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The social construction of medical discourse

By Malcolm MacDonald


The social construction of the discourse of medical institutions\ud is analysed, drawing on both speech act and structural\ud theories. Discourse is defined as a symbol system which has an\ud ideological effect. This effect is linked to the maintenance\ud of the interests of hegemonic social groups.\ud Michel Foucault's archaeological method accords primacy to the\ud relations which exist between institutional and social\ud processes in the formation of discursive relations. Foucault's\ud genealogical method also describes how the identity of the\ud modern subject is constituted within the power nexus of coercive\ud institutions.\ud Medical discourse is paradigmatic of Basil Bernstein's model\ud of pedagogic discourse. Pedagogic discourse is constructed according\ud to the intrinsic grammar of the pedagogic device. This\ud comprises distributive, recontextualizing and evaluative\ud rules. These operate in three institutional contexts: the\ud field of production, the field of reproduction and the recontextualizing\ud field.\ud M. A. K. Halliday's systemic linguistics defines three metafunctions\ud of the text which operate in relation to its context of\ud situation: the textual, ideational, and interpersonal.\ud The textual characteristics of three principal modalities, or\ud genres, of medical text are described in relation to their institutional\ud contexts: the medical research report within the\ud field of production, the medical interview within the field of\ud reproduction and the medical textbook within the recontextualizing\ud field.\ud As a medical text shifts from the field of production to the\ud recontextualizing field, certain transformations take place in\ud the ideational options of tense, transitivity and process and\ud the interpersonal options of modality. These syntactic transformations,\ud organized by codes of the pedagogic device, symbolically\ud authorize the recontextualized medical text

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