereotypes of themselves. So I devoted another chapter to scrutinizing health education components of global health programs.

I wrote the first draft of the book between December 2021 and the following July, living with two wonderful grandchildren, Brielle and Ian, who happen to be here today.

(laughter)

Thanks to Dr. Clara Mantini-Briggs. They’re playing hooky. I’m sorry.

But I had no responsibility for this. I wrote in a dilapidated RV parked in the bottom of our driveway where there was no internet and no telephone, and at times that I was excused from childcare duties. But I also felt compelled to do additional ethnography that would embody methodologically and analytically this perspective.

So after being trapped by public health work and research on cholera and rabies in Venezuela, I promised myself never to research another epidemic. These epidemics sort of left me feeling like a teddy bear with all the stuffing knocked out. I’m using that metaphor rather than using any biomedical sort of labels that I could for the way I felt afterwards.

But you know, here, I became increasingly interested in figuring out why the biggest health communication effort in world history, both in terms of U.S. media attention and communication efforts by global, national, state, and local authorities, was such a disaster. So in July 2021, I began conducting interviews and lots of participant observation that enabled people to reflect on how the pandemic had changed their lives, work, and fundamental understandings of the world. So now I’ve completed 100 interviews.

I’ve interviewed firefighter paramedics, ICU and emergency medicine physicians and nurses, secretaries, parents helping kids with online classes, journalists, judges, police officers, religious professionals, ranchers, teachers, construction workers, and lots more. My research is unique because I spend as much time with people classified as Trump-supporting anti-maskers and anti-vaxxers as the public health professionals and clinicians who crafted COVID-19 policies. I conducted extensive fieldwork in the San Joaquin or Central Valley of California, the Diné or Navajo Nation in New Mexico and Arizona, and a month and a half in rural Montana, using that funky old RV to avoid things like restaurants and motels during a pandemic.

These interviews were among the most magical I’ve ever conducted as people who felt consumed by the exigencies of just not getting by, and so many of whom felt as if they had never been heard, including people working in the I-ER or the ICU, not heard by their colleagues or their family members, as well as people who said, “We know the truth about COVID-19,” and they’re lying to us.” All right. Just to reflect upon their pandemic experiences, I ask a simple question here.

Why would a country that spends more of its GDP on health and had spent billions on pandemic preparedness have one of the worst COVID-19 death rates in the world? Despite, as medical historian Charles Rosenberg taught us, that epidemics X-ray societies in ways that offer insights into what ails them, why have the long-term secondary effects of the pandemic been so incredibly negative? Getting beyond simplistic explanations, why did it result in deep social, cultural, and political polarization that helped lay the basis for an attack on health research and universities that Trump 1.0 largely failed to accomplish?

Why did the pandemic leave public health communication in such a shambles that a new pandemic would likely be even more disastrous? And when are we going to realize that we need to think health communication and education right from the ground up? Now, fortunately, the answer to all these questions is very easy.

It’s in chapters seven and eight of my book. My analysis emerges from the analysis of complex intersecting narratives told by people in dialogue with one another who are cast as pandemic foes. Now, given that Professor Ochs is one of the most distinguished analysts of narrative, listen closely to what she has to say in terms of thinking through these issues.

I would be happy to talk about the pandemic analysis in responding to their commentaries and any sort of questions that you might like. But at this point, I’m much more interested in listening to them, so I’m gonna stop talking right now. Thank you.

(applause)

Professor Ochs.

[ELINOR OCHS]

Okay. Well, thank you, Charles. Very exciting.

So, as many of you know, anthropology as practiced in the U.S. is an extremely broad field. Not only does it contain its four traditional subfields, sociocultural, linguistic, biological anthropology, and archaeology, the boundaries of each of these subfields are porous with other fields. As a result, anthropology also generates and houses a swath of contemporary hybrid subfields alongside the traditional subfields.

The fast-growing star of these hybrid disciplines is medical anthropology, which itself splintered into its own subdisciplinary hybridities. A few days ago, as I contemplated the title of Charles’ book, Incommunicable: Toward a Communicative Justice in Health and Medicine, just for curiosity, I asked my new friend, ChatGPT— does medical anthropology have subdisciplines? And it spun out a long list, including biocultural – biological medical anthropology, critical medical anthropology, clinical medical anthropology, interpretive medical anthropology, medical anthropology, phenomenological medical anthropology, ethnomedicine, global health anthropology, and disability anthropology. “Hmm,” I thought. “Where does Charles Briggs’ crucial insight into incommunicability fit in this list?” “Everywhere,” I concluded.

Not only the recent book, but also many of his solo and collaborative cross-disciplinary research endeavors with Clara Mantini-Briggs upend biocultural, critical, clinical, interpretive, phenomenological, global, and disabling facets of health and care. But yet, I don’t see on this AI-generated medical anthropology itinerary, a focal line of inquiry that addresses the crucial issue of failed health-relevant communication, what Charles calls incommunicability. No reference to, for example, social inequalities in global health communication.

That is, I don’t see medical anthropology studies interfaced with linguistic anthropology. Why is phenomenological medical anthropology on the list, but not scholarship on health and communication? We could brush this off as just another AI error.

So I turned to the Society of Medical Anthropology homepage on the American Anthropological Association website. Here, 10 topical interest groups are listed. None of which attend to what Charles calls stigmatized incommunicable voices or incommunicable populations or biocommunicability or simply global health communication more generally.

I then proceeded to the Society for Linguistic Anthropology website, hoping that Charles and my disciplinary home base would come forward to recognize the substantial research fusing linguistic and medical anthropology. As a former president of this society, I am abashed to report that no, the Ling Anthro website is silent regarding medical anthropology. Indeed, it does not note overlaps with any other lines of inquiry.

Hmm. The lists of scholarly interests that do appear on AAA and academic medical anthropology websites may be just lists on websites. Or the lists may codify what Chuck Goodwin calls professional vision, a disciplined way of perceiving, interpreting, articulating, and responding to entities.

In this view, linguistic and communicative dimensions of medical events may fall outside the parameters of medical anthropology’s professional vision, including attending to potentially racialized and disabling clinical language ideologies, protocols, genres, registers, acts, patient uptake, communicative breakdowns, and the all-important public health incommunicable medical information. Alternatively, incommunicability and other linguistic and communicative facets of health and well-being may not fall outside the professional vision of medical anthropology. Medical language and communication may simply be viewed as a wide domain that can be deciphered by a range of scholars and professionals.

Indeed, Charles writes, “Clinical communication has been recognized as a concern and incorporated into education programs for medical students and beyond.” To understand the difficulties of integrating medical and linguistic anthropology, we have to look deeper, and perhaps draw upon the work involved in cross-disciplinary medical and linguistic anthropological collaborations and their resulting insights. I have spent a great deal of my career in such experiences.

For many years at UCLA, I co-taught a seminar called Narrative and Times of Trouble with medical anthropologist Linda Garro. Then with clinical psychologist Lisa Capps, I co-conducted an ethnographic project and co-wrote a book on panic narratives and co-conducted another ethnographic and clinical study of the everyday lives of children on the spectrum. I also directed the interdisciplinary UCLA Sloan Center on the Everyday Lives of Families, wherein medical, psychological, and linguistic anthropologists, archaeologists, and clinical and social psychologists conducted fieldwork together across thirty-two families, convened and discussed observations and issues once a week for nine years, and co-authored journal articles and books.

Finally, over the past several years, I have been part of a very small cross-disciplinary team of UCLA and University of Utah nursing scholars, they both have PhDs, and anthropologists poring over both survey responses and personal narratives of persons who self-identify as women and disabled to understand body events that upend their sexual and reproductive lives and health. Here is my take on integrating linguistic anthropology and medical anthropology and related disciplines. It’s just one take, and it’s offered as a bid for discussion.

My sense is that scholars outside language-focused disciplines often attend to the content of language, what people are expressing, rather than probing the lush realm of grammatical, phonological, paralinguistic, discursive, pragmatic, interactionally sequential, embodied, and other semiotic features of language and communication. Often the analyses do not display transcripts, and excerpted passages do not display pauses, pitch changes, or pace of utterances, for example. It’s what people say that counts, and how it is said stays in the dark.

The focus on content tends itself to a wide scope of scholarship. Those who know the language fully or even partially, including subjects of our studies, can assemble interpretations, and they do. Why then would anyone need linguistic anthropologists?

Why play a videotaped passage or display the detailed, difficult-to-parse, time-consuming transcript? I don’t have a fancy word for this disciplinary difference in perspective, but I feel, or rather I know, that the ache of health-related incommunicability can never be resolved through analysis of semantic content alone, and that medical and anthropology and linguistic anthropology need one another and need to include critical topics such as incommunicability in clinical settings, as Charles casts it, on their disciplinary lists as essential to both their professional vision and global health. Thank you.

(applause)

[ERIC SNOEY]

Yeah. Good afternoon, everyone. I have to apologize. I’m sure that coming here, you may have expected someone with a beard looking like Noah Wyle.

Because The Pitt has now defined what American ER docs are supposed to look like. My wife recommended that I grow a little bit of a stubble because I’m not actually able to grow a beard, and she thought that might actually gain a little bit of credibility with this audience. But here I am.

I’m not an academic. I’m a clinician, as someone mentioned, in Oakland. I’ve been there for about three and a half decades, and I want to congratulate Charles.

I thought this was an amazing book. I found myself sort of nodding in assent, figuratively and virtually, at least for the parts I understood. I apologize for that.

(laughs)

But it—

(microphone thuds)

Sorry, this just popped off. But you’re right, of course. He’s right.

Briggs is right. We’re all right. The language of medicine is impenetrable, okay?

And that is a feature, not a bug. We like it that way. We want to speak the language of science.

We want to be able to adapt innovation and creation in the world of science and medicine. And we also like to have a bit of a members-only club where we are the only ones that have the password. This is no different than law and lawyers or business and businessmen and women.

This is no different than, I dare say, academics, where this degree of essentially exclusivity is really a feature and not a bug of what we do. So the trouble that I find myself in as a physician is I live at the interface between that exclusivity of language and culture, if you will, and then I’m faced with the patient in front of me, and trying to bridge that gap is an enormous task. And we’ve talked about that, and Charles’ book is basically that question, right?

I often joke that my job is nine parts translator to one part doctor. I ask a question, I get a vague response. I ask another question, it becomes a little bit more clear.

I continually ask questions until progressively over time with that patient, I begin to translate their lived experience of illness into a language that modern medicine can understand with all of its algorithms and its protocols and its nonsense that is something that is intelligible to us and unintelligible to them. In this process, I make mistakes. There is explicit bias.

There’s unconscious bias. I hope less and less as I’ve practiced for so many decades, but it’s there. So I’m clearly making mistakes.

I know that. And yet, and this is a challenge to Charles, I guess, really here. If I was to rate racialized language and cultured language as an impediment to communication of my words to the patient and their words to me, that sort of process, if you will, that sort of construct, compared to other things, I think that race and culture would hardly make par.

For me, a much greater barrier to my communication with my patients is illness itself and the very human response that we all have to sickness. Now I know, Elinor and others, sounds like have done extensive work on, through their medical anthropology, on what narratives we all create for ourselves around illness and disease, right? We all are parts of personal experiences, families, groups, races, ethnicities, etc.

And that carries us forward in our understanding of modern medicine, okay? And that can be a challenge to us if we don’t participate or know those ideas and that language and that seminology, I guess. But there is a moment in my world where the anxiety, the fear, the pain, the bleeding, the violence of being seriously sick and ill can transcend race and culture.

The responses can be very variable. They can vary from mute stoicism, where the person doesn’t say a word, to aggravated, agitated hysteria, and everything in between. You throw into that mix a whole host of other factors like health illiteracy, superstition, self-delusion, alcoholism, drug abuse, domestic violence, and then the pure physiology about what it means to be sick and how that affects your mental capacity and your cognition, your understanding.

And what you have at the end of this is an enormously muddy mix of soup, if you will, of misinformation and non-information. Okay. And I find that we’ve talked about one little aspect of this, but I feel like the issues and the challenges to me as a physician are so much larger than just being sensitive and understanding and cognizant of these differences and how I can fall down in my job of communicating along those lines, because I have so many other things I need to worry about, to say nothing of the medicine.

Right? So I’m not going to take a lot of time here. I want to throw this back to the community because I think this would be useful.

I want to challenge Charles, if I can, to sort of come up with what he might perceive as the pitfalls of a communicable incommunicability framework with adding into this element of illness and how that affects our communication and understanding and our expression of what we’re feeling, because I do feel it’s different. And are we asking too much? Truly, okay, to understand all those subtleties and that finesse, that nuance across all the sort of perspectives I just laid out for you?

And then I’m going to throw another curveball into this discussion, is that as we move forward, the world of medicine is moving inexorably away from time with the patient. Right? We can all relate to that.

We’ve seen a doctor in the last month or so, and it’s being constricted, squeezed, strangled, right? Why? Because of economic imperatives, because of metrics, because of this and that.

And what are doctors doing? They are abdicating this essential art in medicine, which is this sort of synchronized dance with our patients where we try to jointly solve this question of what’s wrong, and we’re abdicating that to the machine, the tests, technology, and then of course, the thing that’s the elephant in the room is AI, right? What does an AI world, what does an AI bot look like?

Is it the bespoke bot who understands who I am and what my background is, what my illness is, and looks at me as an individual in this particular moment in time? I don’t think so. I mean, I’m very pessimistic on AI right now.

I don’t know where this AI takes us. I think it takes us in the wrong direction before it takes us in the right direction. But I think there’s a certain luxury to some of the solutions that Charles put forward.

And I, in all due respect, I feel like there are forces a, a, afoot in the world where we may not have the luxury of making the kinds of changes and implementing the kinds of programs that are going to be important to solve Charles’ issues, my issues, and those are just two issues among thousands of others. So thank you.

(applause)

[ARMANDO]

Okay, Charles, do you want to take a moment to respond to any of that? Anything on your mind?

[CHARLES BRIGGS]

Sure. Yeah. So one thing that’s fascinating to think about, there were a number of precursors, I mean, little people that you’ve never heard of, like Gregory Bateson, who thought fundamentally about medicine, mostly psychiatry, and thought about communication, right?

And but it’s interesting that somehow the work that you’ve done over so many decades, why does it not penetrate the way in which work in general in anthropology and other fields gets done? So what is the impediment there From all of, I mean, on the one hand, is the social organization of the disciplines, the way in which often, you know, you have again, people who are trained in linguistic anthropology who’ve never taken a course in medical anthropology, often faculties that are sort of put up against each other in terms of graduate recruitment, in terms of recruitment of faculty members. And one thing that’s fascinating is to think about what’s happened at UCLA.

People like Stephen Black, right? Who was trained by Sandro Duranti, someone who worked in South Africa, now has worked in Costa Rica and in, you know, right around the corner from his home there in, Georgia, in Atlanta. Really thinking, trained in linguistic anthropology, psychological anthropology, medical anthropology, and of course, he is an ethnomusicologist and professional musician as well.

So there is now a whole generation of people who are entirely different. They’ve been trained in both areas. They do research which crosses over between them.

Some of it, you know, in urban areas in the United States, some of it around the world. So there’s a new edited volume that was just published that is by precisely scholars closer to the beginning of their careers, although some of them are now reaching to become full professors, who have precisely been doing this kind of work, and that has the possibility. So how might we also amplify—

[AUDIENCE MEMBER]

Name the volume, would you?

[CHARLES BRIGGS]

Sorry?

[AUDIENCE MEMBER]

Name the volume you just—

[CHARLES BRIGGS]

Name? Um, it Once it arrives, I will tell you. I can look it up, but it was just published.

I said it’s out there, But I have not received it, so I don’t know. But I’ll let you know. So it’s fascinating to think about this work that is emerging, right?

And then, but how to make that come up against sort of the status quo here. Now, that’s, I think, a very interesting problem here. Now, what we would need to do potentially is to turn you into a research subject.

Ellie and I could videotape some of your interactions with patients, and then what we would need you to do is slow down from the pace of emergency medical encounters, which is… I mean, I love ER doctors. I think it’s, for me, the most intellectually exciting branch of medicine because everything is different.

You have no idea what’s coming across the transom every single moment. But on the other hand, the pace is remarkable in terms of being able to deal with those. So one thing I would say here is think about that, what is it, 2002 landmark volume, Unequal Treatment.

Really naming at that point the way in which patients from racialized populations systematically get worse medical care, right? And one thing they identify there is stereotypes that practitioners have of the presumed ability or inability of their patients to understand what the doctor is going to say. So clearly here what we’re talking about, I would argue that you want to separate.

Really, the language part is less significant than the medical part. How do you separate them? What I’m saying is they’re inseparable.

How do you produce health inequities? How do you produce states of disease? That the communicative dimension is there from the beginning.

Again, I mean, the easy nut there is translation. If you’ve looked at work on medical translation, it is very difficult. Whether you enlist a child to translate for the mother’s gynecological examination, right?

Um, where you have somebody who’s a child who does not know medical registers in either language that’s being translated and ordinarily is judged to be incompetent by both the professionals and by the patients, right? Or whether you have professional translators who ordinarily take the provider’s point of view and will often filter the questions of the patient such that the provider doesn’t know that this person really is getting it and saying, “Wait a minute, I want to know more.” Right?

Because they’re enacting some of those same institutional norms within medical settings. And of course, understanding that time constraints are crucial. So as soon as you separate the two of them out, we’re not going to get anywhere, right?

So we might have to think about how is it that we can look at this more carefully, more slowly? How can we slow this down? I think that we could make you into a believer if you would give us time.

Right? I think if we could look, and I mean, not yours, let’s say some of your colleagues. And again, the idea is\u2014

[ELINOR OCHS]

He doesn’t have time.

[CHARLES BRIGGS]

He doesn’t have time. Well, we’ll get a big grant from the money that no longer exists for research, and we’ll buy some of your time. Um, but it’s fascinating to sort of think about how is it that one would be able to think through these sorts of issues.

And I do think that having those transcripts, having those videotapes, of being able to slow things down and see how things are being enacted would be quite… And by the way, um, I’m actually married to a physician. I am not anti-physician.

Um, I probably have a little bit of wannabe in me, right? Um, but what I’m really interested in is thinking about what happens in the world. Why, when so much is spent on medicine, is there so much disease, right?

Why are there so many forms of not only we call them medical inequities, right? Um, not just, um, health disparities really falls very far. But we’re talking about often health violence, the way in which so many lives are impeded, right?

Some of it’s lack of access to care, and frankly, often the communicative inequities in even getting, I mean, even for those of us getting on, we just signed up with UCSF, and it’s wonderful, good doctors. Can I get onto their website? I get onto it today.

Tomorrow, I can’t get onto it. The whole range of different dimensions, that’s part of it too. It’s all woven together there.

And of course, I’m supposed to know a little bit about the internet, and I do have some degrees of fluency. So how all these things are woven together, and frankly, the problem is we’re all reproducing, right, these problems. So the question is, I want to think about each time I teach a class

or I do some research or work with a provider, how is it that we can work together to produce communicative justice in health and not just the eradication of inequities? How is it that we can think about a problem in which we all need to combine? Because after all, the notion of communicability, try to be able to say we’re talking about, you know, pandemics.

The more that you actually reproduce, the better that health authorities circulate biomedical discourse, the fewer germs will circulate. Look at the CDC manual, right, for pandemic communication, and it says, “The public is a problem,” and the more you can get the problem, the pandemic, the public in a pandemic to shut up and listen and understand that discourse, the less the viruses or bacteria will circulate.” And it is precisely when the, when— laypeople, try to be able to say, “I want to have a role in thinking about what’s going on,” that’s when they say that the public can become more dangerous than the pathogen itself, right?

So I think we’ve got this tremendously overcoding. And biosecurity is a part of everything we do, whether it’s the monthly alarm that goes off at Berkeley or some of the procedures within hospitals. So I think we really need new forms of collaboration, including with practitioners, to slow things down and say, “Well, wait a minute.”

After, I want to say, “What are the communicative problems you’re talking about? How would you define those? How do you separate those from illness, from the medical outcomes?”

I mean, one thing that’s fascinating, my colleague Seth Holmes, who’s the co-director of the Berkeley Center for Social Medicine, and a lot of other people are really working on notions of structural competency. So teaching physicians that when there’s a problem that emerges, right? To think beyond, “Well, I’m seeing a number of patients who have the same symptoms, right?”

What’s going on here? How can I think outside the clinic as to what’s producing them? But no one ever thinks about the communicative part.

What is the role of communicative inequities in producing some of those health outcomes? So I think we really need to sort of unwind from those sort of separations and think about how we can start anew. So thanks for the challenge.

[ARMANDO]

Sure. Charles, I wanted to ask, can you take a moment to, for my own edification and the audience, maybe spend a couple minutes talking about communicative justice and sort of either through ethnographic examples, you know, what do you mean? Give us a sense of what you mean by that.

That would be great.

[CHARLES BRIGGS]

That’s a great idea. Well, look at Alondra Nelson’s wonderful book, Body and Soul. It’s about the Black Panthers.

Not the Black Panthers with guns, the Black Panthers with stethoscopes, right? With tests, who are out in the streets of Oakland fighting against health and communicative inequities. When they accepted medical volunteers, wonderful doctors who really cared about people to work with them, they made them attend classes where they read Mao and Fanon.

So they actually– And they tried to talk about what are the communicative things that happen within provider-patient interactions. And when they find that practitioners were in some ways dominating or becoming– were problematic vis-à-vis how they communicate, were demeaning patients, they fired them.

I mean, those are voluntary doctors. So they were assessing the communicative… And by the way, communication means the body, it means the gestures, it means all the formal features that Elinor– that Ellie was talking about here, not just the words, and certainly not just the content of the words.

I mean, Fanon got that. He was looking precisely at the formal features, including the pronouns, right, which denigrated patients along those lines. So here, they intervened there and were saying, “We’re going to create an incommunicability-free zone.

You try to cast patients as incommunicable, as not able to understand you, and you’re the one who doesn’t get it, and you’re out of here.” ” There are wonderful ones in the– Here’s a great example. In the middle of the cholera epidemic, you know, with Dr. Mantini-Briggs, we spent months going from every little tiny community asking them what happened and doing a count, a popular epidemiological count, because the World Health Organization found out that thirteen people died there from cholera.

And working this, we estimated about five hundred people died. And going through these places, we also did little things like with her, because, you know, I don’t like talking about health when people are dying and not actually doing something. She provided medical care often when there was no one else with the world’s worst nurse.

Me. And going through there one time, we were at a community where we asked them, “What are health conditions like?” “Oh, a couple of colds, that’s it.”

And there had just been a measles epidemic, there had been whooping cough, lots of stuff. And I said, “That’s interesting.” So, and then when we got to the cholera epidemic, they said, “Oh, right.”

So when we had– what happened then? So we had one patient who had these strange symptoms. We took them in a boat to the local clinic, and we listened very carefully to what the doctor said.

And I arrived back, he was the community leader, he was the healer, and he said, “I’m going to tell you folks three things. First of all, you will not drink a single drop of water that hasn’t been boiled.” “Second of all, nobody leaves the community until this mess is ended.

And third, I’ve consulted with the spirits, and I understand how this pathology is coming about, and we’re going to deal with that, right? So here you have this really interesting way in which he understood and he encompassed biomedical communicability, right? And, you know, probably didn’t say anything to the physician at the time, but assimilated that information and was able to incorporate this into a p-health program that at that point, I think two and a half years later, was still having lasting positive effects, right?

I mean, when the epidemic was over, a couple of the leading health officials from the country, one of whom who happened to have been Claude’s first boss and became Chávez’s first health minister, said, “All right, you folks, you’ve come up with some ideas.” We gave a presentation in Caracas at the health ministry, and they said, “All right, we’re going to give you,” it was three and a half million dollars from the World Bank.” So that was one political compromise.

And then they said, “All right, you need to take three years off from your job, and we’re going to give you that money to transform health within Delta Amacuro.” They got it. They understood that things were bad, and this showed that it x-rays what was going on with respect to, again, the ways in which the public health officials and clinicians were stereotyping that population and were embodying, inscribing those stereotypes in the forms of treatment that they received and also with respect to how they treated patients.

They wanted a transformation. Unfortunately, the local government revolves around, and still does, a tremendously racialized economy, and the last thing they wanted was racial justice, which would have undermined the political base for the entire region. Besides, they know Dr. Clara Mantini-Briggs is an anti-corruption— I mean, she has denounced corruption, and boy, in that area, that’s the worst thing you can do.

So they found somebody who would take all of the money and make sure that nothing ever actually happened except to be able to put that back into the political funds. So I think they’re wonderful examples, right? And here was…

You know, the one that happened in the small community was a local healer, right? And community leader who was able to do that. Think about the Black Panthers, who themselves were trained in theory, political and intellectual theory.

So very different spaces where people are making real transformations. I think it actually can happen. And in each case, they thought about the communicative dimension as being part of the medical dimensions.

They were trying to transform health, but they were doing that by saying, “We need to start with justice in terms of how it is that we communicate about health.” And, you know, at this point, again, if we have another pandemic, no, half the population isn’t listening to one single word that health authorities are saying. And a lot of the other folks are gonna say, “Oh, we know all that.

We don’t have to worry about that.” This is a real problem. So I think that this is something we need to really be able to focus upon.

And again, that’s medical and that’s communicative, and I refuse to separate them ’cause when you do that, I think it’s game over.

[ARMANDO]

I wanted to ask, I thought Professor Ochs really hit the nail on the head with this, It’s pushing this distinction between the content of, um, language versus the, these are my own words, the affect, the feeling, the pauses, the, you know, emphasizing some words over others. But I, so I wanted to get some clarity. Is communicative justice, is it about the way that physicians interpret a better, getting medical knowledge, uh, translated into the lifeworld of the patient, and then getting the lifeworld of the patient translated to the physician.

Is it about an exchange of content, of facts about those lifeworlds? Or is it about building trust and respect and the gaining authority to be a mentor and to open and to give honestly about one’s life as a patient? So, what is the communication about for you?

[CHARLES BRIGGS]

I think that he could probably answer that question better, okay, as to what really counts. But, you know, one thing that’s fascinating is we’re asking too much of doctors, right? The whole regime of medical training with respect to training doctor-patient communication asks much too much.

You have to be perfectly transparent and communicative with your patients. It’s an impossibility. Right, it’s an impossibility.

And the more that you try, I mean, one of the initial studies suggested that the problem was that they did a study, and they looked at how it was that, patient outcomes, and they talked to practitioners and said that, 60% of patients—I’m making up the numbers here— but a lot of patients did not really understand what the doctor was saying. They didn’t feel that they were able to ask their chief complaint, right? Along those lines.

And then that often the folks, the physicians would deem the patients who seem to be communicative failures as being non-compliant, as unsuccessful patients. And therefore, what is their program? A whole, just like John Locke, a regime of transparency and communicability.

And, you know, it also falls to the patient, right? If you don’t ask the right questions, if you don’t show that you’re understanding the doctor, it’s your fault. There’s a sense of growing.

And by the way, you know, the news media are full of portrayals of doctor-patient interaction, right? And of course, ideal ones where, of course, look at all of the propaganda for all, for some, not yours, but for a lot of the for-profit medical organizations, right? Oh, yeah, right?

Where you have the perfect doctor who’s very active, effectively engaged and is listening to the patient, and they understand one another. Nobody can do that. We need to start with the idea that there is incommunicability, that it’s produced structurally within society, and how is it that we deal with that together, right?

So when we deal with that together, that would get us closer to communicative justice and health.

[ELINOR OCHS]

Right. Thank you, Charles. I want to– Eric, do you want to take us a second to any thoughts you had?

[ERIC SNOEY]

Well, I mean, if you’re talking about content versus meaning, is that kind of your question? Do I have that correct?

[ELINOR OCHS]

Yeah.

[ERIC SNOEY]

I mean, I think the words themselves are only half the stories, as I think we can all agree. And you mentioned communications being physical language and biological language and tone and everything else.

[CHARLES BRIGGS]

That’s all true.

[ERIC SNOEY]

As you were talking, Charles, I was thinking about the word dizziness, which I hear, um, you know, I don’t know, and it’s got at least 16 different meanings to me.

[CHARLES BRIGGS]

Wow.

[ERIC SNOEY]

There’s the dizziness of the abuela, and there’s, which could be just weakness. There’s the dizziness of the elderly Asian woman who doesn’t speak English, and she’s basically depressed. And then there’s the day laborer, and then there’s every other variation, and it goes from lightheadedness, to weakness, to shortness of breath, to depression to, and it goes on and on and on, and it’s all expressed with one word.

And you need to be savvy. You need to have experience. You need to have, I think, a certain degree of understanding of humankind and your populations to sort of know where to go and what question to ask next.

And you could keep asking questions and, you know, about what dizziness means, but you need to have a roadmap a little bit, I think. Otherwise, again, you run out of time, as we said. Um, so it’s incredibly nuanced and incredibly complicated.

I can’t tell you just how many things that get in the way of my understanding my patients and their understanding me, and you brought up brilliantly many, many of them. I just don’t think it’s a complete list, and I don’t even think it’s a list that necessarily is most important to me. But I have a very specific role.

I’m in the emergency department, where illness is the giant sort of monster that eats everything. In a doctor’s office, in a pandemic, dictums from above or whatever we’re talking about, I think, you know, it’s, it’s probably much more about what you’re talking about than what I’m talking about.

[ARMANDO]

Thank you. Thank you, everyone for joining us. We’re, we’re out of time. So thank you.

(applause)

(silent)