Interactive Frames
and Schema
in Interpreted
Medical Encounters
RESEARCH REGARDING interactive discourse is a complicated undertaking. When interaction between two or more monolingual parties is facilitated by an interpreter, the potential complexities of the interaction are compounded. Are interpreters expected to relay utterances as if they were easily transferable from the linguistic structure and culturally embedded significance of one language and speaker to that of another? Schiffrin (1993) identifies at least two ways of framing the act of speaking for another, as motivated by friendship and support for the second party, or as motivated by more self-centered concerns. This suggests the possibility that interpreters, whose function it is to “speak” for others, could frame the task in ways that impact the nature of an interaction.
Part of the complexity of examining an interpreted encounter is that the interpreter might bring one frame to the event, while the primary participants bring others. Moreover, each participant, including the interpreter, comes to the interaction with a unique set of experiences and background information. Research regarding the interaction between frames and knowledge schema in interactive discourse (Tannen and Wallat 1983, 1987; Hoyle 1993; Schiffrin 1993; Smith 1993) indicates that participants’ frames can overlap, and knowledge schemas can be mismatched within a single event.
Frames and Schema in Discourse
In order to examine the interaction between frames and schema in interpreted discourse, it is first necessary to distinguish the meaning of these terms. The terms frame and schema and even the term script have been applied to the study of interaction by scholars from numerous fields, including psychology, sociology, anthropology, linguistics, and artificial intelligence. As a result, these terms have received diverse and detailed attention. For some researchers, the three terms are essentially synonymous. For others, they are not.
Bateson (1955, 1972) discusses the ways in which activity is framed by participants. In particular, he discusses the fact that a behavior, such as fighting, can be signaled and interpreted as playful rather than serious. This use of the term frame as the way in which interaction can be understood is consistent with Goffman’s analysis of frames (1974). Goffman defines frames as “definitions of a situation [which] are built up in accordance with principles of organization which govern events—at least social ones—and our subjective involvement in them” (11). Goffman discusses an activity, such as fighting, that can be framed by an outer rim, either consistent with the inner activity yielding a primary framework, or transforming the event into a different activity, as in the case of play fighting. Goffman discusses many aspects of frames, including various layers of frames, transformations or keyings, frame breaks, and misframing. In addition, Goffman (1981) expands on his analysis of frames, discussing various potential roles held by the participants in an interaction.
Minsky (1975) provides a detailed description of frames, which he defines as “remembered frameworks to be adapted to fit reality” (212). In his discussion of memory and stereotypes of situations, Minsky, like Kuipers (1975), emphasizes the concept of frames as knowledge structures. In fact, he suggests that his definition of frame is similar to Bartlett’s notion of schema (1932). Gumperz also seems to compare the terms frame and schema, as well as the term script, suggesting that all three terms essentially refer to ways in which participants apply world knowledge in order to understand social encounters (1982, 154).
Language provides evidence regarding the way an individual frames an event. Fillmore discusses linguistic frames at the morphemic level, giving an example of a “commercial transaction.” In his example, he describes the various ways in which the transaction can be framed as if there were a camera view of the transaction, emphasizing certain participant perspectives (i.e., merchant’s view versus customer’s view) through the use of such terms as buy, sell, pay, money, merchant, and customer (1976, 13). For instance, to buy a car and to sell a car are two different ways of framing the transaction. Chafe discusses frames in a similar manner, suggesting that frames focus on the individual(s) in an event (i.e., via agent, patient, beneficiary) (1977). As will be seen shortly, both Fillmore and Chafe make a further distinction between the terms frame and schema.
Tannen (1979) and Tannen and Wallat (1983, 1987, 1993) also provide definitions for the term frame. Tannen, who discusses various applications of the terms frame, schema, and script, considers frames to be structures of expectations. In Tannen and Wallat, interactive frames are defined as “a sense of what activity is being engaged in” (1987, 207). The term “knowledge schema” is used to refer to “participants’ expectations about people, objects, events and settings in the world.” Tannen and Wallat seem to suggest that both interactive frames and knowledge schema are dynamic structures of expectations. In more recent work, some have adopted Tannen and Wallat’s notions, while others cite Goffman’s definitions.
Despite some apparent overlaps in conceptions of frame and schema, the term schema has a different history from the term frame. The first reference to schema as a concept of dynamic knowledge structures that function as “active developing patterns” in an individual’s memory is generally attributed to Bartlett (1932). Bartlett defines schema as “an active organization of past reactions, or of past experiences, which must always be supposed to be operating in any well-adapted organic response” (201). Bartlett emphasizes the dynamic nature of these knowledge structures, although as Tannen (1979) points out, not all who followed him have perpetuated that dynamic nature.
Minsky (1975) and Gumperz (1982) seem to see the terms as essentially the same. However, for Fillmore (1976), frames and schema appear to be distinguishable. He suggests that frames activate certain schema. For example, in the sentence “He was on land briefly this afternoon,” the phrase “on land” is described as being part of a frame that implies a counterpart “at sea.” Thus, this frame activates a schema of a “sea voyage” (15). Chafe (1977) also separates the notions of frames and schema. He provides an example of the “bureaucratic runaround” as a schema that includes a purpose, a series of deflections, and a resolution often at odds with the original purpose (43). For both Fillmore and Chafe, the notion of schema includes knowledge that represents a temporal ordering of events.
The concept of temporal order as a knowledge structure has been referred to in the literature by yet another label, script. The term script is attributed primarily to the work of Schank and Abelson (1977), who not only provide a detailed description of scripts but also other knowledge structures, including plans and goals. Schank and Abelson define script as a “standard event sequence” (38). Three types of scripts that they discuss are situational scripts, personal scripts, and instrumental scripts. Each type of script might contain different parts. For example, a situational script can include a track, various roles, entry conditions, and scene sequences. A well-known example of a situational script is the restaurant script. The track in a restaurant script would refer to the type of restaurant, such as a coffee shop or a cafeteria. The roles might include customer, waiter, cashier, owner, and so forth. The entry conditions that are relevant in a restaurant script include the likelihood that the customer is hungry and has money with which to purchase food. Since a script can be seen as a sequence of scenes in which one or more events are likely to transpire, the restaurant script includes the following scenes:
Scene 1. Entering
Scene 2. Ordering
Scene 3. Eating
Scene 4. Exiting
The exiting scene could include such activities as paying the bill and leaving a tip. The scenes are not restricted to a single occurrence. For example, after scene 3, the customer could return to scene 2 by ordering additional food.
Evidence of the existence of the restaurant script can be seen in the following example:
John went to a restaurant. He asked the waitress for a coq au vin. He paid the check and left. (Schank and Abelson 1977, 38)
The use of the definite and explicit referent “the waitress” might be surprising since there is no prior mention of her in the discourse. Schank and Abelson suggest that the earlier reference to “a restaurant” is enough to evoke a restaurant script, in which “waitress” is an expected role. Thus, the use of the definite, explicit referring term is evidence of the existence of the conceptual structure of a restaurant script.
Script, then, appears to exist as one type of knowledge structure. This is true not only of situational scripts, as described above, but also of personal and instrumental scripts. Schank and Abelson describe personal scripts as the sequence of events based on what is in the mind of one participant. For instance, “John” in the preceding example might follow a script resulting from his interest in getting to know the waitress (1977, 62). Since this interest is only truly knowable by John, this is an example of a personal script. Instrumental scripts are those in which a participant engages in a rigid sequence of activities, such as lighting a cigarette or frying an egg (65). While scripts focus on sequences of events, other information, such as props and roles within an event, are also part of the conceptual structure. Several scholars, including Bobrow and Norman (1975), Fillmore (1976), and Chafe (1977), have referred to sequential knowledge as at least one aspect of schematic structures. Thus, it seems likely that scripts could be considered to be one type of knowledge structure, or schema. In addition, Bobrow and Norman suggest that schematic descriptions can include measuring operations and spatial representations.
Regardless of the terminology used to describe them, the constructs addressed in most of the literature on frames, schemas, and scripts can be described as two basic concepts: perspectives and knowledge structures. Perspectives have been discussed as they apply to both activities and participants. Knowledge structures refer to conceptual information such as where an event occurs and how it unfolds. Although these two concepts are distinguishable from one another, the relationship between the two appears to be quite complex.
The term perspective is used here to represent varying points of view. This term seems to be comparable to a construct that is at least a part of most definitions of the term frame. Despite the fact that some broad definitions of frame might include reference to conceptual knowledge, the term perspective specifically refers to the way in which events or participants are viewed.
Perspectives on an event can be multilayered. A good example of the ways that perspectives can frame events is Goffman’s discussion of inner and outer layers (1974). What Goffman refers to as framing an activity is that aspect that allows individuals to perceive fighting as either serious or playful. Regarding participants, there are potentially many different perspectives. For example, Schank and Abelson (1977) discuss the various roles involved in a restaurant script, pointing out that a perspective encompassing all roles is a whole view, whereas other perspectives might represent specifically the view of a customer, a waitress, and so forth. Thus, it is possible to examine an event from either a situational perspective or from the perspective of participants.
Unlike the notion of perspectives, knowledge structures refer specifically to the conceptual information available to an individual. In keeping with most of the work on schema, knowledge structures are dynamic and develop on the basis of experiential input. Structures of knowledge could conceivably take many forms. For example, some of the types of structures addressed in the literature reviewed here include information about settings, objects or props, participants, and sequences of events. This definition is fairly consistent with that in Tannen and Wallat (1987), and shares features with other work, including Goffman (1974), Fillmore (1976), Chafe (1977), and Schank and Abelson (1977).
Although distinguishing the two constructs, perspectives and knowledge structures, can be useful, the problem of how they relate to one another appears to be complex. Three possible relationships include knowledge structures (hereafter referred to as schema) as primary, perspectives (hereafter referred to as frames) as primary, or some type of dynamic interaction between the two as of primary importance. That is, if schema consists of multiple interrelated information that includes participants, props, and so forth, it is conceivable that every schema has a multitude of potential frames from which to approach a given situation. For example, in the schema of a restaurant script, one could take the whole view or the view of any one of the participants. Conversely, if framing an event is crucial to understanding interaction, perhaps every frame is supported by relevant schema. In this case, the frame is of primary relevance, and would activate the appropriate schema. A third possibility is that both of the previous conceptions are true. In other words, every frame might be supported by relevant schema at the same time that every schema includes a multitude of potentially relevant frames. If this is the case, it would seem that every interaction consists of a dynamic and continuous negotiation of relevant frames and schema, each of which reflects and contributes to the presence of the other. Though complicated, the interactive view seems to make sense intuitively and could explain why these concepts have received mixed and overlapping discussion in the past.
An attempt has been made here to clarify the constructs underlying the use of the terms frame and schema. Despite overlaps in conceptualizations of these constructs as applied to the terms, two basic concepts are identifiable—knowledge structures and perspectives. In order to avoid confusion by delineating new terms to refer to these concepts, in this study, the term schema refers to knowledge structures, conceptions of people, events, and so forth. Frames will refer to perspectives, which can be a particular view of an event or of participants. This distinction between frames and schema should be identifiable on the basis of linguistic evidence. For instance, with regard to the example of a restaurant script discussed earlier, reference to “the waitress” evokes at least one interrelated schema and frame. The use of this reference evokes a schema (the knowledge structure), relating to restaurants; the people (waitresses and waiters, customers, cooks), the events (entering, ordering, eating), and so forth. At the same time, use of the term “the waitress” also evokes a particular frame (particular view of the events or participants); the perception of the restaurant is that of a “sit down” place of business rather than a cafeteria. Once this frame has been evoked, the relevant schema immediately come into play, identifying the relevant events, participants, and so on to this frame (such as menus, for example).
An analogy from the stage can help to demonstrate the distinction, as well as the interrelationship of these terms. In a particular scene in a theatrical script, a director can frame the scene in any one of numerous ways by providing signals that evoke the desired schema from the audience. For instance, if the scene consists of a female and male actor involved in a discussion, the words in the scene could be framed as either suspicious and dangerous, or romantic and happy by using dark or bright lights, and low-pitched, slow music versus light, up-tempo music. The use of particular lighting and music causes the audience to retrieve certain schema related to the appropriate frame. Conversely, on the basis of their schema, the interaction will be framed in one way or the other. The audience is likely to develop expectations regarding the sequence of events about to unfold, as well as each character’s role within them, on the basis of the interaction between their frames and schema. This distinction between the terms is the one that will be applied to interpreted interactions.
Frames and Schema in Interpreted Interaction: Mock Medical Encounter
The interpreted role play of a medical encounter can be analyzed in terms of the framing of the activity, and the evidence of the schema underlying the frames. Evidence from the role play suggests that the layers of framed activity include at least three laminations of the inner activity: interpreting. Interpreting is seen as the most central activity, because without it the speech event would likely not continue. In addition, the purpose of the activity is for the student to interpret. Despite the fact that this is a mock encounter, the student truly is interpreting, since the Deaf and hearing interlocutors are depending on her in order to communicate their parts in the role play.
The next layer of activity is the medical encounter, and most of the discourse includes medical discussion and treatment options. The medical encounter is transformed by the third layer, the role play. Goffman (1974, 58–59) describes these types of keying as technical redoings, being engaged in for the purpose of skills development. Finally, the outermost layer is “a class.” This layer is primarily evident through the bracketing at the beginning or end of the role play, and will not be discussed here. Nevertheless, it is important to recognize the existence of all the layers in order to analyze the interaction between these frames and their underlying schema (see figure 3.1). The data suggest that each participant shares these frames for the activity at hand. However, there is also evidence that the participants do not always share the same schema for these frames.
Role-Play Frame
There is very little evidence of the role-play frame in the mock medical interview. There are no explicit references to the fact that this is a practice event. Possibly the only evidence suggesting that this is not an actual medical event is found in the doctor’s slowed prosody and false starts when responding to a medical question for which she does not necessarily have the technical knowledge.
Figure 3.1. Frames within mock medical encounter.
In example 3.1, the patient has just asked the doctor to explain what an ulcer is. Lines 10–11 include part of the doctor’s response:
Example 3.1
10
Doctor: What’s happening is, in your stomach?
11
The, uh, digestive enzymes actually attack … the di—the—
… the lining.
Although it is possible that a real medical doctor would hesitate when explaining a medical concept in lay terms, presumably the woman playing the doctor does not have medical training. Thus, the hesitation, false starts, and repairs suggest that she is “ad-libbing” in the role-play frame, as though searching for an answer to the question.
The woman playing the role of the doctor could have responded in many ways. If she did not possess the information necessary to respond appropriately, she could have said so, which would break the medical interview frame since most doctors would have this information. In addition, she could have referred the patient to another source, which might also represent unusual behavior on the part of a doctor. She also might have used an explicit frame bracket to temporarily exit the role-play frame (Hoyle 1993). For instance, she might have said, “Time out. I can’t really answer that question.” However, the fact that she responds as she does suggests that she prefers to be consistent within the role-play frame and does not want to break it. The doctor’s response in example 3.1 also provides some information about the schema she brings to this frame. She apparently has a schema regarding the appropriate response from a doctor (perhaps a medical interview script).
It is interesting to note that the slowed prosody, pauses, and selfrepairs in the preceding example are the only evidence of the role-play frame. All of the participants appear to take the exercise very seriously. Whether or not their serious treatment of the role play allows them to successfully replicate an actual medical encounter remains to be seen, however. It would be interesting to study the effectiveness of role playing as a training strategy for interpreters.
Medical Interview Frame
That the encounter has been framed as a medical interview is evident through certain linguistic signals that are relevant to the appropriate schema. It is not clear whether the medical interview frame activates the relevant schema, whether the schematic signals activate the medical interview frame, or some other interaction between the two. Nevertheless, the occurrence of the features discussed here indicates that the encounter has been framed as a medical interview. Because there are no interruptions or other conflicts in the discourse, the participants seem to share similar schema as well. This schema includes, for one thing, a medical interview script, consisting of at least some of these basic scenes:
1.Opening
2.Medical history
3.Examination
4.Diagnosis
5.Consultation
6.Medical advice
Scenes 1, 4, 5, and 6 occur in the role play. The medical interview is considered to be a recheck after a prior visit approximately one week before. Therefore, scenes 2 and 3 are not included in the data, although reference is made to an “upper GI” test supposedly performed at an earlier date.
The unfolding of this script, as well as the topics and question-answer sequences within the interview, provides evidence of the medical interview frame. The doctor initiates the opening of the medical interview by the doctor asking the patient about his current state of health:
3
Doctor: And how are you feeling this morning?
After a brief response to this information-seeking question, the doctor presents a diagnosis on the basis of previous test results in lines 6 and 7 below:
Example 3.3*
6
P:
D: Well your test y’know, you remember, the =
I: = but the medicine has helped a little.
I: YOUR =
7
P: PRO.1 NERVOUS PRO.1 =
D: = upper GI that you had last week…did show that you have an ulcer, so, th- there is a problem.
I:
I: = TEST PRO.1 REMEMBER TEST LAST-WEEK? U-L-C-E-R G-I
8
P: = PRO.1 NERVOUS PRO.1
D:
I: yeah, I’m nervous.
I: PRO.1 PROBLEM ANSW- RESPONSE SAY =
9
P: HAVE? HAVE? U-C-L (pause) WHAT U-L-C?
D:
I: Oh, I have I have an ulcer? Um, what’s that exactly?
I: = WHAT? HAVE U-L-C-E-R HAVE.
*In this example, and most of the examples from the mock interview, the following abbreviations will be used: P = patient, D = doctor, N = nurse, I = interpreter.
The deaf patient responds to this with a request for information about ulcers in line 9. By doing so, he has indicated that the doctor has medical information that he does not. This moves the interview out of the diagnosis phase and into a consultation phase, in which the doctor and patient discuss the meaning of the diagnosis. The doctor then moves into the advice stage of the interview by recommending a dietary change:
Example 3.4
25
D: Uh, I do have a list of, uh, food that I’d like you to … try to stick to
The doctor subsequently describes the recommended dietary changes for the patient. At one point during the encounter a woman’s voice requests that the doctor tend to an emergency. Thus, the mock medical interview even incorporates a “Waiting for the Doctor” scene likely to occur in a medical interview script.
Evidence of the medical interview frame includes topics, question-and-answer sequences, and the unfolding script of events. The mock medical interview itself appears to run relatively smoothly. This seems to suggest that all the participants frame this encounter as a medical interview, and share schema similar enough to support that frame with limited repair or renegotiation. One reason for this could be the commonality of medical interviews. Most people living in the United States are likely to share some semblance of a medical interview script. The fact that all three participants have access to this similar schema would conceivably contribute to the smooth nature of the interaction. Another potential explanation for this could be the fact that neither the doctor nor the patient have a real-life vested interest in the medical part of the encounter. So far, it appears that the role-play frame and the medical interview frame are based on schema shared by the participants. However, both of these frames are outer layers of the activity at hand. Because the innermost activity appears to be the interpreted encounter itself, it is interesting to note some mismatches that occur within the interpreted encounter frame.
Analysis of the data indicates that all three participants share an interpreted encounter frame; that is, all three participants frame this interaction as an interpreted one. However, each participant seems to have a different schema regarding interpreted encounters. Examples of the mismatch between schemas are discussed below.
Evidence that all three participants frame this event as an interpreted encounter can be seen in example 3.5. This example occurs at the beginning of the interaction, just prior to the initiation of the medical interview itself. All three participants are already seated when the interpreter introduces herself:
Example 3.5
1
P:
D: Oh, you’re the interpreter for today.
I: … and I’m gonna be the sign lang- language interpreter for today.
I: … POSS.1 SIGN LANGUAGE INTERPRETER LANGUAGE NOW. PRO.1, PRO.3, PRO.1 OH INTERPRETER= I’ll be the sign language interpreter- language for today. I- she said, “Oh, I’ll be the =
2
P: (nods)
D: It’s nice to meet you.
I: Thank you, it’s nice to meet you too.
I: NOW PRO.1, #OK #OK. PRO.1- NICE TO MEET PRO.1 THANKS NICE MEET-TO (doctor) SAME. interpreter for today, oh okay.” It’s nice to meet me. Thanks, it’s nice to meet you, too.
In this segment the interpreter introduces herself, and the doctor acknowledges her presence by repeating, “Oh, you’re the interpreter for today.” The interpreter has chosen to simultaneously sign and speak her initial utterance, and she interprets the doctor’s response. At that point, the patient nods, apparently affirming or agreeing with the recent propositions.
Although all three participants seem to frame this as an interpreted event, there is evidence that each has a different schema regarding the interpreter’s role within that event. The doctor appears to view the interpreter as a third participant who is a professional expert. This can be seen from the doctor’s utterances that are directed at the interpreter, including those in lines 1–2 above in which the doctor acknowledges and greets the interpreter as one might greet a colleague. Evidence that the doctor sees the interpreter as a professional expert can be seen in line 22 below, in which the doctor interrupts her explanation to the patient, turns to look at the interpreter, and asks her how to sign something:
Example 3.6
21
D: It’s only serious if we put it off and don’t treat it,
22
and just ignore the problem … (gaze shift to interpreter) what is—is there a sign for ulcer?
This particular word, ulcer, has already been the topic of the discourse for some time. Hence, it does not appear that the doctor is asking this question as a part of the doctor-patient interaction per se. It is possible that the woman asks this question “in the character” of the doctor. It is also possible that she is simply curious for her own personal reasons, having nothing to do with the role play per se. The doctor could also be asking as a move to include the interpreter, who has not participated for some time. Nevertheless, the fact that the doctor requests this information from the interpreter rather than the patient (who is a native signer) suggests that her conceptualization of the interpreter is as a professional expert who can provide the information in response to her question. Even if the woman believes that the Deaf patient is equally capable of answering the question, but, perhaps, feels that asking the interpreter removes one step from the process and saves time, she is still treating the interpreter as an expert capable of supplying the information.
The interpreter’s schema regarding her role as an interpreter appears to differ, however. The interpreter seems to view her role as a service provider who would prefer not to be involved in the doctor-patient dyadic interaction. For example, when the doctor speaks to the interpreter directly, attempting to ratify her as an addressee, she rejects the attempt. This can be seen in example 3.7 below, in her response to the doctor’s question:
Example 3.7
22
P
D: What is- is there a sign for ulcer?
I:
I: PRO.3 PRO.1 SIGN =
She asked me, “Wbat’s your sign
23
P: (hand flip)
(Whatever.)
D: No, huh? Oh, okay =
I: Umm …
I: FOR U-L-C-E-R PRO.2?…ASK-TO (interpreter) QUESTION. NO SIGN? ASK TO (interpreter)
for ulcer.” She asked me a question. There isn’t one? She asked me.
24
P: UM, PRO.1 UH U-L-C-E-R
Um, I just spell it.
D: = Well, at any rate, um I do have a- I have a list of- Oh, okay.
I:
I: Um, yeah, you can just fingerspell it. #OH#OK#OK
P:
D: Uh, I do have a list of uh, food that I’d like you to … try to stick to—
I:
I: HAVE LIST FOOD RIGHT =
Although the doctor has directly addressed the interpreter, who does, in fact, know the answer to the question, the interpreter does not comply with the request for information until she successfully elicits it from the patient. The interpreter’s and the patient’s utterances in line 23 occur only in ASL, and during this period of silence there is an empty slot in the question-answer pair that occurred in the English dialogue (Schegloff and Sacks 1973). The doctor attempts to fill the slot in line 23, but, with no compliance from the interpreter, resumes the interview frame in lines 23–24, introducing a list of food for the patient to eat. While the interpreter has not responded to the doctor, she has not remained “silent” either. Her response to the doctor’s question can be seen in lines 22–23; she explains to the patient what has just occurred. Her explanation consists of a statement, rather than a question. The interpreter does not present the first part of an adjacency pair to the Deaf patient. Moreover, the interpreter’s explanation does not indicate whether or not she has answered the doctor’s question. Consequently, the patient cannot know there is an empty slot in the spoken discourse. Not surprisingly, there is no response from the patient. Because the interpreter persists with this strategy, repeating her statement and not relaying the doctor’s return to the interview, it appears that the interpreter’s goal is for the patient to respond to the request directed at the interpreter. The interpreter’s schema of the interpreter’s role seems to reject the notion of interpreter as interacting with the hearing doctor, while allowing some interaction with the Deaf patient. If it is within her schema that the patient should respond to the request, and she is assuming that the patient shares her schema, then her utterance in lines 22–23 makes sense. The explanation would be enough information for the patient to either provide the information or explain to the doctor that she should address such questions to him, and not to the interpreter. The long silences, overlapping talk, and interruption in this segment indicate that the three participants do not share the same expectations at this point in the interpreted encounter.
Although the interpreter appears to be unwilling to accept the role of ratified addressee when initiated by the doctor, it is interesting to note that her responses to the patient’s attempts to treat her as a ratified addressee are not quite the same. However, as can be seen in both the previous and the following examples, the interpreter does not actually comply with either of the other participants’ requests. This supports the contention that her schema regarding the interpreter’s role is different from that of either participant.
The patient’s view of the interpreter seems to represent a third schema regarding the interpreter role. The patient seems to view the interpreter as a potential participant and advocate. During the medical interview itself, the patient does not attempt to engage in conversation with the interpreter. However, when the doctor leaves the room, the patient immediately begins a dialogue with the interpreter, requesting advice, checking on information provided by the doctor, and asking the interpreter for assistance. This can be seen in the translation of lines 28–36 below (see appendix 3 for the full transcript of these lines):
Example 3.8
28
P: Hey, what do you think I should do? She says I have an ulcer but …
29
I don’t believe her. She’s just making it up.
30
I: I think you better talk to her. I really don’t know anything about ulcers.
31
P: [She’s just
making it up. I don’t trust her … hmm, is an ulcer really what she said it is?]
33
I: I just don’t know much about ulcers, it’s better to ask the doctor.
34
P: Ask the doctor? I can’t ask the doctor. I don’t trust her. Ugh, doctors … it’s so
35
awkward, no way, I can’t ask her. Could you ask her? Could you? Um-
36
I: I’d be happy to interpret any questions you might have. (Doctor reenters.)
When the patient asks the interpreter for advice, in line 28, the interpreter responds to the patient, but does not comply with his request and refers him back to the doctor. Similarly, in line 32, the patient asks the interpreter to confirm the accuracy of the doctor’s information regarding ulcers. Again, the interpreter does not ignore the patient, but does not comply with his request either, referring him to the doctor. Finally, in line 34, the patient asks the interpreter for assistance in asking the doctor for information. For the third time, the interpreter does not comply. This time she responds by indicating that she would be more than happy to interpret, thus, affirming that she will not comply with the patient’s request. In this segment, the interpreter’s schema is one of professional service provider, while the patient’s schema is that of advocate.
It is interesting to note that a discussion of this situation occurred among the role-play participants immediately following the activity. The teacher of the class indicated that the student interpreter provided the kinds of responses that she was being trained to provide (personal communication). However, the Deaf “patient” was very upset with the interpreter’s way of handling his questions. He seemed to feel that he was not being supported by the interpreter. This supports the possibility that he and the interpreter have different schema regarding what kind of “support” an interpreter should provide. Perhaps, if the interpreter could find responses more compatible with a Deaf interlocutor’s framing of the interpreted encounter, the conflict could be avoided. It would be interesting, in future research, to determine the effect of various interpreter strategies in such a situation.
That the three participants’ perspectives regarding the role of the interpreter differ could indicate one of at least two possibilities. Either the participants do not share the frame “Interpreted Encounter,” or the event is framed the same way, but the participants do not share the same schema for that frame. Although it might appear to be difficult to distinguish between these two possibilities, it is relevant in a practical sense; if there is a problem resulting from the differences, and the differences are based on the framing of the event, one need only inform all participants of the appropriate (or at least a common) frame so that the event can proceed. If on the other hand, the problem lies within differing schema, simply explicating the interpreted encounter frame (i.e., “This is an interpreted encounter”) will not resolve the underlying problem. Rather, more detailed education and demonstration of interpreted encounters would be necessary to rectify the situation. On the basis of this distinction, this analysis indicates that the participants share the Interpreted Encounter frame, but do not share a common schema.
Frames and Schema in Interpreted Interaction: Actual Medical Encounter
In the mock medical encounter, both the hearing and Deaf participants have had at least some exposure to, and experience with, interpreted interactions. However, many Deaf and hearing people spend only a fraction of their time, if any, in interpreted encounters. Conversely, interpreters spend most of their professional time in situations with Deaf and hearing people who are in a position to communicate with one another. In the actual medical encounter under examination here, the Deaf person has had experience with interpreters. However, the hearing doctor generally interacts with Deaf patients via paper and pencil: he has had limited experience with interpreted medical interviews. Thus, it is interesting to determine what frames and schema the participants bring to the actual medical encounter, and how this compares to the frames and schema evident in the mock medical encounter. Unlike the student interpreter, the professional interpreter under examination here is performing in a situation involving an actual doctor and nurse (both hearing) as well as a Deaf mother with her sick, hearing baby.
Figure 3.2. Frames within actual medical encounter.
Evidence from the actual medical encounter suggests that the central activity here is the medical interview. Although the presence of the interpreter has a profound impact on the nature of the interaction, if no interpreter were available, the doctor and patient would likely have found an alternative means of communication. The doctor indicated that he had rarely worked with interpreters and that he typically communicated via paper and pencil with Deaf or hard of hearing patients.
At least three laminations of the medical interview are identifiable. First, the medical interview is framed as a pediatric examination. The pediatric examination is framed as an interpreted encounter. The outermost layer of activity is the research study. The four layers of activity within the encounter can be seen in figure 3.2. The data suggest that each participant shares these frames for the activity at hand. However, evidence also suggests that only some of the participants share the same schema for these frames.
Medical Interview Frame
Evidence regarding the medical interview frame is easily identifiable on the basis of the medical interview script, through the unfolding of this script via topic and question-answer sequences. Unlike the mock medical interview, in which only certain scenes were identifiable, the actual medical interview clearly contains aspects of all six scenes (repeated below for convenience) considered basic to a medical interview:
2. Medical history
3. Examination
4. Diagnosis
5. Consultation
6. Medical advice
While all six scenes are identifiable within the data, they do not necessarily occur in isolation from one another. Frequently, there is overlap between or among the various scenes. For example, the nurse, primarily, carries out the “opening” and “medical history” scene within the medical interview as she measures the baby’s temperature and weight while seeking information about his shot records. Nevertheless, when the doctor enters, he is also interested in the medical history, as can be seen in lines 41 and 42 below:
Example 3.9*
41
M:
D: I walk in (?) big crowd! Is he sick?
N:
C:
I:
I: LARGE MANY-PEOPLE C-R-O-W-D HERE PRO.3 SICK PRO.3?
42
M: B-E-E-N SICK SO-SO UP-&-DOWN FOR ONE-WEEK NOW, FIRST STOMACH
D: Tell me what’s wrong. With what, =
N:
C:
I: Yeah he’s been sick off and on … for about a week now.
I: (waves for attention)
*In this example and most of the examples from the actual interview, the following abbreviations will be used: M = mother, D = doctor, N = nurse, C = child, I = interpreter.
In this example, the doctor initiates the topic (as well as a recent medical history) by asking, “Is he sick?” When the response is affirmative, the doctor elicits medical information with the utterance “Tell me what’s wrong.” Thus, the doctor initiates a medical history scene after one has been in progress with the nurse. Analysis of this type of scene overlap indicates that the medical history elicited by the nurse is a less recent and more generic kind of information, whereas the doctor elicits information about the recent history leading up to the current medical interview. In a similar way, throughout the medical encounter, each participant focuses on various aspects of the medical interview script, allowing the scenes to overlap and interweave throughout the course of the interview. The fact that these scenes share such an intricate and interdependent relationship could cause interactional problems. As in the case of the mock medical interview, the smooth running of the interview and the limited repair or renegotiation within the encounter indicate that all of the participants share a similar schema for medical interviews. Thus, linguistic evidence supports the existence of not only the medical interview frame, but also of the similarity of related schema.
Pediatric Examination Frame
Additional linguistic evidence, like the use of third-person pronominal reference and switches in linguistic register, indicates another layer to the medical interview: the pediatric examination frame. The use of indirect pronominal reference while speaking to one individual often indicates that a third party is being talked about. Schiffrin (1993) discusses situated meanings associated with the converse phenomenon, when one individual speaks for another. In her discussion, Schiffrin indicates that, depending on the circumstances, speaking for another can be viewed as either respectful or condescending to the party that has been spoken for. For example, Schiffrin points out the difference between when a secretary frees up her boss by making a phone call for him or her, and when “parents arrange play dates for their children who do not yet have the communicative competence to do so themselves” (235). Just as there are situations for which one individual speaks for another, there are situations during which individuals speak about one another. As Schiffrin’s example illustrates, interacting with a child who does not have the communicative competence to respond is one such situation.
In the medical interview, the sick patient is a child. Undoubtedly, because of the patient’s age, the doctor does not attempt to speak with him directly. Instead, the doctor speaks about the child in order to elicit the necessary information from his mother. The nurse also frequently refers to the child indirectly, as in the following example:
Example 3.10
2
Nurse: Let’s put him on the scale
Clearly, the nurse is not speaking directly to the patient in this example. Such indirect references are made throughout the interview. The use of third-person pronominal reference indicates that the patient’s ability to communicate directly is in question and thus represents at least one feature of a pediatric examination frame. However, there are numerous reasons that a patient might not be competent to communicate well during a medical interview. For instance, the patient might not be fluent in the language of the interview, or a drug or disease might influence the patient’s ability to communicate. Hamilton (1994) discusses how an Alzheimer’s patient’s ability to communicate effectively can be hampered. For example, the patient might have an inability to distinguish information that is shared by an interlocutor from information that is new to the interlocutor. Hamilton makes the point that interactional responsibilities do not fall solely on the person whose communicative competence is in question. It is important to remember that supposedly “normal” communicatively competent individuals often contribute to interactional difficulties. Clearly, it is useful to examine additional linguistic features that signal that this medical interview can be framed as a pediatric examination. One such feature is linguistic register.
Linguistic register refers to language “varieties according to use” (Halliday, McIntosh, and Strevens 1964). According to Tannen and Wallat (1993), lexical, syntactic, and prosodic choices made with regard to addressees and the situation at hand are important indicators of frames. In their analysis of a pediatric examination, Tannen and Wallat (1982, 1983, 1987, 1993) identify various registers used by the pediatrician, including a conversational register with the mother and a teasing register or “motherese” used with the child. They describe the teasing register as distinguishable from the conversational register, indicating that it consists of “exaggerated shifts in pitch, marked prosody (long pauses followed by bursts of vocalization), and drawn out vowel sounds” (1993, 63). The teasing register is reported to occur during parts of the pediatric examination. For instance, during examination of the patient’s ears, the doctor playfully implies that she is searching for different animals. The presence of a similar teasing register in the interpreted medical encounter serves as additional evidence of the pediatric examination frame.
The use of the teasing register can be seen throughout the interpreted medical interview. During examination of the patient’s ears, the nurse (like the pediatrician in Tannen and Wallat’s analysis) pretends to search for different creatures. This can be seen in example 3.11 below:
Example 3.11
86
N: Aw, sweetheart.
We’re just looking to see—maybe Barney’s in there,
y’know? (-?-). No, Barney’s not in that ear today.
In this example the nurse playfully indicates that they are looking for Barney, a character in a children’s television program, in the child’s ear. Many of the vowels are elongated, and the nurse utters this with tremendous pitch variation. It is interesting to note that the teasing register is produced primarily by the nurse, and that the doctor never speaks to the baby at all. The pediatrician is juggling and balancing multiple frames, and it can be a burden on the physician to put the child “on hold” (Tannen and Wallat 1993, 68) while consulting with the parent and vice versa. In the interpreted medical encounter, the doctor and nurse might have accepted responsibility for managing different frames in an effort to reduce the doctor’s burden. If that is the case, it might explain why the doctor does not speak to the child. It would be interesting to examine the same doctor and nurse with a variety of patients in order to determine if the observations made here are typical or not. It is conceivable that the doctor is experiencing extra burdens as a result of the interpreted encounter and research study frames addressed below.
Examination of linguistic features indicates an additional lamination of the medical interview frame. Participants’ use of register shifts and of third-person pronominal reference with regard to the patient indicate that this medical interview has a layer that distinguishes it from other types of medical interviews. These linguistic features provide evidence of the pediatric examination frame. Due to the fact that there are no occurrences of major repairs or renegotiations, the participants appear to share similar schema regarding the pediatric examination frame.
Interpreted Encounter Frame
Analysis of the data indicates that all the participants frame this event as an interpreted encounter. Nevertheless, as in the case of the mock interview, there is some evidence that not all participants share the same schema regarding interpreted encounters. Unlike the mock medical interview, in the actual medical interview the Deaf participant and the interpreter appear to share similar schema regarding an interpreted encounter. Similar to the mock interview, this schema does not appear to match the schema of the medical care providers. Evidence of the unanimous existence of the interpreted encounter frame, as well as of the mismatches in schema, is shown in the following examples.
Primary linguistic evidence regarding the medical providers’ interpreted encounter frame can be seen in the use of the third-person pronoun. Both the doctor and nurse frequently refer to the mother in the third person, and often add imperatives for the interpreter to direct comments to the mother. In the example 3.12, the nurse has just asked if the mother has brought the child’s shot records:
Example 3.12
14
N: Just tell her we’d like to have them, because if she needs any forms or anything filled out, we need to have the dates.
In this example, the nurse clearly recognizes that she is not speaking directly to the Deaf woman. That is, by asking the interpreter to “tell her” the message, she has demonstrated an awareness that this is an interpreted encounter. The doctor makes similar reference in the example below:
Example 3.13
85
Doctor: Ask her to just hold his knees.
In this example, as in the previous one, the use of third-person reference serves as evidence that the speaker frames this as an interpreted encounter. Clearly, the doctor is aware that he is not communicating directly with the child’s mother. The fact that both the doctor and the nurse make use of third-person pronouns when communicating with the mother not only indicates that they share the interpreted encounter frame, but also that they share a similar schema for that frame; that they are communicating with the Deaf mother indirectly. In contrast to this, neither the Deaf participant nor the interpreter seem to share this schema, despite the fact that there is evidence that both also frame this as an interpreted encounter.
Unlike the mock interview, the actual medical encounter contains no introduction or explanation regarding the interpreter and her presence. Nevertheless, the interpreter’s utterances primarily consist of retellings of what interlocutors have recently said. Primarily, these retellings actually include the first-person pronoun, although the interpreter clearly does not mean to refer to herself, as in the following:
Example 3.14
52
M: PRO.3 START VOMIT =
D: = times did he vomit from the time it started.
N:
C:
I:
I: = MANY- HOW OFTEN VOMIT. START SICK, VOMIT, HOW OFTEN?
53
M: = TUESDAY NIGHT, FINISH BY WEDNESDAY AFTERNOON … FINISH
D: Okay.
N:
C:
I: He started vomiting Tuesday night, and finished Wednesday late afternoon.
I: #OK
54
M: VOMIT EVERY TIME PRO.1 TRY GIVE PRO.3 (neutral) SOMETHING VOMIT … #SO =
D: And the fever’s -
N:
C:
I: And he threw up, um, and every time he threw up I tried to give him something, SO: =
I:
The interpreter has never met the Deaf woman or her child prior to arrival at the doctor’s office. Obviously, the interpreter does not mean that it was she herself who cared for the sick child on Tuesday and Wednesday. In this case, the first-person pronoun is used to refer to another participant, which indicates that the interpreter frames this event as an interpreted encounter. Further, the use of the first-person pronoun suggests a possible mismatch from the related schema evidenced by the doctor and nurse. The interpreter’s schema for an interpreted encounter seems to be one of direct communication between the interlocutors, despite the fact that the interpreter is conveying the utterances for them. Hence, the interpreter’s use of first-person reference is intended to apply to the original speaker (in this case, the signer) rather than to the interpreter herself.
A repair initiated by the doctor immediately following the previous example provides further evidence for the existence of this mismatch in schema between the medical practitioners and the interpreter:
Example 3.15
54
M: VOMIT EVERY TIME PRO.1 TRY GIVE PRO.3 (neutral) SOMETHING VOMIT … #SO =
D: And the fever’s -
N:
C:
I: And he threw up, um, and every time he threw up I tried to give him something, so: =
I:
55
M: = PRO.1 GIVE-UP … E-V-E-N L-I-Q-U-I-D-S PRO.1
D: You (points to interpreter) tried or she (points to mother) tried?
N:
C:
I: = I don’t know: I- (looks at doctor) I tried =
I: (waves)
M: PRO.1 ++ (glances to interpreter) NO (taps doctor’s arm) PRO.3 INTERPRETER-
D:
N:
C:
I: = to give him liquids too.
I: (taps mother’s knee) PRO.1 TRY OR PRO.2 TRY?
57
M: = LET PRO.1 EXPLAIN. WHEN INTERPRETER TRUE INTERPRET, PRO.3 WILL =
D:
N:
C:
I: = Now let me explain. When the interpreter is interpreting, she will be speaking =
I:
58
M: = BE TALK A-S I-F PRO.3 NOT I-N ROOM PRO.3. TALK FOR PRO.1, #SO (?off screen)=
D:(chuckles) Okay,
gotcha.
N:
C:
I: = as if, she’s not in the room. She’s speaking for me. So, if it =
I:
59
M: = CONFUSE TRUE TALK PRO.1, A-S I-F PRO.3 PRO.1
D: I’m just interested in the pronoun, that’s all.
N:
C:
I: = confuses you, the interpreter’s really speaking as if-
I:PRO. 1 (REALLY) INTEREST =
M:#OK PRO. 1
D:You’re not taking care =
N:
C:(cries)
I: = WORD “I” (i on chest) PRO.3 (left hand) I (i on chest)
61
M: NO PRO. 1 RECENT MEET- (interpreter) #HER FIRST TIME =
D: = of him, you’re just interpreting.
N:
C:(crying continues)
I: I just met =
I: NOT PRO.1, PRO.1 NOT TAKE-CARE -
62
M: = NOW.
D: okay I’ve been in practice thirty-five years, I’ve =
N:
C: (screams then crying stops)
I: = her for the first time today, so
I: #OK PRO. 1 … PRO.1 WORK++ =
The doctor initiates the repair in line 55, when he tries to clarify the interpreter’s first-person pronominal reference. He supplements his own pronominal reference in this case with gestures, indicating exactly who is the referent of the second- and third-person pronouns.
The doctor’s gestures indicate that he, in accordance with his apparent schema, is directing his comment to the interpreter (the referent of the second-person pronoun) and not to the Deaf woman. Similarly, the interpreter’s utterances support her apparent schema of interpreted encounters as direct communication between the noninterpreter participants. Thus, she retells each interlocutor’s utterances without any attempt to initiate an explanation of her own. As in the case of the student interpreter, the professional interpreter’s goal seems to be for the Deaf participant to respond, rather than to accept the status of ratified addressee. The Deaf woman’s utterances indicate that, unlike the patient in the mock medical interview, she shares the interpreter’s schema of what an interpreted encounter entails. That is, the Deaf woman not only understands the doctor’s request for clarification, but she immediately responds to that request without any hesitation or expectation that the interpreter will also respond. She apparently trusts that the interpreter has continued to provide her with “direct” communication with the doctor. It is interesting to note the doctor’s metalinguistic awareness in this example. In line 59, he himself indicates that his confusion is related to the issue of pronominal reference.
In the actual medical encounter, the fact that all participants share the interpreted encounter frame is similar to the findings regarding the mock medical interview. Moreover, the professional interpreter seems to share a similar schema with the student interpreter regarding this frame: that the interpreter is a service provider who prefers not to be involved in the doctor-patient “dyadic” interaction. Unlike the mock medical interview, in the actual medical interview, the doctor does not provide evidence of a schema in which the interpreter is a professional expert and colleague. Conversely, in lines 60–61 it becomes clear that the doctor’s schema regarding the interpreter has been that she is a caretaker of the patient. Finally, although the Deaf patients in each interview frame the events as interpreted encounters, the Deaf patient in the mock interview demonstrates a distinct schema of the interpreter as advocate, whereas the Deaf patient in the actual medical interview shares a schema with the professional interpreter. Thus, although the fact that there are differing schema among the participants is true in both interviews, the nature of the mismatched schema is not the same.
Research Study Frame
The fact that the actual medical interview can be framed as a research study frame is evident through explicit reference to aspects of the event or to the researcher herself. The timing of these comments indicates that the participants not only share the frame for the event, but also that they share similar schema regarding the research study frame.
Of the participants in the actual medical encounter, the nurse provides the least amount of linguistic evidence of the research study frame and related schema. There are only two types of evidence that the nurse provides: comments regarding unusual aspects of the medical interview and limited interaction with the researcher or her camera. These two types of evidence provide only a limited indication of whether or not the nurse frames this event as a research study. As an example of the former, the nurse comments on the fact that the room really isn’t big enough. The room is regularly used for medical interviews and is, thus, taken as big enough for a doctor, nurse, parent, child, as well as medical equipment such as a scale and sink. However, during data collection, this room houses an interpreter, a researcher, and a video camera as well. Thus, she comments in the example below:
Example 3.16
19
N: (enters) ’Scuse me. This room isn’t really big enough, we looked
for a larger room but we didn’t have one available, so.
This comment addresses the fact that the room is overcrowded. It does not indicate the reason for that overcrowding, however. The nurse might make a similar comment with the additional presence of an interpreter or extended family members, even without the presence of a researcher. Thus, although this comment provides some evidence regarding conditions imposed by the research study (overcrowding), it is not sufficient to indicate that the nurse frames this event as a research study. Nevertheless, it is interesting to note that the nurse directs only one comment to the researcher, when her video equipment is in the way of the scale. The comment is made without the nurse making eye contact with, or glancing in the direction of, the researcher.
In example 3.17 the nurse is about to weigh the child. The video camera case is at the end of the table containing the scale, and the nurse reaches to move the camera case while commenting:
Example 3.17
2
Nurse: I’m gonna move this for a second so he doesn’t kick it for you.
The nurse does not look at the researcher, nor does she change her voice quality or prosody in any marked way. Nevertheless, since the camera case belongs with the camera being operated by the researcher, it seems likely that the referent of the second-person pronoun (and hence, the addressee) is the researcher. Aside from the contextual information regarding ownership of the camera case, there is no evidence that the nurse is addressing the researcher. In fact, it is entirely possible that the nurse does not recognize the case as a camera case, or does not know or believe that it is the researcher’s. Given this possibility, there is no way to tell for certain who is the intended addressee of her utterance.
On the basis of the fact that the nurse interacts directly with all other participants, this example serves as additional evidence that the nurse frames this as a research study, and that her schema regarding such studies is that the presence of the researcher should be downplayed or ignored. Although the evidence demonstrated by the nurse is somewhat limited, evidence from other participants indicates that the doctor, the interpreter, and the mother frame the medical interview as a research study.
Like the nurse, the doctor comments on the crowded conditions of the examination room:
Example 3.18
41
Doctor: I walk in (-?-) big crowd!
During the medical interview, the doctor does not direct utterances to the researcher. However, he does address the researcher at the end of the interview:
Example 3.19
226
Doctor: You’ll know it all. You keep cornin’ here, you’ll become an expert.
Thus, the doctor indicates with this utterance that he is aware of the researcher’s presence and that his schema allows him to talk with her. However, similar to the schema suggested by the nurse’s lack of communication with the researcher, this utterance indicates that the doctor’s schema regarding research studies is that the researcher should not be a part of the primary medical interview frame. The timing of the doctor’s utterance suggests that it might be intended as a form of frame bracketing, occurring only after the medical interview frame has reached completion.
The timing of utterances addressed to the researcher also serves as evidence of the frame and schema held by the interpreter and mother. It is important to note that the researcher is operating the video camera. As a result, she is not visible in the data collected. Nevertheless, her signed utterances are recognizable in part as a result of the mother’s and the interpreter’s eye gaze. When the researcher produces an utterance in ASL, the mother and interpreter can be seen to glance in the direction of the camera. The following example occurs during the initial part of the medical interview run by the nurse. Just prior to this example, the researcher has signed an utterance to the interpreter, asking her to move into view of the camera. However, the interpreter does not respond to this utterance until the nurse leaves the room:
Example 3.20
32
M:
N: Doctor should be in in just a few minutes (exits)
I: (to researcher) Wha’d you say?
I: DOCTOR COME FEW MINUTE
Throughout the interview, the interpreter interprets all the participants’ utterances (English to ASL or ASL to English). It follows that if the researcher produces an utterance in either English or ASL, the interpreter would also interpret her utterance. The interpreter does not do that, however. Instead, the interpreter waits until the nurse leaves the room to respond directly to the researcher in English, “Wha’d you say?” This indicates that the interpreter does not view the researcher as she views the other participants. The researcher’s utterance is treated as a part of another frame, the research study frame. The fact that the interpreter does not interpret the researcher’s utterance, and that she does respond directly to the researcher during a frame break indicates that the interpreter has a schema associated with the research study frame that is similar to that of the doctor.
Like the interpreter, the child’s mother also communicates directly with the researcher primarily during frame breaks. In the following example, the nurse has been conducting the preliminary examination. Just prior to the mother’s utterance, the nurse has left the room to get a chart. During this period the child has been crying steadily. Approximately fifteen seconds after the nurse leaves the room, the mother (who is about five months pregnant with her second child) turns to the researcher and interpreter and addresses a comment to them:
Example 3.21
17
M:
D:
N: = So let me just (?) out there, I’ll get it real quick.
C:
I:
I: (?) GO (?) NOTES GROW GROW-UP (?) FAST
(researcher laughs) (researcher laughs)
M: [15-second pause] (to interpreter and researcher) PRO.1 HAVE SECOND ONE
(laughs) And I’m having another one!
D:
N: (leaves—gone for 28 seconds)
C:
I: (laughs)
I: (signs something but off camera)
19
(researcher laughs)
M: BOTH BOYS SAME (laughs)
They’re both boys, too!
D:
N: (enters) ’Scuse me. This room isn’t really big enough, we looked for a larger room but =
C:
I: (laughs)
I: (? not visible) BIG ENOUGH (?) =
This comment receives laughter from both the researcher and the interpreter, and although both are off-camera at this point, it is clear from the mother’s eye gaze that a brief conversation ensues among the three participants in the room. Although the nurse is gone for only twenty-eight seconds, there is time for the interpreter to comment (off-camera, in line 18) and for all participants to be laughing together as the nurse reenters the room. Once again, as the nurse returns, the interaction among the mother, interpreter, and researcher shifts. The mother generally does not gaze toward the researcher and only once directs a comment toward her during the time the medical interview frame is clearly active. This one comment can be seen in example 3.22. In this example, the mother waves briefly at the camera to entertain her son:
110
M: (waves at camera) (looking at researcher) PRO.3 (baby) PISS-OFF =
D:
N:
C: (cries)
I: = THAT INDEX (neutral)
111
M: = SAME BECAUSE PRO.1 WAKE-UP PRO.3 U-P from POSS.3 (baby) N-A-P
D:
N:
C:
I: He’s really pissed off too because I woke him up from his nap.
I:
After waving at the camera the mother gazes to the researcher and says that her son is upset because she interrupted his nap. The interpreter renders this comment in English (line 111). As the interpreter finishes her rendition, the mother gazes back and forth between the interpreter and the doctor. It looks as if the mother might have intended the comment to the researcher to be subordinated communication, ratifying the researcher as addressee but leaving the doctor unratified. It is not clear whether this is the case, although the mother does not address the researcher at all for the remainder of the encounter. This example raises a question regarding the issue of subordinated communication. Whether or not the mother has the opportunity to communicate in ASL with participants, or whether the doctor and nurse have an opportunity for subordinated communication in English is an issue that could be determined by the interpreter’s choice of what to (or not to) render. Such a choice on the part of the interpreter has the potential of being more or less partial to one or another of various participants. How a variety of professional interpreters handle this issue is an area for future investigation. With regard to this study, the mother’s limited interaction with the researcher, combined with rapid inclusion of interaction with the researcher during frame breaks, suggests that the mother frames the medical interview as a research study and that her schema of a research study entails the notion that one does not interact with the researcher as a part of the medical interview lamination of the event.
On the basis of the content of certain utterances that address the unusually crowded circumstances of this medical interview, as well as the limited number, and timing, of utterances directed toward the researcher, it is apparent that this medical encounter has been framed as a research study. Moreover, the evidence suggests that all the participants share similar schema regarding the research study frame. It is interesting to note that the interpreter and mother treat the researcher and interpreter in similar ways. Both are addressed and responded to primarily during breaks in the medical interview frame. For the mother and the interpreter, it appears that the research study frame and interpreted encounter frame share schematic elements in terms of the nonparticipation or noninvolvement of the researcher or interpreter in the task at hand.
A Mismatched Schema
Four layers of frames have been identified in the interpreted pediatric medical interview and discussed in terms of related schema. The medical interview and pediatric examination frames, the interpreted encounter frame, and the research study frame are characterized by a variety of linguistic features, including topic initiation, question-answer sequences, pronominal reference, linguistic register, and the content and timing of certain utterances.
Of the four frames examined, there is evidence that participants share similar schema regarding all but one: the interpreted encounter frame. Although not all participants frame the event as an interpreted encounter, the nurse and doctor demonstrate a schema in which they communicate with the interpreter about the Deaf participant, rather than one in which they communicate directly with the Deaf participant. This differs from the schema demonstrated by the Deaf participant and the interpreter. Both of these participants demonstrated a schema of direct communication among participants through the interpreter, rather than of communication with the interpreter herself.
The result of this apparent mismatch in schema is a problem area in the interaction. For example, the doctor requests clarification of the interpreter’s use of the first-person pronoun. In his schema, the interpreter is seen as a caretaker of the child rather than as a professional service provider unknown to the Deaf participant and her family. His initiation of repair assists in clarifying that the referent of the interpreter’s first-person pronoun is the mother.
The examination of the actual medical encounter with the professional interpreter has indicated that the frame and schema issues found in the mock medical encounter are not entirely unique for the student interpreter involved in a technical redoing. Thus, it would be worth exploring some of the similarities and differences in the interaction between frames and schema in the two cases under examination.
Comparison of Frames and Schema in the Two Cases of Interpreted Encounters
The dynamic interplay of frames and schema can allow people to understand (or misunderstand) interactive events. Examination of these two cases indicates that there are some similarities with regard to the interaction between frames and schema between the two cases. For example, the mismatches between participants’ schema regarding interpreted encounters represents a similarity that is highly pertinent to the question of an interpreter’s influence on interactive discourse.
In both the interpreted role play and the actual medical interview, a variety of linguistic features serve as evidence of frames and schema. These linguistic features include prosody, discourse sequences such as question-answer pairs, topic initiation, and repairs. In each case, linguistic features indicate that the participants share certain frames for the event. Although the frames for each case are not identical to the other, both cases include evidence of frames regarding the nature of the event, such as a role play or pediatric examination, and the interpreted encounter frame. In addition, both cases include evidence that all the participants share similar schema regarding all but the interpreted encounter frame. This could be due to the fact that medical interviews and even technical redoings are not uncommon types of interaction, whereas interpreted encounters are less familiar to the general population.
In both cases under examination, a hearing interlocutor requests information from the interpreter. In the role play the hearing interlocutor asks for information about the language, a question that could have been directed at the native signer in the group, but was not. Similarly, the doctor in the actual medical interview asks the interpreter for clarification of pronominal reference. This doctor also frequently refers to the Deaf interlocutor in the third person. In these examples, other participants talk about the Deaf participants (or their native language) rather than addressing them directly.
The communicative competence of people who are spoken for or about is an issue not just in interpreted encounters. For example, children and Alzheimer’s patients are among those whose communicative competence comes into question in interaction. When hearing interlocutors speak about Deaf participants to an interpreter, do they question the Deaf participants’ communicative competence? Does the hearing participant’s schema categorize the Deaf participant with children or cognitively impaired patients? In what ways do the interpreter’s utterances contribute to the participants perceptions of one another? These questions reflect some potential ramifications of the ways in which all participants (doctors, patients, and interpreters) align themselves to one another via their utterances. That is, the participation framework and the interpreter’s place within it play important roles in the issue of interpreter neutrality and interpreter influence on an interaction.