Text Genres in Cardiac Emergency: from activity to typology
Different lines and research traditions from contemporary Linguistics share an interest for text genres. The aims of this article are, firstly, briefly presenting some fundamental antecedents on the subject for Linguistics and reviewing the main research perspectives and traditions. Secondly, it intends to introduce conceptual developments elaborated within the German Text Linguistics (TL) framework, which in my opinion offer a global and explanatory vision of text genres. Thirdly, the article illustrates the corresponding theoretical aspects, based on a corpus of verbal interviews from an Argentine public hospital, during the treatment of cardiac emergencies. The analysis performed applies a qualitative methodology, which combines the conversational analysis methods (GÜLICH; SCHÖNDIENST; SURMANN, 2003; GÜLICH, 2007) in the case of oral data, and the methods of genre linguistics for the typologizing of texts (HEINEMANN, 2000; ADAMZIK, 2004; CIAPUSCIO, 2005). The theoretical-descriptive paper describes and addresses two complementary angles of analysis for text genre, developed within the TL framework: both as speakers’ communicative activities and theoretical-analytical instruments for the typologizing of texts.
This work is characterized by a theoretical-expository imprint on the issue of text genres, and also an illustration from a specific perspective: Text Linguistics. The aim of the article is to present a brief overview of the different theoretical approaches to text genres and provide a thorough description of a perspective originated in the German Text Linguistics, while illustrating the main theoretical notions and concepts through a small corpus from an Argentine public hospital, collected during the process of treating cardiac emergencies. Henceforth, the intention is showing, albeit in a minimalist way, contemporary angles of analysis and how the knowledge generated from this perspective can be used for theoretical-descriptive and applied purposes.
1. Some antecedents and perspectives on genres
Genre as a concept is multifaceted and it is the subject matter of different Human and Social Sciences; at the same time, Linguistics are indebted to a broad range of traditions that developed founding ideas for contemporary research: Rhetoric, Stylistics, works conducted within the areas of folklore and Linguistic Anthropology (the seminal work of the Russian formalist PROPP, 1958 ), and within the area of the Ethnography of Communication (HYMES, 1972), among others. In my view, there are two crucial antecedents in the elaboration of the concept for Linguistics, which have been —and still are— influential and valid: the Prague Linguistic Circle and the contributions of Mikhail Bakhtin and Valentin Voloshinov circle. Firstly, I will briefly refer to them and, secondly, I will present a short overview of notable contemporary approaches.
In their transcendental Thesen (1929), the linguists of the Prague Circle emphasized the need to study the language by differentiating its several manifestations, with the concept of linguistic functions as a starting point. The intention of the speaker is the explanatory and natural event that indelibly marks linguistic productions: the elaboration of a functional stratification of language, direct antecedent of the concept of text genre, is an achievement of this school. To account for the functionally conditioned linguistic varieties, the Prague linguists coined the concept of functional styles: language provides a set of linguistic resources (in the broad sense) and speakers, according to their purpose, situation, social sphere, among other factors, select the appropriate stylistic variant. One of its most illustrious representatives, Havránek (1964), suggested distinguishing four functional styles: everyday language, referential language, scientific language and journalistic language. Functional languages are determined by spheres of use and this results in the “dominant styles”, which are characterized following the classic categories proposed by Bühler (1961 ): the representative function prevails in the specialized style; the appellative function, in the directive style; and the expressive function has supremacy in the emotional style. The Prague school has had an enormous influence on Functional Systemic Linguistics and Text Linguistics —two approaches that have made important contributions to the study of text genres (CIAPUSCIO, 2005).
The concept of genre attributed to Bakhtin (1979)1 was developed between 1926 and 1930, within the framework of the production of his circle on the dialogism of the statement: on the one hand, it is always responsibility of an individual and is oriented toward an interlocutor; but on the other hand, it is inextricably linked to the social sphere in which it is employed. Each sphere of language use gives rise to its relatively stable types of utterances: genres. The complexity, richness and dynamism of the genres lie in the vital and complex nature of human praxis. Bakhtin distinguished primary (or simple) and secondary (or complex) genres: the former, linked to everyday communication and directly related to experience; the latter, linked to more complex cultural contexts —science, literature, journalism—, predominantly manifest in written form. The relationship between style, function and genre is clearly stated by Bakhtin: a specific function (technical, journalistic, everyday use) combined with certain conditions for each sphere of use result in particular genres, which he defines as “relatively stable thematic, compositional, and stylistic types of utterances” (p. 252). The Bakhtinian conception of genre is reasonably still enduring and widely accepted, due to both its general character and, at the same time, its precision, by combining what the most diverse research traditions and contemporary approaches share: the conjunction of stability and dynamism present in its nature. That is, on the one hand, the stability of the discursive functions they perform, of the communicative contexts and spheres in which they are used, of the thematic range, and of the compositional and stylistic forms that characterize their structure and materiality; and on the other hand, the vitality and dynamism that constitute them, based on the variability of communication tasks —in different socio-historical contexts— that they undertake and that explain the changes, hybridizations and generic combinations as well as the emergence of new genres. The Bakhtinian conception of genre is latent in the different approaches, although its presence is more significant in the French tradition and very characteristic in Brazilian Linguistics.
Maingueneau (2010) justifiably asserts that genre, like every category in the Human and Social Sciences, is subject to socio-historical conditioning; there are, as is well known, different conceptualizations and definitions for it and a plurality of approaches that respond to different research interests. Frequently, in this discipline there is little dialogue between the different orientations, comparative works are very scarce (cf. CIAPUSCIO, 2005), and relatively few works gather contributions from different theoretical sources (cf. BAZERMAN; BONINI; FIGUEREIDO, 2009; SHIRO; CHARAUDEAU; GRANATO, 2012).
Discarding any possibility of a comprehensive rapport, I will make a brief mention of the main approaches with merely illustrative references. In the Anglophone tradition, the most relevant theoretical backgrounds are the studies of Variationist Sociolinguistics and Corpus Linguistics (BIBER, 1988), and Systemic Functional Linguistics (HASAN, 1984). The latter provided the fundamental framework for the interesting theoretical re-elaboration of the concept of genre within the theory, with projections applied especially in education, developed by the Sydney School in Australia (for example, MARTIN; ROSE, 2008; MARTIN, 2015), among many others. Genres were and are intensively studied within the framework of Applied Linguistics, especially that of ESP (English for Specific Purposes), English as a Second Language and English for Academic Purposes (BHATIA, 2004; 2015; SWALES, 1990; 2004; VENTOLA, 1997). Finally, it is necessary to mention the New Rhetoric School in North America (for instance, BAZERMAN, 1988; BERKENKOTTER; HUCKIN, 1995), that produced tenacious developments (BAZERMAN; DEVITT, 2014; BAWARSHI; REIFF, 2010); this line has been enthusiastically received by discourse analysts from Brazil, a country that hosts the SIGET events (International Symposium on Text Genre Studies)2 since 2013, which summon experts from different American countries. Bazerman, Bonini and Figuereido (2009) present an overview of the works of authors from different countries arising within this framework. The works of Brazilian researchers that are framed in text studies (VILLAÇA KOCH, 2008; MARCUSCHI, 2008; CAVALCANTE et al., 2010, for example) are also very relevant. What is more, the contributions of the Francophone tradition are worth mentioning (ADAM, 2001; BRONCKART, 1997; CHARAUDEAU, 2012; MAINGUENEAU, 2004; 2010), with a strong focus on the socio-communicative and structural aspects of genres.
Even though little is known about the reflection and work on genres in the German tradition, they are vast and it is absolutely impossible to mention them even at the representational level; however, it is curious that references to this tradition are generally reduced to the works produced during the 1970s, and particularly aimed at creating a text typology in terms of an abstract, static and deductive representation. In fact, in the early 1970s, the initial research within the framework of Text grammar cast the spotlight on the issue of text typology (GÜLICH; RAIBLE, 1977). However, from then on, countless typological proposals have been presented with growing dynamism and flexibility, nurtured by several generic studies, and that developed in accordance with the dominant paradigms in Linguistics (cf. HEINEMANN; VIEHWEGER, 1991) into what is known as Genre Linguistics (ADAMZIK, 2004).
2. Genres: Activity and Classification
Text genres emerge from the activity of talking itself, originated and made possible because speakers have knowledge on how to adapt their utterances (texts) to their aims, considering specific situational factors, according to the traditions of verbal communication. Eugenio Coseriu created a specific theory category which he called “expressive knowledge”, different from “knowing a language”, and which he explained as our ability to produce texts based on traditions and historic models (COSERIU, 1981; KABATEK, 2006; 2018; KOCH, 2008). That competence is based on the availability of historically coined text models or schemes —with partial or full scope—, which are reused and recontextualized in every verbal communication. Consequently, there are completely fixed texts (courtesy formulae, insults, idioms, proverbs); texts with fixed components (letterheads, legal documents), formal schemes for traditionally established texts (sonnets, contracts) or those defined by technology (Twitter, Instagram), and finally, formal schemes, types of relatively standardized contents and formulation models, according to the genre (research paper, journalistic chronicle, inaugural speech). The repeated and traditional aspect found in the concept of genre is related to that of discursive traditions, which emerged within the context of the Romance Philology (SCHLIEBEN-LANGE, 1982; COSERIU, 1981), oriented to the diachronic study of language. Nowadays, the differentiation of both concepts is an object of reflection (KABATEK, 2018).
With a similar orientation, contemporary models with cognitive and communicative characteristics (HEINEMANN; VIEHWEGER, 1991; HEINEMANN, 2000) study a “knowledge about text classes or generic knowledge” acquired by speakers together with language during their socialization; it is a knowledge on how to create and adapt texts and/or speeches to objectives, situations and the interlocutor, for these aspects to be appropriate and effective for their aims. These are the so called global text schemes, which will be analysed in the following sections.
Linguistic activities result in verbal and multimodal products that reflect, to a greater or lesser extent, distinctive and characteristic features of the different genres in its materiality of meaning. For almost sixty years, Linguistics have tried to address such regularities by suggesting different classification systems, which have radically varied over time as knowledge saw progress: from relatively rigid systems based on certain types of features (inside or outside the text) to systems of different dimensions and parameters, open and flexible, able to generate complex generic descriptions and undergo generic changes and relations (HEINEMANN; VIEHWEGER, 1991; HEINEMANN, 2000; ADAMZIK, 2004; CIAPUSCIO, 2009, among others). However, despite the relative stability of genres and the possibility of systematization, it is important to consider their inherent dynamism, present from their origin: genres emerge from communicative and social needs in historical, political conditions and also specific practices that are not permanent; genres change over time and can also avail hybridization processes and the emergence of new genres (MATTHEIER, 1986; ECKKRAMMER, 2004; MIRANDA, 2010).
In summary, it is important to distinguish two complementary perspectives in the research on genres: the perspective of the speaker’s activity, who produce and interpret texts or speeches, and the point of view of the classification of products resulting from these activities, that is, (individual) characterisation of genres and the text system or typology as an attempt to organise generic diversity (CIAPUSCIO, 2021).
3. Genres, text types and classes
When talking and writing about genres, it is impossible to avoid the terminology problem, as it has gathered a considerable portion of theoretical discussions. The nouns genre, type and class preceded by the noun text and the adjective discursive are the most commonly used denominations. In German text linguistics, the distinction between “text type” (Texttyp) and “text class” (Textsorte) was consistently put into consideration when the discussion on typology was just starting: text type denotes a category within a theory; text class is related to intuitive distinctions made by common speakers. This distinction started to fade with the evolution of research toward a more empirical perspective, and the name text class has prevailed in current literature (it can be considered —and will be in this paper— a synonym for text genre).
In this context and as anticipated, text class was defined in different ways throughout its development. Brinker (1988) suggested a specific conceptualization that became a classic definition:
As can be noticed in that definition, Brinker combines “internal” and “external” features of genres: from the internal-analytic point of view, he emphasises its complex operating nature, which can be explained from a typical combination of situational, functional and structural conditions. Furthermore, the author highlights the importance of historical and cultural aspects and, additionally, its cognitive basis.
Other authors within this line suggest conceptual characterisations that emphasise the cognitive-social aspect and that, in my opinion, achieve a descriptive and explanatory adaptation by distinguishing three concepts at different abstraction levels: text, genre (text classes) and text schemes (SANDIG, 2000; HEINEMANN, 2000). Texts are complex objects with a prototypical nature, characterized by textuality achieved by adhering to certain criterions or norms (BEAUGRANDE; DRESSLER, 1997), related to different analytical dimensions (communicative-functional, thematic —content, its organization and presentation— and the linguistic form, in HEINEMANN; HEINEMANN, 2002, p. 104). Texts are always samples of a text genre, a category that consists of sets of text units that share common features and have a prototypical nature, linked to their different constitutive dimensions. The distinction between text genres and the schemes that generate them (HEINEMANN, 2000) points at a more abstract dimension. Speakers have knowledge on global text schemes, which they have acquired during their communicative experiences and that play a central role in the production and understanding of texts. Daily, speakers face regular communicative activities that they preferably address in a similar way. Text schemes are pre-built resources of social and structural order to “solve” recurring communication tasks; they are general guidelines about text attributes, and they vary based on the communicative experience of the speakers, their academic background and field of activity —which is consistent across different types of communicative processes, most of which have a systemic structure, namely, a field of communicative genres (a “communicative budget”, BERGMANN; LUCKMANN, 1995, p. 301). In sum, genres are representations shared by the community of speakers, with a certain degree of abstraction, but linked to text realizations with prototypical features within the different dimensions.
In recent years, interest has mostly lied on the study of generic relations: in fact, texts are always included in major communicative processes, hence specific relations with other texts and genres are established. This is the reason why, beyond the typological framework, there is a sustained interest in suggesting global representation models that encompass intergeneric relations, mostly named after metaphors, as generic networks (ADAMZIK, 2011; BRINKER; CÖLFEN; PAPPERT, 2014), or biological-social metaphors, such as “family of genres” or “kinship” (BERGMANN; LUCKMANN, 1995; CIAPUSCIO, 2009), that are consequence of the evidence that different genres used by different linguistic communities are interrelated. Analysts are challenged by the systematisation of different genres that can constitute networks of genres (BRINKER; CÖLFEN; PAPPERT, 2014, p.149). Their connection can be diverse: thematic, functional, situational and/or formal, that is, they can refer to the different text dimensions. For instance, speeches on the COVID-19 pandemic, climate change or abortion are respectively organised in constellations of genres that are essentially constituted on the base of common contents. Generic functional interrelations constitute “chains”: texts belonging to specific genres are sequentially linked, namely, they constitute the necessary steps within a communicative process.
4. Typologizing text genres
Typological suggestions evolved from options that aimed to find opposing features for the contrastive characterization into multidimensional complex, flexible systems, which include different interrelated subsystems. Notions based on groups of features used to contrast individual text types through the representation in grids constitute “internal” and “external” text features (see, for instance, WEINRICH, 1972; LOUREDA, 2003). The comparison is drawn from pretty general features related to certain dimensions of speech, and it results in a global vision of those features. The decision on which features to include and the additional procedure generates fruitful discussions, which in the case of many authors resulted in the search of “superior” criteria for the typology of texts. For instance, Brinker (1988) suggests a typology based on a functional, situational and structural criteria hierarchy, in which the former is considered the predominant parameter. The prototype theory, refurbished for the text and genre theory (SANDIG, 2000) offers an interesting alternative: generic features in different dimensions are relevant as prototypes; namely, a text genre does not encompass all the features of potential text units within a certain genre, but only those features relevant for the specific constitution of the text in the given context.
Cognitive-communicative models developed within the German context explicitly favoured typologies of several dimensions at the interactional level, which would account for the typological knowledge of speakers. This approach focuses not on the text as a product, but on its processing. It postulates a schematic knowledge about genre that is added to the encyclopaedic knowledge (knowledge about the world), linguistic knowledge (lexicon and grammar) and interactional-situational knowledge (HEINEMANN; VIEHWEGER, 1991). Knowledge about genres is multidimensional, in the sense that it comprehends prototypical qualities related to the different text dimensions, which can also achieve a different relevance based on genre. Text typologies are, from this perspective, representations of generic knowledge, which can incidentally be used as reference models to characterise texts. Heinemann and Heinemann (2002) suggested a typology with a considerable influence on the Spanish speaking context (e.g., CUBO DE SEVERINO, 2005). It comprehends the function, situation, theme and structure, and formulae adaptation levels, which enable describing the object and accounting for textuality. Likewise, levels comprehend parameters that are instantiated in certain linguistic features. This strategy makes it possible to describe and contrast different genres, based on category distinctions of text levels and their particular ‘values’ as specific features. It is a holistic typology that includes partial typologies for each dimension. The following table provides a general representation that combines the aforementioned proposals and my own research, focused on specialised discourse (CIAPUSCIO, 2003; 2016). Such representation may be read in dynamic or processual terms (namely, as decisions taken by the interacting parts when they produce or interpret texts), and in static terms (when characterising or typologizing specific text units or genres):
|Level 1: Functionality||(Macro) Main functions: a) Express; b) Contact; c) Inform; d) Direct ? ; e) Produce aesthetic effects. d1) suggest, d2) give advice, d3) recommend, d4) order, d5) compel.|
|Level 2: Situationality||Parameters: a) Activity situation; b) internal/external communication to the speciality sphere; c) medium/channel; d) speaker´s profile (specialist/semispecialist/layman/…); d) number of speakers; e) speaker´s social roles; f) context situation.|
|Level 3: Structure and thematic content||Parameters: Strategic procedures for the information selection, organization and disposition: a) Thematic imprint (determination degree of text theme); b) Thematic attitude (modalities); c) Thematic perspective (specialised, informative, didactic, etc.); d) Ways of presenting text theme (narrative, expositive, argumentative, directive); e) Text structure. Particular tactical procedures.|
|Level 4: Linguistic form||Parameters: a) Genre communicative principles; b) linguistic/non-linguistic forms (images/projections); c) stylistic peculiarities; d) Genre-specific formulae schemes; d) Grammar and lexicon-related aspects; e) Terminology: density and treatment.|
Typological levels should not be interpreted as static compartments; there are overlapping, transitions and reciprocal conditioning relations among them. Although the current typological proposals present a high degree of generality, flexibility and openness —which allows to accommodate variation, changes and even generic hybridization—, the representation by levels could transmit a classifying image, which overshadows the dynamic character of genres, and partly for this reason it is common to find mentions of the "impossibility" of typologies (COUTINHO; MIRANDA, 2009, p. 36) in the literature. Indeed, typologies are limited instruments due to the object they must "categorize", which is subject to permanent variation and expansion, so that current trends based on an approximation of a prototypical, multidimensional and dynamic order achieve greater theoretical and descriptive adaptation (cf. BERNÁRDEZ, 1995, p. 185) than models based on the presence versus the absence of features.
The following section aims to illustrate the previous concepts and reflections by way of presenting examples, based on a set of texts belonging to the corpus gathered for analysis in a research project focused on studying the communication of cardiac crises in the hospital context.
5. Text genres in the treatment of cardiac crisis
The corpus examined in the research was collected in the public Hospital "El Cruce Néstor Kirchner", a tertiary care hospital and model medical centre, which admits patients only by referral from other health units, located in Gran Buenos Aires3. The patients are mostly people from highly vulnerable social backgrounds, who have suffered a severe cardiac episode, generally a heart attack, and are treated due to an emergency situation, which requires surgery with different degrees of complexity. The complete data corpus consists of 12 face-to-face interviews between cardiologists and cardiac patients (six interviews on admission and six on discharge), and six written texts that belong to the epicrisis genre (a written report, quite standardized, in which patient data, diagnosis and treatment in hospital, together with therapeutic and pharmacological indications for medical discharge are recorded). In summary, the texts belong to three genres, which can be placed at the initial and final terms of the hospitalization process to handle the medical emergency, as can be seen in the following diagram:
These are three routine genres of the hospital practice, with different degrees of specialization, which carry out and constitute a socio-communicative process, typical of this area: once the cardiac crisis is overcome, the interlocutors need to deepen their understanding of the case, decide on a treatment during the hospital stay, and establish a treatment to be followed upon discharge. It is clear that the three genres —instantiated in particular texts— constitute and collaborate in the "solution" for the medical emergency. From a functional point of view, the admission interview aims to obtain information about the patient, history and habits, and to inquire about the circumstances and characteristics of the critical event: based on this information, the results of specific diagnostic tests and the evolution, the treatment and general prophylaxis are defined —information that is incorporated in a technical way in the epicrisis and that is explained to the patient in an appropriate way, including the pertinent aspects, in the medical discharge interview. In short, the admission, the epicrisis and the discharge interviews constitute a generic network in which we can verify multidimensional relations: functional, situational, thematic and also linguistic. In addition to their functional orientation to handle the medical emergency and guide future behaviour, considering the situational point of view, they occur in the context of the hospital institution and the identity of the speakers coincides completely in the face-to-face interviews and partially in the epicrisis (the producer of the text is the physician who interviews, the patient addressed in the report is the interviewee).
5.1. Hospital admission interviews
As explained in the previous section, once the cardiac crisis is over, cardiologists talk to patients in order to gather a more precise information about their clinical history, the circumstances, characteristics and intensity of the critical event suffered, and the actions taken. These admission interviews respond to a regular rhetorical scheme, which follows parameters of the classic clinical interview or anamnesis, a practice that is part of the medical training. In the selected corpus, three large components can be recognized in the six admission interviews, which fulfil specific functions in the interaction:
I. Introduction: the fundamental activity is the physician´s investigation, who collects personal data, the patient’s medical history and family history, the patient’s habits and customs.
II. Development: patients, at the request of the physicians and with their collaboration, report the critical event suffered.
III. Summary and closing: the physicians synthetically explain the medical case (type of cardiac event suffered and the actions taken in the operating room) and give general recommendations regarding the patient's behaviour for the future.
I would like to focus on component II, in order to analyse the formulation activities that patients carry out to narrate their critical events. The analysis of the interviews shows that, in order to linguistically and communicatively reconstruct past events, patients predominantly resort to storytelling as a conversational method. Using this reconstructive method (BERGMANN; LUCKMANN, 1995), patients, supported by questions and comments from physicians, evoke and present the context of the disease, namely, the circumstances and events prior to the heart attack or crisis, the crisis itself, focusing on the description of pain, and its consequences. In this respect, they appeal to different narrative reconstruction methods or techniques (GÜLICH; SCHÖNDIENST; SURMANN, 2003; GÜLICH, 2007). These are textual formulation procedures to reconstruct past events, available to speakers in order to carry out the conversation. In the corpus of interviews, three main techniques can be identified, which have been described and characterized by the above mentioned authors: the iterative narrative that consists of the reconstruction of recurring events that are presented as typical and recurring; the episodic narration, that is, the reconstruction of a singular episode, which is clearly delimited from the rest of the actions and events; and finally, the scenic representation (or dramatic representation), a technique by which the past is placed in the present scene, facts and events are narrated as if they were happening before our eyes; in other words, the narrative becomes drama (GÜLICH; SCHÖNDIENST; SURMANN, 2003, p.227-228).
In the following example4, the partial reconstruction of a heart attack can be seen, which occurred fifteen days before the conversation took place. The exchange shows the conversational efforts of the patient (Pa), a family member (F) and the physician (Phy); they collaborate in different ways during the conversation: the patient recounts the episode of his heart attack to the physician; his wife (F), as a participant witness of the critical event, provides accurate details; the physician, for his part, makes questions and comments aimed especially at obtaining specific information about the circumstances, quality and intensity of the pain. Immediately before the quoted extract, the patient has reported sensations and symptoms experienced in the hours prior to the heart attack, such as lack of appetite, fatigue, spatial disorientation and confusion, a situation that he describes as “muddling”.
|1||P. o sea estaba como abombAdo y me fui a CAsa.. y guardé el AUto en casa y: [Pa. I mean I was like muddlING and I went HOme.. and I parked the CAr at home and:]|
|2||P. le comento a mi mujer.. que yo estaba como abombado y me dice no será. algo que te debe [Pa. I tell my wife… that I was like muddling and she says isn’t it something that must have]|
|3||P. haber paSAdo... y no f/ [Pa. happeNED… and not f/]|
|4||M. y aHÍ no fue a ningún hospiTA:L ninguna salita ahí no consultó´ [Phy. and THEN he didn’t go to any hospiTA:L any medical practice he didn’t go to a consult]|
|5||P. No=no ningún lado no porque no no porque me senté [Pa. No=no anywhere no because no no I sat]|
|6||M. no se tomó la presión tampoco. nada´ [Phy. he didn’t check his blood pressure, anything’]|
|7||P: no= no. me senté en la mesa comimos algo qué se yo. [Pa: no= no. I sat at the table we ate something I don’t know]|
|8||P: terminé de comEr.. me voy a acostar no tengo ganas muchas ganas de comER [Pa: I finished eatINg.. I lie down I am not very hungRY]|
|9||F. y dijiste no tengo ganas de comer [F. and you said I don’t feel like eating]|
|10||P: y me fui a acostar, y a las trEs de la mañana cuando me levanté me levanté con [Pa: and went to bed, and at thrEE in the morning when I got up I got up with ]|
|11||F: estoy cansado [F: I’m tired]|
|12||P. dolor de pecho y ahí NO no yo me levanto porque me levanto a esa hora [Pa. chest pain and then NO no I got up because I get up at that time]|
|14||M: bien. [lo despertó el dolor o se levantó usted’ [Phy: ok. [did the pain wake you or did you wake up‘]|
|15||M: bien. usted de qué trabaja’ [Phy: I see. where do you work’]|
|16||P. me sent/ me senté en el comedor. e: trabajo con mi Auto. de remIS pero me voy a la [Pa. I sa/ I sat on the living room. er: I work with my car as a taxi driver but I go to the]|
|17||P. caPITAL. entonces yo me voy a las cuatro cuatro y pico de la mañana salgo [Pa. caPITAL. so I leave shortly after four in the morning I go out]|
|18||M: está bien. entonces se despert/ [Phy: well. so you woke u/]|
|19||M: se desperTÓ y a lo largo le surge un dolor [Phy: you woke UP and there appears a pain across]|
|20||P: me desperTÉ estaba tomando mate cocido no. estaba tomando mate cocido [Pa: I woke UP I was having some tea no. I was having some tea]|
|21||P: sentado prendí la televisiÓN. me preparé el/ el mate coCIdo TOdo. porque ella me deja todo [Pa: sitting I switched the televisiON on. I prepared the/ the tEA EVERYthing. because she leaves everything ]|
|22||P: prepaRAdo viste’ pero. calentar el Agua el microondas y en un tIro.. y en un tiro me:. siento [Pa: reADy for me you see’ but. boiling Water in the microwave and suddEnly.. and suddenly I:. feel]|
|23||P: un dolor en el pecho tremendo. entonces trato de abrir la puerta de:: de mi casa hacia el [Pa: a terrible chest pain. so I try to open the door to:: to the house from the]|
|25||P: la canIlla de:: de afuera del jardín. y meto la cabEza abajo de la caNIlla. como para tomar [Pa: the fassEt from:: from outside the garden. and put my hEAd under the faSSEt. to drink]|
|26||M: [y el dolOR cómo era’ era/’ [Phy: [and the paIN how was it’ it/’]|
|27||P: frEsco. Aire viste’. por el abombaMIENto que tenía.. era mUY agudo [Pa: some frEsh. air see’. for the muddLING I had.. it was vERY accute]|
|28||M: [qué sentía usted’ [Phy: [what did you feel’]|
|29||P: era era preSión era como que me agaRRAban con una mano un pedazo de carne acá [Pa: it was preSSure it was as if a hand graBBEd my flesh here]|
|30||M: ajá y el dolor se quedaba ahí en el PEcho o se iba para [Phy: aha and the pain remained there in the CHest or did it go]|
P: dentro así
|32||M: la espALda los bRAzos el cuello ahí y le faltaba el aire [Phy: the bACk the ARms the neck there and you were short of breath]|
|33||P: nono para/ no aHÍ lo tenía ahí lo tenía ahí lo tenía y yo [Pa: nono for/ not tHERE I had it had it I had it there and I]|
|34||P: me pegué y me empecÉ a faltar el aire. entonces le digo a mi mujer le digo:: da traé las llaves [Pa: I hit myself and startED to be short of breath. so I tell my wife I tell:: go bring the car]|
|35||P: del auto que nos vamos sí sí. cuando le digo [Pa: keys that we are leaving yes yes. when I say]|
|36||F: no despuÉS te empezó a doler el dorso. izquierdo, [F: no latER on your left. side started to hurt,]|
|37||P: traéme las llaves del auto que nos vamos porque me parece que eSto es un infARto le dije [Phy: bring me the car keys that we are leaving because I think thiS is a heaRT attack I said]|
To reconstruct the critical event, which occurred recently, Pa uses episodic narration as the dominant narrative strategy. In this context, he also employs the stage presentation at certain moments, bringing the dramatic representation of certain events, which remain vivid in his memory, to the present. In the first lines (1-10), Pa introduces the circumstances that frame what happened: his state of confusion when he got home, the dialogue with his wife (to be reproduced in the form of the stage presentation: see the use of present tense and direct speech: "and she says isn’t it something that..."); then the actions prior to the heart attack (“I sat at the table, we ate something (...) and I went to bed”). In this passage we can also see F's collaborations to complete the narration, which as usual consists of a co-construction (DAUSENDSCHÖN-GAY; GÜLICH; KRAFFT, 2015). Finally, in several lines (for example, 4, 6, 14, among others) the physician’s interventions can be noticed, usually in the form of questions aimed at obtaining specific information.
In line 10 begins the narration of the central episode, the critical event, which is located temporarily and precisely in the simple past tense and with a defined time, thus clearly delimiting it from the previous and subsequent events (“and at three in the morning when I got up I got up with chest pain...”). After a secondary discussion on the time (which draws the attention of the physician), on line 21, Pa returns to his narration —which extends to line 37. As is very frequent in narrations about cardiac crisis, Pa refers to the episode as something "sudden" (in line 22, the repetition of the Spanish expression "en un tiro" can be noticed, which must be interpreted as "very quickly"): "and suddEnly.. and suddenly:. feel a terrible chest pain. so I try to open the door to:: to the house (…) and I go outside because I realise I cannot breathe”. It should be noted that there is a notorious change in the tenses of the verbs employed by the narrator: the dramatic actions of the main event are formulated in the historical present; in this way, they are presented as if they were occurring at the moment of enunciation, which allows the emphatic and vivid expression of the experience.
Although the description of the pain is part of the patient’s initiative, who highlights its intensity (line 23: “terrible chest pain”), the physician's demand for greater precision (line 26) triggers the thorough exposition of Pa, along lines 27 to 33: with great effort to formulate it, the speaker appeals to a common resource in order to describe acute pain, the metaphor of personification (cf. CIAPUSCIO, 2017): “it was as if a hand graBBEd my flesh here/deep inside like this”. The subjective nature of the occurrence of the disease and the difficulty of elaborating, describing and transmitting these experiences explain why patients frequently resort to metaphor and analogy (SURMANN, 2005; LASCARATOU, 2007, among others), mechanisms that allow them to roughly convey sensations and emotions.
The following example (2) from a different interview, shows the narrative activity by the patient to elaborate on his heart attack:
1 P: bien. domingo. bueno el domingo. vinImo(s) de votar y llego a mi casa. y yo me
[Pa: well. sunday. well on sunday. we cAme home from the ballots. and then I
2 P: acosté porque tenía frío. porquE me mojé. me agarró un poco el agua.. temblaba de
[Pa: lied down because I was cold. becausE I got wet. I got a bit water... I was shivering with]
3 P: frío y cuando yo me levanto.. este. me levanto así para levantarme porque mi marido
[Pa: cold and when I get up… this. I stand up like this to get up because my husband]
4 P: me dice. ya está la comIda. porque él es una persona que me ayuda MUcho. cociNó
[Pa: tells me. lunch is reAdy. because he is a person that helps me a LOt. he cooKed]
5 P: tOdo ese dÍa.
[Pa: All that dAy.
6 P: en el pEcho le digo yo. me duele el brAzo.. me duele la MAno todo le digo yo. [de qué será’..
[Pa: pAin in the chest I tell him. my Arm is hurting… my HAnd is hurting everything I say. [what can it be’..]
7 P: y no sé dice. mi marIdo. vas a tener que ir otra veh=al mÉdico y deCIRle dice. lo que te pasa.
[Pa: I don’t know says. my husbAnd. you’ll have to go to the dOctor=again and tELL him. what you feel.]
8 P: bueno. después la cosa buEno que. comÍ así unos bocaditos pero no:. no tenía hambre
[Pa: ok. then the thing wEll that. I aTE bits and pieces but I was not:. not hungry]
9 M:[ no tenía apetito´
[Phy: you were not hungry’]
10 P: & no. fui. me acosTÉ.. y me voy a sentar así al dar la vuelta y empezó el dolor.
[Pa:& no. I went. I lied doWN… and I’m going to sit like this when I turn around and the pain started.]
11 M: mhm *este dolor que sintió [era el mismo´
[Phy: mhm *that pain you felt [was it the same’]
12 P: fuERte. un dolor como que me apre.TAba. que me* apretAba.
[Pa: sTRong. a pain that kind of squEEZed me. that squEEzed* me.]
13 M: le hac/ era pareCIdo a lo que venía recibiendo previamente’ pero más fuerte
[Phy: it di/ was it siMIlar to what you were feeling before’ but stronger]
14 P: sí sí sí sí sí sí=sí pero mÁs fuerte. sí
[Pa: yes yes yes yes yes yes=yes but strOnger. yes]
15 P: .. bueno. ese dolor me llevó al=al con lluvia y todo él también. y vinieron
[Pa: … well. that pain took me to=to even under the rain and he as well. and they came]
16 P: y me llevaron al:/ al hospital de: solano
[Pa: and took me to:/ to the solano: hospital]
17 M: bien,
Firstly, she contextualizes the critical event by providing the temporal-spatial circumstances (lines 1 and 2) and then, in order to narrate the central episode, she elaborates a discourse that combines different narrative techniques: from the episodic narration (“when I get up”… 2) and the scenic representation (“my husband tells me…” lines 3-7) to the episodic narration of the critical experience ( “ I ate bits and pieces… I lied down… and the pain started”, lines 8 to 10). Then, the cardiologist enquires about the quality and intensity of the pain, to which the patient answers on line 12 with a metaphorical expression (“that kind of squeezed me”, applying a conventionalized conceptual metaphor: pain is pressure, KÖVECSES, 2000; CIAPUSCIO, 2017).
The scenic representation is a very recurrent narration technique in patient´s discourse. This procedure is especially revealed in the use of verbs in the present tense and in the presentation of voices through direct speech, introduced mainly by the verb “to say”. Below, there are lines 5-7, in which the patient reproduces her own statements and those of her husband through direct quotations:
5 Pa: All that dAy.
6 Pa: pAin I tell him. my Arm is hurting… my HAnd is hurting everything I say. [what can it be’..
7 Pa: I don’t know says. my husbAnd. you’ll have to go to the dOctor=again and tELL him. what you feel.
Through this technique, patients convey the drama of the experience, bringing it to the present: facts and events are narrated as if they were happening before our eyes, that is, the narrative becomes drama, and the protagonists re-enact and dialogue through the direct reproduction of their voices (GÜLICH, 2007).
In summary, the corpus of admission interviews reveals that patients possess this particular expressive competence, which allows them to use different narrative reconstruction techniques to elaborate and formulate their expressions, in order to be able to convey not only the events that occurred, but also their feelings and the particularly intense experience of having a heart attack. These narrative strategies are pre-formed schemes or resources of a social and structural order that, as stated in Section 3., allow "solving" recurring communicative efforts: together with other types of textual schemes, they constitute generic competence. It can be elaborated according to the speakers’ communicative experiences, but it is obviously an essential part of the socially and culturally shared communicative “budget” (BERGMANN; LUCKMANN, 1995), which enables and guides the communicative activities of the speakers. Texts, understood as products (ergon), result from these activities. They are complex objects, prototypical in nature, which require different levels for their analysis: functionality, situationality, structure and thematic content, and finally, the linguistic form. From this point of view and for the purposes of presenting a typology, the admission interviews are analysed in the following section foregrounding the last two levels.
Hospital admission interviews exhibit regular schematic, thematic, and formal patterns. To summarise, I present below a typology of the admission interviews, based on the two levels introduced in the previous section: content and structure, and the linguistic form.
|Typological levels||Admission interview|
|3: Structure and content a. Text structure b. Text theme Thematic attitude (modalities) Thematic perspective Strategic and tactic proceedings:||Text parts: introduction, body, summary, conclusion Dialogic structure, question/answer Predetermined: cardiac crisis and the corresponding emergency treatment Subthemes: clinical history of the patient, critical event, circumstances, the experience of the heart attack and cardiac pain; intervention performed (angioplasty, bypass, among others) and recommendations. Interrogative, emotional, assertive, hypothetical General Thematic progression based on the temporal span of the event. Prevailing narrative sequences. Use of narrative reconstruction techniques: iterative narration, episodic narration and scenic representation. Resource of metaphorical proceedings to express pain|
|4: Linguistic form||Communicative closeness, linguistic forms of face-to-face interaction (formal addressing), repetitions, poor terminology, use of formal variations (heart attack/cardiac arrest/chest pain), formulative work evidence (false starts, stammering, paraphrasing, etc.), abundant metaphorical expressions and comparison strategies, broad hedging (it is as if, something like, kind of, etc.) and intensifiers (to quantify pain).|
Information on typological features is systematically represented in the table, which allows us to appreciate substantial characteristics of the admission interviews. However, the information, contrary to what the table might suggest, is not composed of non-related data, but mutually conditioned factors. At the level of linguistic form, these conditioning factors translate into the dominance of the first and second person singular to refer to the participants, the presence of traces of verbal formulative work, the frequent denomination variation to refer to medical phenomena or events, and the abundant occurrence of metaphorical illustrations, among other features.
Vertical representations of the typological characteristics of the texts (resulting from the activities and decisions of the speakers and producers) can be useful for didactic tasks and serve as a reference guide for the analytical work of text description, since it is possible to order and control of the analysis stages. They can also be used as an instrument of reference and reflection to plan the production of texts and underpin interpretation. However, it should not be forgotten that they respond to an analytical perspective, subsequent to the use of the texts —be it production or interpretation. In real text processing, genres are general, flexible, variable orientations that can be adapted to the situation and belong to a multidimensional order. The different narrative techniques that patients use in their narrations during admission interviews are precisely part of this generic knowledge.
This article has presented a brief overview of textual genres, taking into consideration some fundamental antecedents, research perspectives and traditions. Likewise, it has focused on contemporary conceptual developments elaborated within the framework of Text Linguistics of German tradition, which imply a comprehensive vision of text genres. These developments are oriented, on the one hand, toward the notion of genres as knowledge that leads and guides the activities of speakers and the social groups they belong to; on the other hand, they are oriented toward the notion of genre as an instance of performing those activities, which has repercussions on prototypical multidimensional features that are evidenced in the resulting texts. Furthermore, this paper has illustrated the main theoretical notions and concepts on the basis of a corpus obtained in an Argentine public hospital, during the treatment of cardiac emergencies. In a minimalist way, research showed two types of generic analysis. They were addressed as communicative activities of the speakers, who, based on their knowledge of text schemes, perform conversational efforts and use different narrative techniques to convey and communicate the cardiac events they experience. Additionally, an example of the typologizing of hospital admission interviews was presented, focusing on the data analysis levels, the schematic structure, the selection, presentation and illustration of the topics, as well as the most salient linguistic resources. It is important to mention that this is an illustrative analysis that aspires to show different angles of contemporary analysis of text genres in that framework, and the way in which the knowledge gained in this perspective could be used for theoretical-descriptive and applied purposes.
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