Essay
Character
Comment
Language
6 min read

Our language use is leading to a cultural abyss

We are witnessing a profound loss of commitment and discernment in the use of language, writes Oliver Wright.

Oliver is a Junior Research Fellow at Pembroke College, Oxford, writing and speaking about theology and AI.

Four rugby players stand and watch beside a referee gesturing with his arm.
Rugby players wait upon Wayne Barnes' word.
RFU.

The 2023 Rugby Union World Cup Final was one of the most iconic international matches in living memory, involving two of the most iconic teams – the All Blacks and the Springboks. It’s not surprising that after reaching such a pinnacle of a sporting career, there should be retirements that followed. But two retirements caught my eye. Not from players, but from referees: Wayne Barnes, the most experienced international referee in the world, the main match official, and Tom Foley, also highly experienced, the Television Match Official. Why? Wayne Barnes’s statement is particularly gracious and thoughtful. But the reason given in common with Tom Foley, and indeed many others in similar situations and similar high-pressure roles in the public eye, is worrying: online abuse. After the cup final, death threats were even sent to the school of Foley’s children.   

Online abuse has become an endemic, worldwide problem. There are real people issuing these threats and abuse; and there are real people receiving them, and responding in some way. Of course, there is also the problem of online ‘bots’. But they only succeed in their abuse because of their imitation of real abusers.  

It’s worth asking why, because we can go beyond the helpless handwringing of ‘the perils of being online’. There are philosophical and indeed theological reasons, and philosophical and theological ways, I suggest, of climbing out of the abyss.   

In fact, all words ‘act’ in some way. Even plain truth-describers assert something, such that an interlocuter can learn or discern for themselves. 

Let’s go back to the 1950s, when two important advances in the philosophy of language and in religious language occurred. The first came from Oxford, and the White’s Professor of Philosophy, J.L. Austin. The second came from Durham, and its then Bishop, Ian Ramsey.  

Austin, whose remarkable life and work has now been brilliantly documented for the first time in the biography by Mark Rowe (published by OUP, 2023) was a decorated Second World War veteran in the intelligence corps who was widely recognised as being one of the masterminds of the success of the D-Day Landings. On his return to Oxford in the late 1940s he perceived with great dissatisfaction a certain philosophical move which accorded the greatest importance in language to words and phrases which described things, which indicated some form of empirical truth about the world. For sure there were other kinds of use of language, religious language, emotional language, and so on, this argument continued. But that was fairly worthless. Describing cold hard scientific truth was the true utility for language.  

Austin’s most famous response was in his book How To Do Things With Words. The function of language goes way beyond the scientific description of the world. Language acts, it does things. We promise, we name, we cajole, we threaten, we apologise, we bet. There is no real ‘truth’ as such conveyed in such ‘speech-acts’. Their importance lies, rather, in what is thereby done, the act initiated by the words themselves. Or, in the Austin-ian jargon, the ‘illocution’ within the ‘locution’.   

But Austin realised something even more important as he investigated this form of language – these performative utterances. In fact, all words ‘act’ in some way. Even plain truth-describers assert something, such that an interlocuter can learn or discern for themselves. What matters is how ‘forceful’ the relevant act of speech is in each case. Sometimes the speech-act is very simple and limited. In other cases, such as threats, the performative aspect of the utterance is most forceful indeed.   

Austin’s student John Searle took the idea of performative language to America, and developed it considerably. Most notable for our purposes, however, over against Austin’s idea, was the separation of speech from act. By analysing the conventions and circumstances which surround the performance of a speech act – a baptism service for instance – we can observe how and why the act occurs, and how and why such an act might go wrong. But the debate was then divorced from the context of speakers themselves performing such actions, an integrity of speaker and action. The philosophical problem we then hit, therefore, is that a spoken word and the associated act (‘locution’ and ‘illocution’) are two entirely separate ‘acts’.  

Let’s move now from Oxford to the great Cathedral city of Durham. At the same time as Austin was teaching in Oxford, the Bishop of Durham Ian Ramsey – apparently unaware of Austin’s new theory of performatives – investigated religious language to try and get to grips with both how religious language does things, and what it says of its speakers and writers. Ramsey developed a two-fold typology for religious language – that of commitment and discernment. First, religious language implies two forms of commitment: there is the speaker/writer’s commitment of communicability, a desire to communicate, to be comprehensible, to ‘commune through language’; and the speaker/writer of religious language also  entertains prior commitments for the language adopted – language is rarely neutral when it comes to religion. Second, religious language implies a form of discernment about the words that are being invoked and for what purpose. They are not universals, but carry special meanings according to the particular conventions involved. Commitment and discernment.  

But this new innovation in the philosophy of religious language too was taken up and developed away from Ramsey’s idea – particularly in the much more famous work of John MacQuarrie, a Scottish philosophical theologian who spent much time teaching both in the States, and in Oxford. In MacQuarrie, writing at the height of the influence of thinkers such as Heidegger and Bultmann, Ramsey’s ‘commitment’ and ‘discernment’ got subsumed into existentialism and myth. The religious speech act became merely an event or an act for the self, a personal matter which might involve transformation, but might not.  

 These two strands, of the philosophy of language as it got taken up by Searle and his American counterparts, and of the philosophy of religious language as it got taken up by MacQuarrie, have for some time now predominated. And it is only recently that scholars on both sides have begun to perform a ressourcement, both on Austin, and on the nature of religious language in the wake of Bultmann.  

 The Twitter-sphere seems irrevocably to have divorced the bonds that tie speaker to their acts. In these fertile conditions, abuse flourishes. 

We can now return to the cases of Wayne Barnes and Tom Foley, and many others in many different walks of life just like them. Undoubtedly, the emotional, existential, and physical distance secured by interacting online has created the conditions for online abuse to flourish. But at a deeper level, what we are witnessing is a profound loss of commitment and discernment in the use of language, in society as a whole and also in the Church. Real people feel free to use language oblivious to any inherent act contained within it. The Twitter-sphere seems irrevocably to have divorced the bonds that tie speaker to their acts. In these fertile conditions, abuse flourishes. Similarly, in the Church, the commitment and discernment which has lain behind millennia of liturgical and doctrinal language has become a private spiritual matter; or indeed has been neglected in public when religious witness has not been matched between word and deed.  

How do we walk back from this cultural abyss? There is an ethical, and, potentially, a religious choice to make. The ethical choice is to think about what our language does to those who read (or hear) it, and to change the way we speak or write, accordingly. Ramsey's modes of ‘commitment’ and ‘discernment’. The religious dimension is to recognise that our words bind us to a system of belief, whether we like it or not. Saying one thing and doing another in a religious context implies a diminution in value of language for all concerned, not just the private life of the individual believer.  

Actions speak louder with words.  

Article
Care
Comment
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 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:  

“It is more important to know about the patient who has the disease than the disease that has the patient”.  

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too.