Body Movement and Speech in Medical Interaction

AutorHeath, Christian, 1952-
PealkiriBody movement and speech in medical interaction / Christian Heath ; illustrated by Katherine Nicholls
IlmunudCambridge [etc.] : Cambridge University Press ; Paris : Ed. de la maison des sciences de l'homme, 1986
ViideHeath, Christian 1986. Body Movement and Speech in Medical Interaction. Illustrated by Katherine Nicholls. Cambridge: Cambridge University Press.

Amongst the social sciences it is perhaps in sociology that we find the greatest commitment to the analysis of the consultation or, more generally, social interaction in medical settings. As far back as 1935, Henderson, drawing from pareto, describes physician-patient interaction in terms of the constituent parts of a social system. more important, in 1951 Parsons published his classic The Social System, a chapter of which is devoted to the analysis of modern medical practice in relation to the maintenance of social equilibrium, an analysis which provides rich conception of the mutually compatible roles of physician and patient. This chapter alone not only revealed the significance of doctor-patient interaction to sociological inquiry, but is widely accepted as forming the beginnings of medical sociology itself. However, it was the lectures and essays of Everett Hughes at the University of Chicago in the 1950s which led to the emergence of a wealth of empirical work, largely ethnographic, concerned with social interaction in medical settings. Studies by Becker et al. (1961), Davis (1960, 1963), Glaser and Strauss (1965), Goffman (1961), Roth (1963), Strauss et al. (1964), and many others provide a substantial body of findings and an array of insights concerning the organization of everyday medical practice and the interaction between the profession and its clientele. (Heath 1986: 2)
Historiography of like studies. Medical sociology is a new term for me.
As with utterances and talk, human movement performs social action and activity. A movement, whether a gesture or postural shift, a nod, or a look, may be used to accomplish particular tasks in face-to-face interaction. Movement performs "locally" and gains its significance through its coordination within the moment-by-moment progression of action or activity, be it vocal, visual, or a combination of both. Moreover there is no reason a priori to assume that doing things visually rather than through speech will be limited to particular types of action or activity, or certain forms of nonvocal behaviour. Rather, as with utterances and talk, it may be fruitful, at least in principle, to consider how the immense variety of movement found in face-to-face interaction may perform social actions and activities. (Heath 1986: 10)
There is no original thought under the sun. Heath is here trying to show that Austin's speech-act theory and nonverbal communication can be combined.
Moreover one discerns from public commentary and the ethnographic literature that certain forms of street life and so-called deviant occupations rely upon persons not only making themselves available to others but also eliciting responses from "strangers" through a look. Simply turning and looking at another can serve to initiate interaction, yet has the advantage of avoiding vocal commitment, which as a first move can lead to comment, complaint, and even prosecution. A display of recipiency encourages another to begin the activity without demanding his or her participation. (Heath 1986: 34)
He goes on to quote Goffman's Behavior In Public Places p. 92, but the point is clear: glances indicate readiness to interaction and is in itself a form of interaction, that of low risk.
The opportunity provided through a display of recipiency may of course be declined. Turning and looking at another commits neither party to actually beginning but rather encourages a co-participant to cooperate in the start of an activity. Another's gaze, unlike, say, his utterance, can be ignored and the expected response withheld. Declining the opportunity afforded through a display of recipiency frequently involves one or both of the following forms of response. In receiving the gaze of another but noy cooperating in the start of an activity, an interactant will turn further away, not infrequently shielfing the eyes with the hand. Declinations to a display of recipiency are also a location for self-preens and other bodily focused activity; in particular face and head touching. Consequently turning and looking at another does not leave the interactional environment untouched. They implicate a response and project relevancies for a certain location; whether it is accepted or declined, the recipiencies of another's gaze is responding to pressure generated by another through a slight, yet significant, shift in his visual orientation. (Heath 1986: 35)
More on eye engagement and interaction.
The power of the look features in human communication and interaction. Even without looking at the person who is looking at one, a person is aware that he is falling under the gaze of another. Being looked at renders one the object of another's attention; it shows that one is being taken account of in some fashiona dn thtat one may be subject to the expectations of another. Becoming the focus of another's attention renders a person relevant to his actions and activity, as featuring here and now in his concerns and matters at hand. The look affects the other; it can arouse and encourage activity, initiate or progress interaction between persons. Turning and looking at another is used in human interaction; it accomplishes particular work or tasks, performs actions and activities. (Heath 1986: 45)
This is basically just as far as I got in my seminar paper.
The movements respect the momentary concerns and territorial right of the other; they operate on the wings, trading on our ability to notice changes on the margins of our attention. And it is interesting to observe that the more gross movements, the demands rather than requests for another's attention, not infrequently follow earlier and gentler attempts to encourage the cointeractant to attend. Finding the other failing to respond to hints rather than demands on his attention, a speaker increases the pressure on the other to realign his gaze, moving part of his body progressively closer to and sometimes invading the recipient's line of regard. (Heath 1986: 72)
Very general remarks, but nevertheless useful and interesting.
Much of the interactional work accomplished throughout movement is performed on the periphery of human vision, noticed but not seen, working alongside the business and involvement at hand. In fact, as we have seen elsewhere, for the accomplishment of many actions it is essential that the movement does not become the focus of visual or vocal attention (Heath 1986: 89)
Short, but important, musement over attention in interaction. Cf. sensory gating, selective attention, [mitte-märkamine].
Undergoing examination: attending to disattention
During the examination patients adopt a characteristic pose, a pose which is often maintained throughout its course. The pose is adopted by patients across a range of different types of examination, and it is relatively insensitive to the proddings, tuchings, tests, and the like performed on the patient's body by the doctor. [...]
In each case it can be observed that the doctor is conducting an examination whilst the patient looks to one side, in many cases with the eyelids slightly lowered. Though the precise angle of the patient's orientation in relation to the examination and the doctor varies from case to case, it rarely moves further away than twenty-five degrees and typically remains just to one side of the co-participant. It is as if the patient is looking into the middle distance, away from the other, yet at no particular object in the local environment; the look casts its orientation to neither the foreground nor background but rather to an apparent middle domain. This middle-distance orientation is adopted at the beginning of the examination and then held. The patient rarely looks at the doctor, his face, or the area in which the examination is conducted. Whether the doctor is listening to the patient's chest, testing his blood pressure, tapping his body, or simply inspecting a difficulty, the patient looks to one side, seemingly inattentive to the proceedings. As the examination is brought to completion, the middle-distance look is abandoned, and the patient once again orientates towards the co-participant, taking note and attending to his action and activity. (Heath 1986: 107-108)
Next paragraph ("Insensivity") begins with the note that "This middle-distance look, the pose adopted by patients during an examination, is insensitive to a range of actions performed by the doctor on the patient." and goes on to bring examples of seeming insensitivity (or "attended disattention") to the doctor's actions. The importance of this? The relationship of Power and Immobilization.
In passing, it is interesting that the middle-distance look does not occur only in the physical examination or the medical consultation. Anyone who has suffered the first few weeks of the services or even the school corps will recall how the middle-distance orientation plays an important part in parade and inspection. This aspect of military life is put to the service of melodrama in a film by Warner Brothers, An Officer and a Gentleman (1978), with the staff sergeant insisting on not being "eyeballed" and being looked at only on the periphery. In a rather different setting, visitors to actuion houses may well have noticed how surreptitious bids will accomplished from the floor by punters apparently uninvolved in the sale of a lot; and in the classrooms teachers will recall the pupil who, appearing to keep an eye on the class, is receiving messages from a friend behind. The middle-distance look is a way of attending but not be seen to attending, of being engaged but not engaged, of delicately monitoring the world on the periphery, the margins of visual involvement, ready for action should the occasion arise. (Heath 1986: 119)

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