“We’re Bringing Bio Back”: Putting Biomedical Back into Lay Mental Models of Alcoholism
E. Polander & V. L. Shalin
Wright State University
Results
Results cont’d
Although posts with high biomedical content containing narrative do exist (Excerpt 1), they were the exception to the rule.
After controlling for the effects of site orientation on figurative language (X2(2, N = 200) = 18.03, p < .001) and accounting for a non‐significant
interaction effect between biomedical content and forum orientation (t(199) = ‐1.05, ns), we found a significant negative relationship between biomedical content and figurative language (t(199) = ‐3.87, p < .001). Introduction
Multiple sources of information shape individuals’ mental models of alcoholism. Our culture provides the lay public with both biomedical and psychosocial information, both of which guide medical understanding, reasoning and decision‐making (Gentner, 2002). However, biomedical as opposed to psychosocial information is typically more difficult for untrained individuals to fully comprehend because of the dynamic, abstract, and sometimes imperceptible nature of a complex system such as the body (Hmelo, Holton, & Kolodner, 2000). Researchers may study mental models and understanding through the analysis of language (Carley & Palmquist, 1992). Two ways that individuals use language to convey coherence, meaning, and understanding are through the construction of narrative (Pennebaker & Seagal, 1999) and figurative language (Lakoff & Johnson, 1980). The present study examines these indicators of understanding in the use of biomedical content articulated in the lay dialogue of internet discussion forums, using both quantitative and qualitative methods. Method
We used Linguistic Inquiry and Word Count software (LIWC; Pennebaker, Booth, & Francis, 2007) to perform quantitative analyses on 311 opening posts (from January 2010 to December 2011) from alcohol abuse forums in three websites: www.medhelp.org, www.soberrecovery.com, www.uncommonforum.com. Posts were categorized by their site orientation based on the site from which they originated (Medhelp, medically oriented site; Soberrecovery and Uncommonforum, psychosocially oriented sites). We also coded agency (i.e., posting about self versus other) for each post. We created an LIWC biomedical dictionary specific to alcoholism to obtain percentages of biomedical content within each post. To measure figurative language, two raters identified instances of metaphor, simile, and idiom. Inter‐rater reliability was demonstrated with the top and bottom 100 posts containing figurative language. Inspired by Herman (2007), we combined z‐scores from four linguistic dimensions to define narrative: three LIWC dictionaries (i.e., causation, time, affect) and one
customized dictionary (i.e., transitions). We hypothesized that, because of the complex nature of biomedical phenomena, posts higher in biomedical content would contain less
figurative language and narrative than posts lower in biomedical content. Narrative
Excerpt 1. “I desperately want to stop drinking, and I think the only way I can is antabuse. I am currently taking klonopin and drinking on top of it as well, and I think that is why blacking out so much when I drink and I am getting so violently sick every morning. I have horrible anxiety and the klonopin makes it completely disappear which is a godsend… ”
After controlling for the effects of agency on narrative (t(309) = 4.82, p < .001) and accounting for a non‐significant interaction effect between biomedical content and agency (t(310) = ‐.82, ns), we found a significant main effect of biomedical content on narrative (t(310) = ‐2.51, p < .05), with posts higher in biomedical content containing less narrative. Posts low in biomedical content (Excerpt 2) contained more narrative than posts high in biomedical content (Excerpt 3).
Excerpt 2. “In the past I attempted suicide, I know now that my abuse of Alcohol was the reason I went down that road. For me it was a solution, a way out, I had problems which left me unable to face another day, truth be told my problems were because my life was controlled by my drinking…”
Excerpt 3. “The only symptoms I have are a few tiny spider angiomas and my doctor says that those are pregnancy related. Also some pain which I was prescribed Nexium for and it seemed to help. I have convinced myself that I have alcoholic liver disease and want to get a biopsy done but the gastro said he wouldn't do it.”
Metaphor
Although posts with high biomedical content may contain figurative language (Excerpt 4), they were also the exception to the rule.
Excerpt 4. “The fat from the ethanol is stored right in the liver... causing
the liver to have an appearance like marble cheese, with little fat deposits here and there. As these fat deposits are broken down, your liver appearance becomes much like swiss cheese, little holes are here and there.”
Posts low in biomedical content (Excerpt 5) contained more figurative language than posts high in biomedical content.
Excerpt 5. “So if you are an alcoholic, do you want your family legacy to look like mine? Every one of us has had battles with alcohol. Most of us have come out "unscathed" or so we thought.”
Discussion
The results suggest a dearth of understanding of the biomedical domain, as measured by figurative language and narrative usage. While the connections between understanding, figurative language usage, and narrative are not without controversy (Pinker, 2006), we maintain that these two linguistic devices provide different mechanisms for demonstrating the same goals: understanding, sense‐making, and coherence. Exceptions to the rule (Excerpts 1 and 4) demonstrate that it is indeed possible to relay biomedical information and experiences through figurative language and narrative. Individuals’ struggles with the integration of understanding‐
based figurative language and narrative into their dialogue may be due to the tensions associated with shifting identities (i.e., healthy to ill) (Holland & Lave, 2009). Individuals that are not well‐adapted to this new medical culture may not be adopting the biomedical model as effortlessly as the psychosocial model. Effective instruction takes into account the inadequacy of simply laying a new, potentially disparate mental model on top of existing mental models (Greeno, 1983). While we are not suggesting the replacement of existing psychosocial models with biomedical models, we do propose the development of patient education systems that can effectively integrate biomedical knowledge into these psychosocial models. Selected References
Carley, K. M., & Palmquist, M. (1992). Extracting, representing and analyzing mental models. Social Forces, 70, 601‐636. Greeno, J. G. (1983). Forms of understanding in mathematical problem solving. In S. G. Paris, G. M. Olson, & H. W. Stevenson (Eds.), Learning and motivation in the classroom (pp. 83‐ 111). Hillsdale, NJ: Erlbaum.
Herman, D. (2007). The Cambridge Companion to Narrative. Cambridge: Cambridge University Press.
Hmelo, C . E., Holton D. L., & Kolodner, J. L. (2000). Designing to learn about complex systems. The Journal of the Learning Sciences, 9, 247‐298.