Medical Interpreting and Cross-cultural Communication

Harold F. Schiffman haroldfs at
Mon Sep 26 12:31:48 UTC 2005

Forwarded from Linguist-List

AUTHOR: Angelelli, Claudia V.
TITLE: Medical Interpreting and Cross-cultural Communication
PUBLISHER: Cambridge University Press
YEAR: 2004
Announced at

Reviewed by Simon C. Bacchini, Department of Linguistics, Queen Mary,
University of London, PhD research student in linguistics.

Claudia V. Angelelli's book is a study of medical interpreting in a
Northern California hospital. To carry out her research, the author
adopted an ethnographic approach and for a period of almost two years she
shadowed a team of interpreters who work for the hospital, California Hope
(not the real name). All interpreting was done from English into Spanish
and vice-versa. Angelelli's stated aim was to problematize the role of the
medical interpreter. In particular, she wanted to challenge the idea that
the interpreter -- in particular the medical interpreter - can be
invisible, a simple carrier of meaning from language A to B. in addition,
the other myth to be dispelled is the one that places the interpreter and
the practice of interpreting in a social vacuum.

For Angelelli, the interpreter's invisibility is 'a myth' and the fact
that it is presented as both a fact and an ideal is a cause for concern.
The concern, Angelelli argues, is both theoretical and at the level of
practice. In Angelelli's opinion, for the field of interpreting to
advance, one needs an underlying theory; but 'a theory based on a myth
[that of the interpreter's invisibility] is not a substantial theory' (p.
3). The other concern is at the level of practice. It is 'about the ways
in which the belief system of invisibility impacts on the lives of those
who rely on interpreters for their daily communicative needs [...] as well
as the interpreters themselves and the healthcare providers' (p.3).

It is these concerns that prompted the author to question the role and the
very existence of the invisible interpreter and to explore, on the other
hand, his or her visibility. Angelelli's ethnographic immersion in the
world of interpreted interactions at California Hope (CH) resulted in
several hours of recorded material, both of face to face as well as over
the phone 'interpretative communicative events' (ICEs) between patients
and health-care practitioners (HCPs). Through a careful analysis of these
interactions, many of which appear in the book, Angelelli shows how
interpreters become visible by showing agency.

The author contributes to making interpreters visible by including a
chapter in which synthesis of interviews with the interpreters she
shadowed and recorded is given, as well as of an interview with the
manager of the interpreting department at CH. Interestingly, during these
interviews many interpreters described their role using metaphors, which
Angelelli discusses in her final chapter where she also gives us her
conclusions and illustrates the theoretical and practical implications of
her findings.

'Medical Interpreting and Cross-cultural Communication' is an ambitious
work. As the author herself states, it is aimed at a variety of readers,
'researchers, policy makers, interpreter-educators, practitioners,
students of interpreting, healthcare professionals, and communication
specialists' (p. 5). With such a varied readership in mind, the risk is
always that of disappointing one or more of the intended target audiences
by, for example, concentrating on theoretical aspect while neglecting more
practical points, or vice versa. Another possible risk, in this kind of
work, is that of falling into the trap of an easy prescriptivism by giving
lists of dos and don'ts. And so forth. Angelelli, a professional linguist
with vast experience in both academic research and translation and
interpreting, mostly avoids this pitfall.

The book is well planned. From the outset, she states her aims and
concerns, as well as the gaps in the current literature that the book is
intended to fill. Angelelli recognises that researchers have begun to
address the notion of the interpreter's neutrality and invisibility. Her
goal was to expand on previous research by studying a large number of
interactions over an extended period of time. Hence the choice of an
ethnographic approach.

As noted, one of the author's main aim was to question the interpreter's
invisibility. Participation in a large number of ICEs led her to propose a
new model of medical interpreting, one where the interpreter is all but
invisible, a mere facilitator. Angelelli argues that the visibility of
interpreters manifests itself when they do one or more of the following
(p. 11):

1) introduce or position the self as a party to the ICE, thus becoming
co-participants and co-constructors;
2) set communication rules (for example, turn-taking) and control of
the traffic of information;
3) paraphrase or explain terms or concepts;
4) slide the message up and down the register scale;
5) filter information;
6) align with one of the parties;
7) replace one of the parties to the ICE.

When an interpreter does one or more of the above, 'agency' manifests
itself. In chapter 6, Angelelli shows interpreters doing just that, in
various degrees. 'Agency' here, is located in discourse moves, rather than
in specific lexicogrammatical choices. The more an interpreter controls
the traffic flow (instead of following it), the more he or she shows
agency. Another way identified by the Angelelli as a means of showing
agency is by showing awareness of differences in register. The
manifestation of much of this type of agency depends -- as the author
acknowledges -- on the institutional setting in which the ICE takes place.
Courtroom interpreting, for example, poses many more restrictions on the
kind of discursive actions an interpreter can take, thus imposing -- in a
way -- a role of conveyor of the linguistic message.

In addition, Angelelli alerts us to the fact that interpreting does not
take place in a social vacuum. All the parties involved in the ICE have
socio-economic and cultural backgrounds, and thy take place within
institutions (the hospital, for example) that operate with a certain set
of norm, most of which are assumed to be shared knowledge. And here the
author shows how interpreting in a medical setting involves a lot of
cross-cultural brokerage and that there is much more than language that
needs translating in an ICE. Parties in an ICE in a medical setting often
come to the interaction with different expectations and different sets of
socio-cultural norms. What constitutes appropriate behaviour in a doctor,
for example (degree of formality vs. informality, directness, etc.) can
vary considerably across cultures. The interpreter is thus responsible for
the success (and, potentially, the failure) of the interaction by
operating simultaneously on various levels of translation: the linguistic,
the cultural, and the personal.

It is in this arena that interpreters display their abilities, demonstrate
their visibility, and exercise their agency. As noted, in Ch. 6 the author
provides many examples of this. They clearly show various degrees of
visibility and agency on the part of the interpreters. In some cases,
interpreters even take the lead in the encounter. They begin a line of
questioning of their own initiative and even reprimand patients when they
are not complying with the health practitioner's instructions. Crucially,
Angelelli shows examples of what motivates an interpreter's display of
agency. This could be the perception of a possible misunderstanding, often
caused by the perceived imbalance between the educational level of the
patient and that of the health care practitioner.

In those cases where the author shows that the display of agency is caused
by the interpreter's wish to tone down a statement by the HCP or by the
patient, it could have been helpful to have referred to notions of
politeness and face (Brown and Levinson 1987) as a way of explaining some
of the discursive move by the interpreters. This, in my opinion, would
have added explanatory power to Angelelli's argument. The medical
encounter provides fertile ground for the generation of face-threatening
acts (with potentially devastating effects). It could have been
interesting to have looked at the possible 'face-saving by proxy' that
might occur in this kind of interactions. As mentioned, the author
conducted interviews with all the interpreters she shadowed asking them
clarifications about particular occurrences and also about the perception
of their own role. The former was a very useful tool for clarifying the
reasons behind some of the interpreters' choices. In linguistic
investigations, it is quite easy for the linguist to read too much in the
talk of the informants. This particular aspect of her ethnographic
approach allowed the author to avoid that pitfall, simultaneously adding
scholarly rigour and giving interpreters a voice or more visibility, one
is tempted to say. Particularly interesting is the part where interpreters
use metaphors to describe their own role.  And so we have the interpreter
as bridge-builder, diamond connoisseur, and miner. Perhaps here, some
reference to Lakoff and Johnson (1980) would have not gone amiss. This
might have helped clarify what the participants' own, possibly
sub-conscious theories of translation might be. In this respect, it would
have been interesting to conduct interviews with at least some of the
patients and some HCPs to shed light on their ideas of the interpreter's
role in the medical encounter. This, however, would have certainly added
another burden on Angelelli's already heavy task of data collection and
analysis, and perhaps is more suited for a multi-authored work.

Overall, this is a very useful and readable work. In it, the author sheds
light on the complexities of cross-cultural medical interpreting, and
shows convincingly that -- at least in this kind of interpreting -- the
notion of an invisible interpreter is no more than a myth, and a
potentially dangerous one at that. This is applied linguistics with the
'applied' part very much in the author's mind and it will certainly prove
useful to the categories in the intended readership mentioned above.
Importantly, Angelelli's clearly explained methodology makes it possible
for other researchers to replicate the study (perhaps on a smaller scale),
thus exploring the issues further, addressing other questions or the same
ones while taking into consideration other theoretical orientations (an
investigation the interpersonal metafunction from the point of view of
Systemic Functional Linguistics would be one of my preferences).


Brown, P. and Levinson, S. (1987). Politeness. Cambridge: Cambridge
University Press.

Lakoff, G. and Johnson, M. (1980). Metaphors We Live by. Chicago:
University of Chicago Press.


After a Master's in General Linguistics and Comparative Philology at the
University of Oxford, I began a PhD in Linguistics at Queen Mary,
University of London. The aim of my project is to investigate the
linguistic expression of physical pain. I am looking at issues such as the
grammatical encoding of pain, the expression of evaluation, subjectivity,
affect and agency. The analysis is carried out on an original corpus of
interviews with Italian women suffering from autoimmune diseases, such as
Lupus and Rheumatoid Arthritis. The theoretical framework of my work is
functional (drawing in particular on Halliday's Systemic Functional
Grammar) with insights from sciolinguistics and discourse analysis. My
other interests are sociolinguistics, Italian linguistics, discourse
analyisis, and language variation.

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