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Wellness Beyond Words

Maya Compositions of Speech and Silence in Medical Care

T.S. Harvey

Publication Year: 2012

The delivery of health care can present a minefield of communication problems, particularly in cross-cultural settings where patients and health practitioners come from dissimilar cultures and speak different languages. Responding to the need for in-depth ethnographic studies in cultural and communicative competence, this anthropological account of Maya language use in health care in highland Guatemala explores some of the cultural and linguistic factors that can complicate communication in the practice of medicine. Bringing together the analytical tools of linguistic and medical anthropology, T. S. Harvey offers a rare comparative glimpse into
Maya intra-cultural therapeutic (Maya healer/Maya wellness-seeker) and cross-cultural biomedical (Ladino practitioner/Maya patient) interactions.

In Maya medical encounters, the number of participants, the plurality of their voices, and the cooperative linguistic strategies that they employ to compose illness narratives challenge conventional analytical techniques and call into question some basic assumptions about doctor-patient interactions. Harvey’s innovative approach, combining the “ethnography
of polyphony” and its complementary technique, the “polyphonic score,” reveals the complex interplay of speaking and silence during medical encounters, sociolinguistic patterns that help us avoid clinical complications connected to medical miscommunication.

Published by: University of New Mexico Press

Front Cover

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pp. 1-3

Title Page

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pp. 4-4


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pp. 5-5


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pp. v-7

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Prologue: Vindication of Voice

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pp. vii-x

Postmodernism need not become what it has, a period that portends the end of the possibility of other questions, the last word of a worn-out slogan, an artifice of intellectual immortality forged by claims of having left nothing unsaid and calls for the deconstruction of not less...

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pp. xi-xii

The distance between the monolingual inner-city streets of downtown Newport News, Virginia, where I grew up, with its economic disadvantages, educational barriers, and racial inequalities, is a long way from the multilingual Maya world of highland Guatemala where I conducted...

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pp. 1-14

My concern with the vitality of indigenous voices (in Guatemala and the United States) began with a recognition of common losses, for me and heirs to legacies of colonialism elsewhere in the Americas, remnants of these voices can be found in our own lives, in the handed-down stories...

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1: Between Belief and Relief: Apologue of Maya Wellness Seeking In Medias Res

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pp. 15-26

After a two-hour bus trip, Xuan and Per finally reached the western highland market of San Francisco el Alto. Their small child, Tun, had been sick for three days, but the family hadn’t taken him to the clinic yet because they desperately needed any money that they might earn from...

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2: The Ethnography of Polyphony: Dialogue of Disciplines (Needful Divigations of Theory)

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pp. 27-36

Little if any imagination is needed to envision a world where the multiplicity of our expressions and experiences and of those around us are juxtaposed and counterposed in harmony and discord in the ebb and flow of everyday life. This is the sensing world of full-valued voices and...

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3: Which One of You Is the Patient?: Heterologues in Health Care

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pp. 37-57

The first clinical encounter to be examined is a cross-cultural biomedical interaction between a Ladino Spanish-speaking doctor and Maya K’iche’- speaking wellness seekers. The consultation occurred at a centro de salud, a government-funded and staffed health care outpost...

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4: The Roar on the Other Side of Speaking: Communicative Collogue, the Wordiness of Wordlessness

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pp. 59-76

With the initial application of the polyphonic approach to the cross- cultural consultation in Nima’ discussed in the previous chapter, we have begun to explore what the reorganization of representations of speakers and speaking on the page can reveal about communicative interactions....

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5: A Call to Competence: Metalogue (Logos about Logos)

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pp. 77-92

Shifting our attention from cross-cultural biomedical to intracultural therapeutic care, the consultation that we examine in this chapter unfolds at the dispensario between a K’iche’ wellness seeker, her rachi’l (companion), and a Maya theurgical herbalist.1 The epigraph comes...

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6: Wellness Made Out of Words: Audiologue (Hearing Voices)

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pp. 93-103

Revisiting the polyphonic score of the dispensario consultation and the communicative contributions of the participants across the eighty-two bars suggests that information regarding the wellness seeker’s illness experience is not elicited (primarily) through the healer’s use of questions...

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7: Vaccinated Voices: Lugubrious Logos (Voices of Lamentation and Vexation)

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pp. 105-144

At the time of the initial phase of this research (2000–2001), the Maya peoples with whom I lived and worked openly vocalized their misgivings about Western biomedicine and, as this chapter explores, expressed trepidation and leveled charges of maltreatment that were often based...

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Epilogue: Vital Voices

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pp. 145-154

In this study of language use in health care, by treating communicative interactions in biomedical and therapeutic encounters in Guatemala as an unfolding scene of lived experiences that can only be “followed” by the ethnographer and never quite “fixed,” I have sought to offer a scientific...

Appendix A

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pp. 155-162

Appendix B

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pp. 163-168

Appendix C

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pp. 169-182

Appendix D

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pp. 183-196

Appendix E

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pp. 197-200

Appendix F

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pp. 201-203


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pp. 205-213


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pp. 214-227


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pp. 215-240


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pp. 241-243

Back Cover

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pp. 257-257

E-ISBN-13: 9780826352750
E-ISBN-10: 0826352758
Print-ISBN-13: 9780826352736
Print-ISBN-10: 0826352731

Page Count: 264
Illustrations: 17 drawings, 7 halftones, 2 charts
Publication Year: 2012

OCLC Number: 825767708
MUSE Marc Record: Download for Wellness Beyond Words

Research Areas


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Subject Headings

  • Mayan languages -- Guatemala.
  • Language and medicine -- Guatemala.
  • Oral communication -- Guatemala.
  • Anthropological linguistics -- Guatemala.
  • Mayas -- Languages.
  • Guatemala -- Social conditions.
  • Guatemala -- Public health.
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