Wellness Beyond Words: Maya Compositions of Speech and Silence in Medical Care by T. S. Harvey (review)

Contributing to an increasingly robust ethnographic literature on cross-cultural medical communication, T. S. Harvey’s Wellness Beyond Words documents “intracultural therapeutic and cross-cultural biomedical interactions” (p. 6) in the town of Nima’ (a pseudonym) in the K’iche’ Maya–speaking area of highland Guatemala. Based on a decade of research in the town, the book examines and contrasts talk in biomedical interviews at a centro de salud ‘government-funded clinic’ and in Maya healing consultations, revealing how misalignments across languages and discourse norms produce cultural misunderstandings and compound Mayan Guatemalans’ distrust of Ladino medical personnel and public health programs.

Inspired by Dell Hymes’s legacy of the ethnography of communication and Bakhtin’s writings on heteroglossia, Wellness Beyond Words is also a methodological exposition. One of Harvey’s stated goals is to set a precedent for an ethnography of polyphony, a “methodological and analytical orientation” (p. x) that entails a nonauthoritative authorial stance and conventions for representing participants’ voices. Throughout the book, an extended argument is made for using a horizontal “polyphonic score” in lieu of conventional transcripts, situating the work in long-standing debates concerning transcription theory.

Chapter 1, “Between Belief and Relief: Apologue of Maya Wellness Seeking in Media Res,” introduces readers to the context of ethnic, linguistic, and medical plurality in highland Guatemala through the story of one K’iche’ Mayan couple as they seek answers and treatment for their sick infant son. Readers get a sense of the complications that the couple faces due to circumstances of poverty and discrimination as well as the challenges that are involved in navigating competing demands and explanations from various practitioners of indigenous, popular, and biomedicine.

Chapter 2, “The Ethnography of Polyphony: Dialogue of Disciplines (Needful Divagations of Theory),” lays out the tenets of Harvey’s ethnography-of-polyphony approach, which prioritizes the unfolding and indefinite qualities of interaction and aims to “follow rather than fix the multiplicity of voices” (p. 29). Harvey rejects the scientific charge of delivering authoritative interpretations of meaning and attempts, instead, to follow and represent “K’iche’ ways of speaking through multiple and diverse scenes of interaction” (p. 28). The author argues that conventional transcript formats are inadequate for these purposes, pointing out that vertical transcripts hierarchize participants and obfuscate nonspeaking forms of participation. The chapter concludes with an introduction to the “polyphonic score,” the author’s trademark transcript format, which was designed to remedy the drawbacks of a vertical, playscript format.

Chapter 3, “Which One of You Is the Patient?: Heterologues in Health Care,” is organized around an excerpt from a typical doctor’s visit at the centro de salud and focuses on processes of turn-taking, questioning, and co-narration. Harvey found that Mayan wellness seekers and their companions co-narrated illness episodes rather than designating a single interlocutor to convey information to the doctor. This interactional preference is grounded in the cultural principle of accompanied living that is central to Mayan sociality. And it is consequential because it conflicts with participation norms in conventional biomedicine, which privilege the speech and perspectives of individual patients.

Chapter 4, “The Roar on the Other Side of Speaking: Communicative Collogue, the Wordiness of Wordlessness,” centers on “communicative silences” in biomedical visits and illustrates the facility of the polyphonic score for visually depicting the cooccurrence of speech and silence that interactants concurrently produce. Harvey disputes the idea that refraining from speech is a sign of patient disempowerment and reviews instances when participants in the excerpted medical visit “made silence.” Discussion highlights how each case constituted a distinct participatory action: sustaining the floor for others, upholding the commentary of another speaker, repairing an interruption, eliciting speech, stalling, and opening the floor.

Chapter 5, “A Call to Competence: Metalogue (Logos about Logos),” introduces the form of care that is provided at the dispensario ‘dispensary’ in Nima’, where K’iche’ Maya wellness seekers and their...