The corrosive effect of profuse profanity

The coarsening of speech prompts Yaroslav Walker to remember that what you say influences who you are.

Yaroslav Walker

Yaroslav is Vicar of Christ Church, Hampstead.

An irate man holds a mobile phone to his ear while gesticulating with his other hand.

Malcolm Tucker makes his point.

“You breathe a word of this to anyone, you mincing f*****g C**T, and I will tear your f*****g skin off, I will wear it to your mother’s birthday party and I will rub your nuts up and down her leg whilst whistling ‘Bohemian-f*****g-Rhapsody’…right!?”

This is my favourite Malcom Tucker line of all time. This is what Malcom might call, ‘top swearing’. The Thick of It exploded onto our screens in 2005, supposedly lifting the lid on the workings (or absolute lack of) of the twenty-first century British government. The show immortalised the sweary Scot Malcolm Tucker – supposedly partly based on real-life New Labour spin-doctor Alastair Campbell, and played to perfection by Peter Capaldi. The nation watched with a mix of horror and delight, enraptured by the best political comedy since Yes, Minister. However, unlike Yes, Minister, power in The Thick of It is not wielded through the obscurantist language of the elite Oxbridge-educated civil service, but through the terrifyingly unhinged and violent rantings of Tucker’s Svengali spin-doctor. I can only assume that most people on the outside of government took it all with a pinch of salt – I certainly did. Surely, SURELY, it couldn’t be as bad as ‘that’!?

Dipping in and out of the coverage of the UK’s COVID public inquiry showed me just how wrong I was. Civil servants and political appointees writing on WhatsApp were indistinguishable from eighteenth century press-ganged sailors in a tavern. The highlight was the testimony of Dominic Cummings, who was confronted with his use of the saltier elements of the English language: “Due in large part to your own WhatsApps, Mr Cummings, we’re going to have to coarsen our language somewhat…” the investigating KC chided. “I apologise”, was the rather phlegmatic response.

We were then given a tour-de-force of aggressive sweariness – ministers were called ‘useless f**kpigs’, ‘morons’, ‘c**ts’, and it was suggested that in the case of civil servant Helen MacNamara he would ‘handcuff her and escort her’ from Downing Street. Upon being asked whether this language might have contributed to a lack of effectiveness in the Downing Street COVID response, Mr Cummings denied the charge – he was just reflecting the prevailing mood…but of course such language did.

He is very clear in teaching people that the words that leave their mouths have the power to bless them or damn them.

We live in a culture where speech, especially public speech, has progressively been coarsened. The television ‘watershed’ excludes less and less offensive speech, performative profanity is now de rigueur for many celebrities and even some politicians, and there has emerged a real generational divide between those of my generation and the baby-boomers. We appear to have forgotten a basic rule that the ancients knew all too well: affect has effect. What you say influences who you are.

What we say, just as what we do, impacts the sort of person we become and the virtues (or lack of them) that we build up and possess. If we look to Aristotle, we are introduced the concept of habitus. It isn’t just a habit – not just an activity that we engage in on a regular basis – but is a repeated behaviour that builds up our character, for good or for ill. This idea was taken up in some form by Augustine, Averroes, Aquinas, and even people whose name doesn’t begin with the letter A. Our speech, if repeated over and over again, moulds our character. Kind speech, lovely speech, righteous speech – repeated ad nauseum – will have as their end product a kind, a lovely, a righteous person. Violent speech, aggressive speech, coarse speech, will have as their end product a violent, aggressive, and a coarse version of the same.

Going beyond Aristotelian categories to biblical ones, the use of language is often a favourite theme. The most famous Hebrew example is perhaps the commandment: “Thou shalt not take the name of the LORD thy God in vain…” Our speech is important to God, because it is a basic indicator of how we conduct ourselves – and so an indicator of who we are – and we ought to be conducting ourselves in the light of God’s will and God’s law: “Let the words of my mouth, and the meditation of my heart, be acceptable in thy sight, O Lord, my strength, and my redeemer.”

As we move from the Old Covenant to the New, we find St Paul continuing this idea and extending the principle – our words reflect our relationship with God, and so will impact our relationship with other people (who are made in His image). He asks the Colossians that they speak ‘always with grace’, tells the Ephesians to avoid ‘filthiness…foolish talking…jesting’, and commands the Romans to always have a word of blessing ready rather than a curse. The community of holy people, living a life for God and for each other, can easily be destroyed by a cruel slip of the tongue – a fight can break out over even a mild insult. Perhaps this is why Jesus is quite so strict about speech – “But I say unto you, That every idle word that men shall speak, they shall give account thereof in the day of judgment.” He is very clear in teaching people that the words that leave their mouths have the power to bless them or damn them.

Perhaps one of its recommendations could be that at the highest levels of national decision making, our leaders and officials always strive to behave with calm and considerate courtesy.

“Do you think your description of your colleagues, the way in which you described them, their functions, their abilities, their talents, added to that dysfunctionality?” the KC asked Cummings. “No, I think the opposite…” came the slightly bewildered reply. But how could it not? How could speech that has been revealed to be so chaotic, so hostile, so unpleasant, and so callous contribute anything positive to the working environment? More importantly, and I don’t know Mr Cummings and am not making a statement on what his inner character and virtue actually is - how can it contribute anything positive to the person who utters it?

The COVID inquiry has been set-up to teach us lessons on how to be better prepared to tackle the next pandemic. I pray that it succeeds in this aim. Perhaps one of its recommendations could be that at the highest levels of national decision making, our leaders and officials always strive to behave with calm and considerate courtesy, where speech is used to edify, support, and commend. I believe, and Scripture teaches, that if this is taken on as a vital lesson we will, not only be better prepared to steer the country through the crises of the future, but the entire tenor of our political and public life will be better – holier even. The good news is that it costs nothing to put this recommendation into practice...all it takes to get started is a kind word.

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21 June 2023

5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.

Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;

“Fine thank you sir.”

He then went on to ask what she had done with her younger child who came with her.

Looking more astonished she said:

“I left him with my aunt who lives in Edinburgh.

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.

Turning to the students he explained

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens and the skin rash on her hands is typical of workers in the Linoleum factory.

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket. We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?

He replies:

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process.

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford, said: