The social construction of medical discourse

Abstract

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