S6E9: Language's Role in Identity

Hạ: Last week I decided to go on this quest of binging this K-Drama. If you like "Avatar: The Last Airbender" or "Korra," you can find it on Netflix. It's called "Alchemy of Souls." First 19 episodes, beautiful. It's so hard because I really like the female lead in Part 2, but I would suggest just stopping at episode 19 or halfway through 20, and not continuing. But the storytelling can't save it.

Margaux: Chloe's a fan too. She's actually not. I lied.

Lina: All right. Well, we can just get started. Hi, everyone. Welcome to "Bundle of Hers." This is Lina speaking to you all. And I'm here with . . .

Hạ: I love it.

Lina: I am here with Margaux and Ha in the virtual studio. Hi, guys.

Margaux: Hey.

Hạ: Hello.

Margaux: So happy to be here with you.

Lina: With me. Today I wanted to talk a little bit about language. We have recorded episodes about language before. We've talked about English as a second language and going through med school with that. And we've also talked about barriers in healthcare when it comes to language. Those episodes are Season 1 Episode 14, and then Season 2 Episode 5 respectively. So if you want to get a little bit of an intro to what we've spoken about before, feel free to listen to those.

But I wanted to focus a little bit more today on not specifically having different languages, but how the mannerisms, wording, certain accents, proper English versus not proper English, and how that can relate to advocacy and advocacy in healthcare as well.

I am a fourth-year, as those who have been listening know, and I've been going through my interview trail, and I feel like I've had a lot of anxiety about how I sound on these interviews. And that's how I'm speaking.

I always feel like whenever I've practiced with you, Margaux, or Ha, with Harjit, the thing that comes up is like, "Oh, I feel like I don't sound smart. I sound weird. My English is weird." I feel like they'll be able to tell that I have an accent. And I just feel like that will be something that affects my interviews.

I was very anxious about that. And the thing is, I am a very smart person and I have a great story to tell, and somehow I was feeling the most anxious about how I'm going to sound. And that is something I feel like is not uncommon. I feel like a lot of us can relate to that.

And then the other thing I always know is I am always very passionate about retaining not just my Arabic language, but retaining my Palestinian accent, my Gazan accent, and how much that is something very important to me. I want that dialect to be with me, because of how much history and identity I have through retaining both of those languages within me, if that makes sense.

Hạ: A lot of what you said really resonated with me, Lina. Partly also going through residency interviews and trying to grapple with thinking about language and the use of words to really express myself, but also for me, for context for a lot of our listeners, I actually have a pretty big fear of public speaking. So whenever I do talk and try to use language, what I often do is I zone out and my tongue just keeps moving.

It's always this really frustrating thing because for me I think language can be so powerful, and I always wish I had a greater grasp and control over my language. But I think that oftentimes in the verbal use of language outside of the written world, it's something that I struggle with.

And it's also something that I struggle with not only in English, but also when I think about myself as someone who is bilingual. I grew up speaking a lot of Vietnamese, but I've noticed that throughout these years as I haven't lived with my grandparents anymore, and I live more with just my mom and communicate mostly in Vietnamese with my mom, I feel that I'm losing a lot of the language that I used to have.

Even though it was very clear by my accent that I was speaking Americanized Vietnamese, I still felt like I had a really good grasp of language. And then now because I'm able to easily switch between speaking Vietnamese to English in a conversation with my mom, I haven't really put that effort into it.

And it sometimes scares me because I'm really scared about completely losing that language and my understanding of it. Even as I've been trying to listen to, for instance, Buddhist sermons that my mom thinks I should listen to, I'm constantly reminded that my language, even though I grew up speaking it, is not permanent, and if I don't put extra effort in trying to maintain it, I might soon lose a very important part of my identity.

Margaux: Your languages are tied to your identities. And to hear you say, Lina, how much of an extra weight and maybe conflict it is in interview season to try to present yourself one way and carry that with you, it's so sad. What's the advice that we give when you're interviewing? It's "just be yourself."

Even I felt this pressure to have correct grammatical syntax and speak eloquently when you're doing an interview. And how do you, if language and your accent is part of your identity, find the place and space, because it feels like maybe not everyone is going to be receptive to that in the interview way?

And so that's something that we need to change, obviously, in our medical system and in our interview process, which we've probably also done episodes on how the application process is stupid.

But to your point, Ha, about losing language, my mom, and I have talked about this before on the podcast, emigrated to the U.S. from the former Czechoslovakia. And when they came here, they, I think as an act of resistance and cutting out their country that did not serve them, chose not to speak Czech. My grandmother, my grandfather, and my mom and her sister all fully dove into learning English and spoke English to each other.

As a byproduct of that, I was not taught Czech. And I think also there was very few . . . It would have only been my mom that would've spoken it to me. So that part of my heritage and ancestry was not passed down to me. And that's something I think a lot about, and how I feel is a missing connection for me in maybe understanding where my mom and her family came from.

And another part of it is when I go looking for histories and to learn more about this side of my life and my identities, a lot of the books and the texts are not translated to English. And so then I also feel even more disconnected.

And so I share that maybe anxiety that you express, Ha, about losing the language and maybe losing the connection or the doors that it keeps open for you for what it brings to your identity.

Lina: Yeah, you bring up a good point, Margaux. To a lot of us, and I feel like to a lot of people, language is a huge part of your culture, and your background, and your identity. And as we've seen with immigrants, some people retain the language, and then some people, like your family, Margaux, decided not to pass down that language because it was a way for them to survive.

Hạ: Yeah. It does also make me think a lot about how some people do have access to being able to be more bilingual than others. And I think about this a lot in the context of my family. My cousins who grew up in the U.S., as I did, most of them aren't able to really speak Vietnamese as much. And even when I try to speak with them in Vietnamese, their default is to try to have conversations in English.

And I think a lot of it is not to blame them, but what I really think is the reason why I just opt to speak Vietnamese when I'm with my family is because I grew up with my grandparents. So I had to know how to speak Vietnamese because otherwise I couldn't communicate with my grandparents.

It makes me reflect a lot because I think that in the U.S., it's very easy to be able to say goodbye to a language from the background or culture that you come from, because there is, as you said, Lina, not that much of a push for you to really embrace those languages.

And when they do want you to embrace a second language, a lot of times it's thought in a bit more of a capitalistic way. Sometimes it's really great when you think about, for instance, when you're thinking about learning Spanish to really connect with the Latinx community. Sometimes it is with that bend, but sometimes it is also in a very capitalistic bend.

I remember growing up I was told learning Spanish is great because a lot of people that you might serve or that a lot of people who you might work with will speak Spanish. And learning Chinese is great because it's the big global language that is shooting up.

There are definitely priorities about which languages in a way matter more, and it really gets in the way of people being able to really appreciate their background through language.

Margaux: It's no secret that language is so powerful for culture and identities, and that's why it has been used as a tool of colonization. So for example, when you're in the U.S., when they sent indigenous children to essentially genocide camps, they did not allow them to talk or speak their language, thus driving a further wedge between the children and the younger generations and their grandparents, and losing that generational and cultural knowledge.

And so there is so much resistance and advocacy in retaining languages that are not the dominant languages that you were talking about, Ha. And so I think there's a huge movement that's been cool to see of reviving indigenous languages here in the U.S.

Just people I've been following on TikTok, it's their goal to try to learn their native and indigenous languages. And so I think there's so much power in language.

Lina: Yeah, I mean, there were huge movements to always make sure that people, like you said, Ha, say goodbye to their languages or forget their backgrounds. And it was also seen in enslaved Africans on plantations, Chinese railroad workers in the 19th century, and Hispanic and Latinx immigrants, all of those. We've seen again and again through history how English, and a specific form of English, was forced on a lot of these communities.

There was this English-only movement that happened in the 1990s and it gained a lot of momentum. There was a lot of immigration coming into the U.S., but everyone was put in their mind that in order to succeed, and for social mobility, and to work, and to be a part of the community, you have to speak English. And research showed that that is not actually true.

For a lot of the Latinx and Hispanic communities, even though a lot of them switched over to English only, it didn't really show that much social mobility or that much increase in their status. Research showed that it was the opposite.

And so, again and again, we see that English-only or the things that are happening are based on racism and white supremacy. I feel like there should be a "ta-da" every time that we speak about this, but that's what we've seen and what we continue to see too.

A lot of communities have come up with ways to speak their language and continue to speak English. We've seen African American Vernacular English and other forms of English that are created from people with African descent. We have the Jamaican, I think, patois and other English-based creole languages. But they're still seen as improper, and they're still seen as something that doesn't fit within the community. It's seen as something that is still trying to be put down, or still try to leave it outside of institutions, and leave it outside of school. Just staying in your family.

Margaux: It doesn't fit the elitist white supremacist ideals that have been set to define what is "proper" and what is the norm and standardized to be what is successful in our society. And I think that's where a lot of the stress comes from that you identified in the beginning of the episode, Lina.

Hạ: But what's also really wild about it is then that same language is often co-opted and is seen as cool when it's someone who is white who is saying it. And again, it just comes back to I feel that the power of language, a lot of people sometimes place in the people who are at the top, the people who have the privilege from white supremacy and from their background.

And also I think a lot about it is similarly too when I think about academic language, and how a lot of times people who come from more privileged backgrounds are able to get away with being less academic in how they speak. But for you to get heard as a person of color or someone who's from a background that is less privileged, you have to sound/speak in a much more elitist or academic way.

And that was something that I noticed quite a bit when I headed off to college, is that a lot of times the people who would often "win" in the arguments, or be heard were the people who sounded a lot more fancy, who used the elitist language.

But a lot of times, if you really broke it down, the content of their words weren't that great. It was just really couched in a lot of fluff. But if you went in and tried to have it in a much more easy-to-understand, a much more direct conversation, people wouldn't really listen to you unless you inherently had a more privileged identity.

Margaux: It reminds me of something I saw on a meme on Instagram that was like, "How would you write, 'I changed a light bulb,' on a CV?" There were all these examples of, "I single-handedly initiated and deployed an energy-efficient model to do blah, blah, blah." The language and the ways you can utilize this to fit into a system for those who are privileged enough to know the rules and how to play the game can always get ahead. And so it still continues to be an oppressive tool to this day, this idea of proper English.

And I think a lot about that in medicine when I was a medical student, it's a whole different language, especially when you're presenting and how much power the attending has when they're like, "No. Don't say it like that. I want you to say. . . Present to me like this and use this word instead of this, or say this."

And you see a lot of that power and manipulation in rounds and stuff. And now as a resident, I have more power to reject this, but it's something I still . . . when I'm writing notes, the thought still comes into my head of, "I can't just say runny nose. I have to say rhinorrhea," or sometimes I'll have to Google search, "What is the doctor word for toe pain?" just so I can sound smarter. But why? It's just because we were socialized to want to search for this idea of what's proper and make us sound more authoritative I guess.

Lina: Well, yeah, we're socialized to think being part of the elitist language is the way to do it. Succeeding in academics and succeeding throughout our careers, especially medicine enforces that, "Use specific words. Use a doctor language."

And I feel like throughout all of my years of medical school, that is one of the common things that I'm always very anxious about. And it has happened in my rotations where again and again and again, I have been told that I am pronouncing things wrong, my grammar is all over the place, that I am just not speaking well.

Not particularly that I'm saying something wrong about a patient or condition, it always comes down to how I'm articulating that thought. How many fluff words and how many doctor words am I using?

And so it's this back and forth thing where I'm like, "Well, we're told to speak to patients in language they understand. But why do I have to do that switch? Why can't we all just not put so much pressure on the doctor language?"

Honestly, I don't think it'll really ever click for me. And a part of me doesn't want to be completely in this very rigid, using fluff and a particular form of language. I am fine with speaking in a way that my patients will understand me. Why do we have to put that divide up? But yeah, I still continue to feel anxious about it.

Hạ: I mean, it is really interesting because I do distinctly remember in one of my rotations we had a presentation about doctor language, essentially. We had a presentation about how you say terms to sound more appropriate for your colleagues. But the issue is as we get trained in how to have that language and how to sound more appropriate in this elitist way, we do end up losing connection with our patients.

I felt that my ability to have conversations and explain things to my patients at the beginning of my third year was a lot better than where I'm at now. And it's just because I've spent a year with people . . . more than a year now because I'm nearing the end of fourth-year, with people just ingraining that I have to speak in a certain way, and write notes in a certain way, and use certain languages.

And then when you're in that patient room, you are just so used to it, and this often creates difficulty with being able to communicate with patients. This creates barriers, and breaches, and being able to be approachable to your patients.

So it's really detrimental in trying to uphold this elitist system, but we uphold this elitist form of language because it's our way of barring and excluding people who can't hit it, people who can't be able to reach it.

I also think about it a lot, too, when I even think about the language of advocacy, because even in a lot of circles with advocacy, a lot of the people who are noticed and who are appreciated are also the people who are able to couch their language using very elitist frameworks.

Margaux: And we have the audacity in healthcare to use and create this own elitist system for language, and then turn around on patients and then say they have poor health literacy. We've gone through how many years of schooling and how much of the system do we go to learn it ourselves, and then throw it back at the patient as if it's their problem that they are not literate. And that is the actual word that we use.

It's interesting. Health literacy, that the patient doesn't have the literacy to understand what we're talking about, so then we need to historically categorize them in a different place. "We don't need to explain as much. We'll just do to them, because they're not going to understand," versus if your patient is a doctor, it's a whole different dynamic.

And so that thought just popped into my head, that we use the term, "They have poor health literacy." And we're talking of the systems of language as a tool.

Lina: Is it poor health literacy, or are we trying to enforce an elitist system?

Margaux: Something I've noticed in terms of advocacy and language development, working with adolescents, something that's been really cool for me to see is that compared to when I was in high school, they have so much more access to words to define themselves and their identities.

When I was in high school, I think it either was straight and gay. But now people can talk about bisexual, pansexual, asexual, aromantic, transgender, non-gender-conforming. So many different words, and they keep neopronouns beyond just he, she, and they. And it's so cool to see that transformation spin it positively in terms of advocacy, how language can be used to empower people to embolden their identities.

And so people who are on the grassroots doing the advocacy work, having language can be such a positive tool as well. I know we've talked a lot about how it can be used as an oppressive tool, but it can also be used to help in such a positive way. And that's one example that I've seen, is just the way that people can use so many terms to define themselves and their identities. That's been really fun.

Hạ: Yeah. I really think that big thing about how it's positive comes back to really centering it on the individual and their identity. Not using language as a way to box them, but language as a way to expand who they are.

And that really is the big issue, is that we don't use language to give autonomy or empowerment. We don't really use language for people to embrace their identity, all aspects of it. We really use language to make people be a certain way and to feel like they can get heard, and be there and be listened.

That's really what's the pain about it, which is really rough because I think that language is very beautiful and I love the spoken word, the written word, all the types of words. Even the visual language too, I think it can do so much, but the society knows about what the core of language beauty is, and it turns it over its head to make it something really ugly.

Lina: You bring up a great point, Ha. But I feel like to truly be in the place where we are where language can be so beautiful is using it as a tool of empowerment, using it as tool empowerment for its communities, whether that's through using the language that you want to speak in, feeling confident in, all these identities that have appeared because of language.

And the more that people see it around them, the less shame there is, or truly feeling confident in their language, and their identities, and speaking their identities. And so it's all about that empowerment and empowering those communities from whatever background or from whatever identity they want to share.

Another thing that I think about is how important language is to my mental health. And it's even just changing a few words in how I speak about myself, or about my family. A big part of it is also removing a lot of shameful wording about how I'm feeling and the negative aspects about how I'm feeling and how that can be such a difference in my confidence, my mental wellbeing throughout the day. And that is a huge part.

I feel in some of my interviews that I was able to truly be myself and speak just in my words without the pressure of feeling like I need to sound a different way. I have felt so much more confident and so much better about who I am, honestly. And that's a huge thing I feel like language can also contribute to.

Margaux: Language is so powerful. And the power of a positive affirmation for mental health goes so far. I think it's so underestimated, and probably because language historically has been used as a negative tool.

But to your point, Lina, just shifting or reframing even simple sentences or simple things that we say to ourselves or each other on a daily basis can make such a huge impact.

Hạ: And I think deeply in that re-shifting, it's also just really removing a lot. And I think both of you have alluded to it.

A lot of that shame that comes with how society wants us to perceive language and how we use our language, thinking about mental health, those positive affirmations are to remove the shame that we feel for ourselves and the ways that we interact with the world, because that's what society puts onto us.

And again, removing the shame from the language that we use and recognizing that our language, even if a lot of what society says is not correct, is still very powerful. And in fact, if it's going against the grain of society, oftentimes it means that we're probably doing something right.

Lina: We've seen a lot of emphasis on trauma-informed care, and there is a huge contribution of how language can be with trauma-informed care and how it can be trauma-informed language.

It's what we talked about, removing the shame and the negativity about situations or about people themselves. And that's truly a way to speak in a very trauma-informed way to your patients or even just communities around us.

We're focusing less on using words like victim, and using words like survivor. And we're not fixing people, we're not rescuing them, and we're not blaming them either. We are using words that focus less on the negative aspects of their situations and their identities, and focusing more on their strength, on the positive things, and on, "Look at you being a survivor. You're not a victim. You're a survivor."

And there is a time and place for using different identifiers, but it is important to really give your patient that autonomy and give your patient that power to speak for themselves and to identify themselves rather than us doing it for them.

Margaux: I think us as healthcare providers need to all take on this work of learning trauma-informed language. It's not just something that a psychiatrist does or a therapist or someone who only does trauma-informed therapy. We all need to unlearn the systemic word that we've used that caused trauma, and then how to utilize trauma-informed and safe, inclusive language as we care for patients across specialties.

Hạ: And I think we always have to recognize that language is so fluid and flexible, and that we can't control language and how others use language and define themselves.

Margaux: I think in that vein, Ha, it's important to . . . that key thing you said, language is fluid. The same set of rules should not be applied that were applied 200 years ago. It needs to change and we all need to be drivers of the positive change we want to see in language and all be accepting that language is fluid.

Lina: Although we've talked about how language has been used as an oppressive tool and how it originated on that oppressive tool, there are many ways that we can switch that and bring it back to its positive note, because language is so beautiful and it is so powerful.

I think whether throughout our own friends, with ourselves honestly, our community, our patients, we have to continue to do the work of remembering to give space and give the power to people to truly speak in the language that they want and truly feel empowered by their language. Remove all that shame and meet people where they are and how they speak, and that's okay. And that's really the best way for all of us.

For anyone listening, if you have a story or reflection to share with us about how language has impacted you, wherever you are, let us know, share with us, and you will get this "Power From Identity" pin. They're so cute and we'd love to hear from you.

Margaux: Yes. The pins look great on your lanyards, by the way.

Lina: Listen to us. We're . . . Sorry.

Margaux: It's all good. You've got it.

Hạ: You're doing well. You're doing great.

Lina: We hope to always hear from you guys. Listen to us wherever you podcast, and follow us @bundleofhers on Instagram. And we will see you guys next time.

Margaux: Bye-bye.

Lina: Bye.

Hạ: Bye.