規避詞在台灣醫學言談與期刊論文中的比較

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(1)國立臺灣師範大學英語學系博士論. 文. Doctoral Dissertation Department of English National Taiwan Normal University. 規避詞在台灣醫學言談與期刊論文中的比較. Hedges in Medical Discourse: A Comparison between the Spoken and the Written Genres in Taiwan’s Medical Setting. 指導教授：張妙霞 Advisor: Dr. Miao-Hsia Chang 研究生：林婉華 Student: Wan-Hua Lin. 中華民國一百零三年六月 June, 2014.

(2) ABSTRACT The study investigates how hedging phenomena are manifested in the medical specialist-to-specialist communication in Taiwan. Hedging strategies utilized in two types of genres are examined and compared. The spoken genre consists of ten peer lectures, while the written genre comprises forty research articles. I explore the questions as to what linguistic devices are used as hedges in the medical profession, what functions those hedges serve, and what are the differences in the use of hedges in terms of genres. At last, I also compare the medical spoken discourse with Chinese daily conversation and the written discourse with Chinese academic written texts. The results show that the medical professionals make use of various hedging devices to modify their commitment towards the propositions being stated. These hedging devices are classified into modal auxiliaries, lexical hedges, and non-lexical hedges. Lexical hedges include lexical verbs, adverbs, adjectives, and nouns, while non-lexical hedges contain conditionality, rhetorical questions, and addressing limitations. Hedges are observed to manifest their polypragmatic functions in the medical discourse. That is, the medical specialists utilize different hedging devices to convey different functions depending on communicative circumstances. It is not uncommon to note that one single hedge may serve various functions and an individual function may be fulfilled by different hedges. In the medical discourse, lexical hedges are found to be the most commonly used hedging devices regardless of genres, which confirm the findings of many studies in the literature. Overall, the speakers employ more modal auxiliaries, conditionality, and rhetorical questions than the writers, whereas the writers utilize more adjectives, nouns, and addressing limitations than the speakers. The discrepancies in the application of those various hedging categories show statistically significant. Among those hedging strategies, adverbs are used the most frequently in both genres, and the application between these two genres does not show any statistical ii.

(3) significance. Modal auxiliaries are normally used to express the speakers/writers subjective attitudes or feelings towards the propositions. Hui 會 ‘will/may’ is found to occur the most in the spoken discourse, while keyi 可以 is favored in the written discourse. Sensory verbs are overwhelmingly used by the speakers, whereas quotative verbs are favored by the writers. Genre difference accounts for the difference as writers rely heavily on hearsay evidence and research findings in literature to support their arguments and speakers adhere to conversational hedges to express their attitude and feelings towards the propositions. Hedging adjectives are predominately employed to modify their following nouns with various degrees of uncertainty or inaccuracy. Approximative nouns are used the most frequently in the spoken discourse, whereas question words occupy the majority of hedging nouns in the medical writing. It is worth noting that the speakers tend to apply a greater variety of forms than the writers. In addition, the speakers mostly use disyllabic hedges, whereas the writers favor monosyllabic hedges. In the medical profession, there is always existing uncertainty and there are always layers upon layers of explanation. Therefore, uncertainty can be counted as the crucial motive for the application of hedges. Hedges enable the medical specialists to express politeness in order to avoid potential FTAs, to express tentativeness and cautiousness, to convey less than full commitment to their statements, to convey vagueness to the exact accuracy or quantity, to show solidarity with medical community, or to present modesty for their achievements. In Chen’s (2008) conversational data, question words sheme 什麼 ‘what’ is employed the most frequently among all the lexical hedges, while in medical speech, the modal auxiliary hui 會 ‘will/may’ occur the most. In Chen’s study, there is no category of hedging adjectives due to their extremely small amount; however, adjectives occupy 6.01% in medical spoken discourse. In Lo’s (2010) academic written texts, modal auxiliaries are the most frequently used hedges for all the three disciplines, while in the medical written discourse, the iii .

(4) hedging adverb huo 或 ‘alternatively’ and jiao 較 ‘relatively’, and the auxiliary keneg 可能 ‘may’ occur the most. The adverb of indefinite degree jiao 較 ‘relatively’ is used by medical specialists to modify the degrees of qualification and quantification. The hedging adverb huo 或 ‘alternatively’ is used to present potential alternatives commonly seen in medical discourse.. Keywords: hedge, medical discourse, face-to-face encounter, commitment, proposition. iv .

(5) ACKNOWLEDGEMENT. I would like to thank all those who supported and encouraged me in the process of completing my dissertation. This accomplishment would not have been possible without the help of a number of people. First, I would like to express my sincere appreciation to my advisor, Dr. Miao-Hsia Chang who inspired me with the direction for this study. Her thorough knowledge and insightful ideas guided me throughout the process. I would like to thank the committee members, Dr. Chun-Yin Doris Chen, Dr. Jen-I Li, Dr. Mei-Hui Tsai, and Dr. Huei-ling Lai for their perceptive comments and suggestions. I am grateful to Dr. Chun-Yin Doris Chen, Dr. Jen-I Li, and Dr. Jen Ting, whose warm support and encouragement greatly comforted me and gave me the strength to continue. I am indebted to Kao-Shan Lin. His keen computer skills assisted me greatly in analyzing data. I would like to express my appreciation to my colleague, Jim Tso, for his kind assistance in the data translation. Also, I want to thank my students at NCUE who helped me type the data in Excel. I am thankful of those physicians who allowed me to use their lectures as my spoken data. I especially thank Dr. Yu-Lin Li. He kindly spared time to be interviewed by me, and offered me with some professional viewpoints regarding special jargon usages by physicians. I would like to thank my dear friend, Mei-Zi Huang, who took good care of me during my several episodes of hospitalization. Without her help, I would not have been able to recover so speedily. I also thank her for taking care of my little girl whenever I was tied up with my dissertation work. I owe my sincere appreciation to my brother (天信法師). His words of wisdom help me answer a lot of doubts in life, enhance my confidence and calm my nerves. My earnest and deepest gratitude goes to my mother (天定法師). Her unconditional v .

(6) support and love accompany me all the way. In the summer of 2012, I underwent three major surgeries in a row. Each time my mother prayed devoutly for me outside the operation room. The people who serve in her temple took good care of me and helped me recover. Words cannot express my infinite gratitude and love to my mother. Herein I would like to dedicate this dissertation to her.. vi .

(7) TABLE OF CONTENTS TABLE OF CONTENTS ··········································································· vii LIST OF TABLES ····················································································· x LIST OF FIGURES ·················································································· xi ` CHAPTER ONE 1.1 1.2 1.3 1.4 1.5 1.6. INTRODUCTION .................................................................................. 1 . Background ............................................................................................................. 1 Terminology and definition of hedges ..................................................................... 5 Uncertainty in medicine .......................................................................................... 7 Purpose of the study ................................................................................................ 9 Significance of the study ....................................................................................... 10 Overview of the Study ........................................................................................... 11 . CHAPTER TWO. LITERATURE REVIEW ................................................................... 12 . 2.1 Studies in hedges: from semantics to pragmatics .................................................. 12 2.2 Hedges in medical research ................................................................................... 22 2.2.1 Hedges in medical writing ........................................................................ 23 2.2.2 Hedges in physician-physician interaction ............................................... 29 2.2.3 Hedges in doctor-patient interaction ......................................................... 30 2.3 Hedges in non-medical research ............................................................................ 36 2.3.1 Hedges in conversation ............................................................................. 36 2.3.2 Hedges in research articles ........................................................................ 40 2.4 Hedges in studies of genre difference (spoken vs. written)................................... 45 2.4.1 Approximators in leisure, business, political, and academic discourses .. 47 2.4.2 Stance expressions in TOFEL 2000 Spoken and Written Academic Language Corpus .................................................................................................. 47 2.4.3 If-conditionals in academic discourses ..................................................... 48 2.4.4 Discourse features in medical conference and journal articles ................. 53 2.5 Functions of hedges in academic discourse........................................................... 54 2.5.1 Expressing politeness and saving faces .................................................... 54 2.5.2 Avoiding full commitment and convey uncertainty .................................. 55 2.5.3 Presenting tentativeness and cautiousness ................................................ 56 2.5.4 Showing solidarity and asserting in–group membership .......................... 58 2.6 Categorization of hedges ....................................................................................... 59 2.6.1 Modal auxiliaries....................................................................................... 63 2.6.2 Lexical hedges........................................................................................... 68 2.6.2.1 Lexical verbs ................................................................................ 69 vii .

(8) 2.7. 2.6.2.2 Adverbs......................................................................................... 71 2.6.2.3 Adjectives ..................................................................................... 73 2.6.2.4 Nouns ............................................................................................ 74 2.6.2.5 Vague expression of quality and quantity ..................................... 77 2.6.3 Non-lexical Hedges ................................................................................... 84 2.6.3.1 Conditionals .................................................................................. 84 2.6.3.2 Questions ...................................................................................... 88 2.6.3.3 Reference to limitations of the current study................................ 92 Summary of Chapter Two...................................................................................... 94 . CHAPTER THREE. METHODOLOGY .......................................................................... 97 . 3.1 The database .......................................................................................................... 97 3.2 Discourse analysis and corpus-based approach................................................... 104 3.3 Working definition of hedges .............................................................................. 105 3.4 Data analysis........................................................................................................ 106 3.4.1 Statistical methods .................................................................................. 107 3.4.2 Data transcription and word segmentation.............................................. 107 3.4.3 Data categorization ................................................................................. 109 3.5 Summary of Chapter Three ................................................................................. 112 CHAPTER FOUR RESULTS AND DISCUSSION ....................................................... 114 4.1. Overall distribution of hedges ............................................................................ 114 4.2 Auxiliaries ........................................................................................................... 117 4.2.1 Keneng 可能 ‘may’ ............................................................................... 120 4.2.2 Ke(yi) 可(以) ‘can’ ................................................................................. 127 4.2.3 Hui 會 ‘will ; may’ ................................................................................ 131 4.2.4 Ying(gai/dang) 應(該/當) ‘should’......................................................... 135 4.2.5 Neng(gou) 能(夠) ‘can’ .......................................................................... 140 4.3. 4.2.6 Summary ................................................................................................. 143 Lexical hedges ..................................................................................................... 145 4.3.1 Verbs ....................................................................................................... 145 4.3.1.1 Judgmental verbs ........................................................................ 147 4.3.1.1.1 Speculative verbs ........................................................... 148 4.3.1.1.2 Assertive verbs ............................................................... 151 4.3.1.1.3 Resembling verbs ........................................................... 154 4.3.1.2 Evidential verbs .......................................................................... 157 4.3.1.2.1 Quotative verbs .............................................................. 158 4.3.1.2.2 Sensory verbs ................................................................. 161 4.3.1.3 Other verbs .................................................................................... 165 viii. .

(9) 4.4. 4.3.1.4 Summary..................................................................................... 165 4.3.2 Adverbs ................................................................................................... 167 4.3.3.1 Stance adverbs ............................................................................ 168 4.3.3.2 Adverbs of indefinite degree ...................................................... 173 4.3.3.3 Adverbs of indefinite frequency ................................................. 176 4.3.3.4 Adverbs of approximation .......................................................... 179 4.3.2.5 Summary........................................................................................ 181 4.3.3 Adjectives................................................................................................ 183 4.3.3.1 Stance adjectives ........................................................................ 184 4.3.3.2 Adjectives of indefinite degree ................................................... 186 4.3.3.3 Adjectives of indefinite frequency ............................................. 189 4.3.3.4 Adjectives of approximation ...................................................... 193 4.3.3.5 Summary..................................................................................... 195 4.3.4 Nouns ...................................................................................................... 196 4.3.4.1 Judgmental nouns ....................................................................... 197 4.3.4.2 Nouns of approximation ............................................................. 202 4.3.4.3 Question words ........................................................................... 205 4.3.4.4 Summary..................................................................................... 210 4.3.5 Summary ................................................................................................. 211 Non-lexical Hedges ............................................................................................. 215 4.4.1 Conditionality.......................................................................................... 216 4.4.2 Rhetorical questions ................................................................................ 234 4.4.3 Addressing limitations ............................................................................ 254 4.4.4 Summary ................................................................................................. 271 . CHAPTER FIVE CONCLUSION .................................................................................. 275 REFERENCES..................................................................................................................... 286 . ix .

(10) LIST OF TABLES Table 1. Information of the ten speeches ................................................................................. 98 Table 2. Information of RAs from Journal of Internal Medicine of Taiwan .......................... 102 Table 3. Information of RAs from Taiwan Medical Journal .................................................. 103 Table 4. Categories and subcategories of hedges identified in the present study .................. 109 Table 5. Frequency of hedges in the spoken vs. written genres ............................................. 115 Table 6. Results of Mann-Whitney U test on the relation of hedging devices used in the spoken and written discourses ............................................................................................... 115 Table 7. The stratum of auxiliaries used in the spoken vs. written genres............................. 120 Table 8. Subcategories of judgmental verbs and evidential verbs ......................................... 147 Table 9. Frequency of speculative verbs used in the spoken vs. written genres .................... 149 Table10. Frequency of assertive verbs used in the spoken vs. written genres ....................... 151 Table 11. Frequency of resembling verbs used in the spoken vs. written genres .................. 155 Table12. Frequency of quotative verbs used in the spoken vs. written genres ...................... 159 Table 13. Frequency of sensory verbs used in the spoken vs. written genres........................ 162 Table 14. Frequency of stance adverbs used in the spoken vs. written genres ...................... 169 Table 15. Frequency of adverbs of indefinite degree used in the spoken vs. written genres . 173 Table 16. Frequency of adverbs of indefinite frequency used in the spoken vs. written genres ................................................................................................................................................ 176 Table 17. Frequency of adverbs of approximation used in the spoken vs. written genres .... 180 Table 18. Frequency of stance adjectives used in the spoken vs. written genres................... 184 Table 19. Frequency of adjectives of indefinite degree used in the spoken vs. written genres ................................................................................................................................................ 187 Table 20. Frequency of adjectives of indefinite frequency used in the spoken vs. written genres ..................................................................................................................................... 190 Table 21. Frequency of adjectives of approximation used in the spoken vs. written genres . 193 Table 22. Frequency of judgmental nouns used in the spoken vs. written genres ................. 198 Table 23. Frequency of nouns of approximation used in the spoken vs. written genres ....... 203 Table 24. Frequency of question words used in the spoken vs. written genres ..................... 206 Table 25. Frequency of conditionals used in the spoken vs. written genres .......................... 217 Table 26. Functions of conditionals observed in the spoken and written genres ................... 218 Table 27. Functions of questions observed in the spoken and written genres ....................... 239 Table 28. Types of imitations identified in the spoken vs. written genres ............................. 254 . x .

(11) LIST OF FIGURES Figure 1. Overall distribution of hedges found in the spoken vs. written genres .................. 117 Figure 2. Distribution of modal auxiliaries used in the spoken vs. written genres ................ 119 Figure 3. Distribution of epistemic verbs used in the spoken genre vs. written genres......... 146 Figure 4. Distribution of judgmental verbs in the spoken vs. written genres ........................ 148 Figure 5. Distribution of evidential verbs in the spoken vs. written genres .......................... 158 Figure 6. Distribution of subcategories of epistemic adverbs in the spoken vs. written genres ................................................................................................................................................ 168 Figure 7. Distribution of subcategories of epistemic adjectives in the spoken vs. written genres ..................................................................................................................................... 183 Figure 8. Distribution of subcategories of epistemic nouns in the spoken vs. written genres ................................................................................................................................................ 197 Figure 9. Distribution of non-lexical hedges used in the spoken vs. written genres ............. 215 Figure 10. Distribution of questions used in the spoken vs. written genres .......................... 238 . xi .

(12) CHAPTER ONE 1.1. INTRODUCTION. Background The word 'hedge' conveys the sense of imprecision, dodging, refusing to commit. oneself, or avoiding giving a direct answer to a question. ‘Hedging’ is a feature that used to receive pejorative connotations and is characterized as ‘poor’ in its usage, especially in circumstances inclining to formalization (Skelton 1988). It is believed that ‘hedges’ is initially used as a linguistic term (Skelton 1988, Crompton 1997, Markkanen & Schröer 1997, Meyer 1997, Varttala 1999, 2001, Kaltenböck et al. 2010) “to make things fuzzier or less fuzzy” (Lakoff 1973:471). Since the 1970s, the research of hedging phenomena has become a popular issue for subsequent linguistic analyses, and its scope has been extended from semantics to pragmatics and applied linguistics. As the scope expands to various linguistic fields, the notion of hedging is then approached from different perspectives, such as speech act and politeness theory (House & Kasper 1981, Brown & Levison 1987, Myer 1989, Tchizmarova 2005) and interactional pragmatics (Cheng and Warren 2003, Jucker et al. 2003, Overstreet 2005). The hedging phenomenon is thus realized as an inevitable feature that serves a variety of functions in communication. Channell (1994: 3) argues that vagueness is neither all ‘bad’ nor all ‘good” but depends on whether the vague language is used appropriately. In academic discourse, for example, hedges are shown to be an important part of a speaker’s/writer’s argument. They only help speakers/writers avoid categorical and straightforward assertions and distance themselves from full commitment to a claim, but they also allow speakers/writers to express their tentativeness and possibility regarding the factuality of their statements or to indicate deference to their audience. Investigation of use of hedges in academic discourse has also been an important line of inquiry since the 1990s (Salager-Meyer 1994, Hyland 1994, 1996a,b, 1998, 2000, Crompton 1997, Zhang 1998, Li 1999, Meyer 1997, Varttala 1999, 2001, Ruzaite 2004, Lewin 2005, Lo 2010, Yang 2013), The concept of politeness is the most frequently mentioned motivation for hedging practices 1.

(13) (Brown & Levinson 1987, Meyer 1989, Channell 1994, Markkanen & Schröer 1997). The politeness strategies of hedges are used to save either the speaker/writer’s or the reader/listener’s face. Being imprecise or mitigating one’s commitment to the truth value of a proposition or a claim helps protect the speaker/writer’s face from potential disapproval, and at the same time show deference to the reader/listener for not being too forceful. Hedges can be thought of as a typical feature of highest-level scientific peer communication, such as in professional specialist-to-specialist medical discourse. Research in medicine is normally explored in the fields of EAP (English for Academic Purposes) and ESP (English for Specific Purposes), and the use of hedges in the medical realm has also gained considerable attention (Prince et al. 1983, Adams Smith 1984, Bonanno 1994, Salager-Meyer 1994, Skelton, 1997, Varttala 1999, 2001, Webber 2005, Li & Ge 2009). In the earlier days, doctor-patient relationship was seen as an asymmetric one (Fisher 1984, West 1993, West and Frankel 1991, Ainsworth-Vaughn 1992, 1994, 1995, 1998), with doctors assuming a superordinate position while patients assuming a subordinate position. The asymmetry is ascribed to doctors’ specialized medical knowledge, the technical skills, and the professional prestige of their role. Nowadays, “patient-center” care is the newest trend in medicine (Srivastava 2011). As indicated in a speech by Dr. Huang, a chaplain and psychiatrist, of a Christian Hospital in middle Taiwan, conventionally doctor-patient relationship was viewed as professional to unprofessional, but now this traditional concept is challenged due to easy access to information. As long as one has the means to obtain the information s/he needs, everyone can be the so-called “professional”. In one lecture, Dr. Huang asked the audience with his own experience, “Have you ever met certain patients who come to your office with their laptop and show you the information they found from google?” Those patients have checked the possible causes and subsequent development of their illness before entering the doctor’s office. In other words, the role of the patient is transforming from a passive seeker to 2 .

(14) an active participant. With the advancement of medical technology and the promotion of human rights, the doctor is no longer the authority to decide what a patient should do or should not do because patients have the right to know and participate in their medical treatments. The higher the patients’ rights are valued, the more frequently the medical legal problems occur. To respect patients’ rights and avoid unnecessary legal problems, a better way for doctors to deal with doctor-patient interaction is to face their patients with honesty. The doctor has the obligation to tell his/her patient the possible causes of the illness, his/her diagnoses, the options of treatments, and the potential cure rates and risks along with those treatments. As exploration of the hedging phenomenon has been very much in vogue and spread from classic logics to various disciplines, the research is particularly flourishing in literature about English hedges. Comparatively, the linguistic realizations and functions of hedges in Chinese have not been taken with admirable attention (Biq 1990, Chen 2008, Lo 2010, Chang et al. 2012). Biq (1990) examines hedging functions of question words in conversational Chinese. Chen (2008) explores the realization of hedges in natural occurring Mandarin conversation. Her spoken corpus displays the manifestation of hedges in different linguistic categories. Lo‘s(2010) compares the use of hedges in three written academic disciplines, biology, business, and history & literature. Chang et al. (2012) extend Lo’s study by focusing on authorial stance in attribution hedges. Lo’s study is probably the first academic research which deals with hedging phenomenon in written Chinese. While some attention has been directed toward written academic discourse, to my knowledge, there is no corpus providing access to authentic Chinese academic spoken discourse, and there has been much less or no attention given to spoken discourse in the Chinese academia. This is probably due to the compilation of speech corpora is “more time-consuming, complex, and costly” (Swales 2002:150). In light of this insufficiency, the present study attempts to investigate the realization of hedges in both spoken and written genres. I compare the 3 .

(15) utilization of hedging strategies in physician-to-physician discourse and research articles. The motives for me to target medical discipline, to compare hedging realizations in both spoken and written genres, and to select physician-physician discourse and research articles as my research objects are explained as follows. First, medicine is tightly related to matters of human welfare. As human beings, our lives have immediate entanglement with medical science. In the past, the medical profession was seen to be distant from ordinary people, and it used to be regarded as mysterious and supreme. Nowadays, with the increasing demand of human rights and the current trend of “patient-centered care,” patients are able to participate more actively in their visits to the hospital. Patients then gradually realize that not only they themselves but also physicians are troubled by the increasingly visible uncertainty present in clinical practice. I believe that for many people, including me, the more the glimpses we are allowed to take into the medical profession, the more intrigued we are. Second, speech and writing are two common genres for communication, and hedges are employed in both genres. Yet some researchers (Markkanen & Schröder 1997, Flowerdew 2002, Swales 2002, Hyland 2009) have noticed that compared with written academic discourse, hedges in speech have been neglected for quite some time in the field of academia. In fact, it has been shown by a few studies in spoken academic discourse that hedges used in academic speech differ from writing in a range of different practices. Some lexical hedges have been examined to distribute divergently between speech and writing, and certain hedging devices are exclusively used in either spoken or written discourse (Ruzaite 2004); for example, the frequency of if-conditionals appear much more frequently in speech than in writing (CarterThomas & Rowley-Jolivet 2008). Third, in the medical discipline, a disproportionate amount of spoken and written discourse has also been observed. Except for Prince et al.’s study (1983) which focuses on physician-physician discourse, a majority of research examines written medical discourse (Adams-Smith 1984, Salager-Meyer 1994, Nwogu 1997, Skelton 4 .

(16) 1997, Varttala 1999, 2001, Carter-Thomas 2007, Li & Ge 2009). Since research articles are realized as one type of specialist-to-specialist discourse, the face-to-face interaction among physicians would be the symmetrical and compatible counterpart of research articles. The physician-to-physician discourse and medical research articles are then selected as the representatives of the spoken and written genres. For a better understanding how hedges are applied in medical discourse and for comparative purpose, it is worth investigating hedges in terms of genre. 1.2 Terminology and definition of hedges In previous studies, analyses of hedges and hedging-related phenomena are treated under various terminologies, such as vagueness (Danell 1978, Wierzbicka 1986, Wardhaugh 1985, 1993, Channell 1990, 1994, Myers 1996, He 2000, Jucker et al. 2003, Ruzaite 2004, Cutting 2007), fuzziness (Zadeh 1965, 1972, Wu 1999, Zhang 1998), imprecision (Du Bois 1987, Tannen 1989, Skelton 1988), mitigation (Caffi 1999, 2007), and pragmatic force modifier (Nikula 1996, Lin 2010). As fuzzy as its terminology, there is so far not an consistent definition for hedges. According to Adolphs et al. (2007: 62), “defining VL1 is a problematic endeavor, and VL is itself, arguably, a vague concept.” For Lakoff, a hedge is used to make things fuzzier or less fuzzy; however, after the 1980s, most studies apply the approximating and attenuating sense of this term rather than its ‘less fuzzy’ sense (Chafe 1986, SalagerMeyer 1994, Hyland 1998, 1999, 2005, Varttala 1999, 2001, Li 1999, Lo 2010). Although Lakoff’s definition of hedges is always quoted as a starting point by subsequent hedging studies, some researchers propose that hedges are indeed multifunctional, genre-related and context-sensitive (Channell 1994, Hyland 1998, Vartala 1999, 2001, Lin 2010). Thus, straightforward definitions of hedges are not commonly found in literature. Channell (1994: 20) defines an expression or word as a hedge if “a. it can be contrasted with another word or 1. Vague Language.. 5 .

(17) expression which appears to render the same proposition; b. it is ‘purposely and unabashedly vague’; c. its meaning arises from the ‘intrinsic uncertainty’.” Channell points out that “there are a number of different ways that a speaker can avoid being precise or exact” (p. 17). Different writers might focus on different aspects of the same topic and use the term “vague” to mean different things. In Hyland’s (1998: 1) investigation of scientific research articles, hedging refers to “any linguistic means used to indicate either a lack of complete commitment to the truth value of an accompanying proposition, or a desire not to express that commitment categorically.” Following Hyland (1996), Varttala (2001) describes hedging as a “polypragmatic” interactional strategy. That is, one single hedge may fulfill numerous pragmatic functions in discourse, depending on the communicative situation. Thus, Varttala defines hedging in a broad terms as “a strategy by which one may indicate different degrees of less than full commitment to conceptualization of the universe” (p. 34). Fraser (2010) sees hedging as a crucial aspect of pragmatic competence. If one wants to communicate effectively in a language, mastering the art of hedging is necessary. In his words hedging is “a rhetorical strategy, by which a speaker, using a linguistic device, can signal a lack of commitment to either the full semantic membership of an expression or the full commitment to the force of the speech act being conveyed” (p.22). Hedges are viewed as one of the interpersonal features by Warchal (2010: 141), who focuses on the interpersonal potential of conditional clauses in written academic discourse, and hedges are defined as “expressions that tone down the force of a statement by limiting the commitment of the author to the expressed proposition.” As suggested by the above studies, the notion of ‘hedging’ is essentially vague. The definition varies depending on genres, disciplines, and communicative purposes. In the present study hedges are seen as a polypragmatic interactional strategy, as proposed by Hyland (1996) and Varttala (2001), which serves to fulfill various functions in discourse. 6 .

(18) Hedges in this study are not restricted to single words or phrases that modify individual utterances or elements within them since hedging is context-dependent. In many situations, hedging devices cannot be determined by individual lexical units or phrases. More information is needed to make propositions comprehensible. Therefore, it is not unusual to observe that hedges are employed across utterances. I examine both the spoken and the written medical genres in terms of the attenuating sense of hedges. Linguistic expressions defined as hedges in the present study include: those which express the speakers/writers uncertainty about the precise quantity; those which convey the speakers/writers less than full commitment to the arguments or claims; those which the speakers/writers express tentativeness and possibility. 1.3 Uncertainty in medicine Medical professionals, especially physicians, are generally regarded as almighty experts who know everything about patients’ problems and who own the professional knowledge to treat patients’ health problems. However, the reality seems not to meet ordinary people’s expectation as there always exists uncertainty in the medical discipline (Bosk 1980, Schwartz et al. 1981, Prince et al. 1982, Kong et al. 1986, Simon 1988, Levenkron and Johnson 1988, Tsai 2006, Carney et al. 2007, Srivastava 2011, Smith et al. 2013). Doctors realize that in clinical practice, there are layers upon layers of explanation, and “it’s sometimes exceedingly difficult to arrive at simple, understandable definitions of diseases and how they afflict us” (Srivastava 2011). As clearly indicated by Bosk (1980: 72): It is rarely the case that signs and symptoms are unambiguous markers of specific diseases. Signs and symptoms often do not appear exactly as described in textbooks, and the full constellation that describes the “class” presentation of a disease is often not seen (p. 72). Uncertainty is commonplace clinically, and it is the most basic problem that all physicians face while making diagnoses and prescribing treatments. In the doctor-patient 7 .

(19) interaction, communicating uncertainty requires the ingenuity as studies find that physicians’ disclosure of uncertainty reduces patients’ satisfaction (Levenkron and Johnson 1988, Simon 1988). Levenkron and Johnson (1988) argue that the majority of patients can still respect physicians if uncertainty is communicated in a reassuring and confident manner. Their study finds that uncertainty can take at least two forms in medicine, one is physician uncertainty and the other is medical uncertainty. The physician uncertainty refers to situations when the physician cannot readily identify a piece of established medical knowledge, while the medical uncertainty refers to the probabilistic nature of a disease outcome, therapeutic response, or differential diagnosis that is associated with some degree of uncertainty. The way a physician conveys uncertainty varies individually, depending on the circumstance. It can be a frank open discussion of uncertainty, a quick mention of it, or consciously concealing it. Uncertainty arises not only in diagnosis in doctor-patient communication, but also in description of physical finding in physician-to-physician discourse. Prince et al. (1982) examine physicians’ talk in the rounds of a pediatric intensive-care unit, and find an uncommonly high rate of hedged assertions. The common hedges identified in the physicianto-physician discourse are classified into approximators (e.g. sort of, about, around, approximately) and shields (e.g. I think, according to her estimates). “Approximators” are employed the most frequently in the description of symptoms, which indicates that the physical situations and the terms chosen to describe the symptoms are, at best, imperfectly matched. “Shields” appear the most frequently in discussions of diagnoses and planning, which signals the speaker’s less than full confidence towards the statement being said. The high frequency and great variety of hedging devices observed in the physicians’ talk manifest that uncertainty is a ubiquitous feature in the medical realm. It is clear that “the hedging, or fuzzy communication, is as much a shared way of coping with uncertainty as it is an indicator of it” (Bosk 1980: 73). 8 .

(20) The above discussion shows that uncertainty is an inherent feature in the medical discourse, and the linguistic expressions of hedges serve as means for the physicians to express their uncertainty. The application of hedging devices is thus seen as a necessary and vitally important skill for physicians to manipulate their uncertainty either among physicians or between physicians and patients. Hedges are often employed by physicians to express tentativeness and caution for their arguments and claims either in face-to-face encounter or in writing. The interpersonal nature rooted in face-to-face discourse is presumably the factor which differentiates the choice of hedging devices and communicative purposes from those in written discourse. 1.4. Purpose of the study The purpose of this study is to investigate the hedging phenomenon in the specialist-to-. specialist discourse in Taiwan’s medical setting. The application of hedging strategies in the spoken and in the written genres is explored and compared. As hedges are seen as characteristic of medical discourse and are identified as a necessary and vital means in English medical communication (Bosk 1980, Prince et al. 1982 Adams-Smith 1984, SalagerMeyer 1994, Nwogu 1997, Skelton 1997, Varttala 1999, 2001, Carter-Thomas 2007, Li & Ge 2009), it is important to examine whether hedging strategies are also tactically employed by medical professionals in Taiwan. The hedging devices utilized by physicians in the peer communication is the focus of the present study as Bosk (1980: 72) suggests that “physicians’ talk provides one indicator of the uncertainty endemic to a medical environment.” I then compare the application of hedging strategies in two medical genres, spoken discourse (peer lectures) and written discourse (research articles), in order to reveal (i) what functions hedges display in the medical discourse, and (ii) whether and how genre difference affects the manifestation of hedges in Taiwan’s medical discourse. The research questions which will direct this study are: 9 .

(21) 1. What linguistic devices are used as hedges in the medical profession in terms of genres? What are their frequencies and distributions? 2. What functions do the hedging devices serve in the spoken and written medical discourse? 3. What are the differences in the use of hedges between the spoken and written medical discourse? 4. Are there any difference in the use of hedges between Chinese spoken medical discourse and Chinese daily conversation? If yes, what are they? 5. Are there any differences between Chinese written medical discourse and other written disciplines? If yes, what are they? 1.5. Significance of the study The present study aims at exploring the hedging phenomenon in the medical setting of. Taiwan. I examine hedging strategies used by medical professionals in face-to-face discourse and in research articles, attempting to see how hedges are manifested in the Taiwanese medical profession and whether they effect differently in the spoken discourse and in the written discourse. Although the investigation of use of hedges in academia since the 1990s have yielded significant results (Salager-Meyer 1994, Hyland 1994, 1996a,b, 1998, 2000, Crompton 1997, Meyer 1997, Varttala 1999, 2001, Ruzaite 2004, Lewin 2005, Lo 2010, Yang 2013), the researches mainly aim at written data. To date, there have been few systematic studies comparing the use of hedges in research articles of different subject fields (SalagerMeyer 1994, Varttala 1999, 2001, Lo 2010). To my knowledge, there are no studies focusing on hedges by means of genre comparison in Chinese. Furthermore, the use of hedges in Chinese medical discipline has not yet received attention, especially in the specialist-tospecialist spoken discourse as spoken discourse data is not easy to obtain in the medical setting. Prince et al.’s work (1982) is so far the only research which explores lexical hedges used in physician-to-physician communication. The current study, therefore, may be regarded 10 .

(22) as a pioneering work in a Chinese medical context. 1.6. Overview of the Study This study is composed of five chapters. The Introduction chapter presents the. background and purpose of this study, terminology and definition of hedges, and significance of the present study. In addition, the relation between uncertainty and medicine is also explicated in this chapter. An overview of the study is provided at the end of the Introduction. In the second chapter, I review literature of hedging from its initial semantic concept to its pragmatic and academic applications. The methodology is presented in Chapter Three, including description of the database, collecting procedure, and analytical framework. In addition, the working definition of hedges for the present study is described. In Chapter Four, I present and discuss the results of the analysis. I compare the frequency, forms, and communicative purpose in the use of hedges by means of genres. Chen’s (2008) conversational study will be used to compare with my spoken data, whereas Lo’s (2010) study in academic texts will be applied to compare with my written discourse. Chapter Five recapitulates the findings and concludes this study.. 11 .

(23) CHAPTER TWO LITERATURE REVIEW In this chapter, I review previous studies concerning investigation of hedging phenomena. The application of hedges is quite ubiquitous, which can be observed from ordinary daily conversation to formal institutional interaction or to academic discourse. Hedging devices, as well as communicative purposes of hedges, are utilized differently depending on disciplines, genres, cultures, and communication circumstances. Although the research in exploration of the hedging phenomenon has been particularly flourishing in English literature, lately there are several studies focusing on examination of Chinese hedges, which will also be reviewed in this chapter. In Section 2.1, I review the development of hedging concept, from its semantic origin to its pragmatic perspective. In Section 2.2, hedges in medical research are discussed, including hedges in medical writing, physician-tophysician interaction, and doctor-patient interaction. Hedges employed in non-medical fields, such as conversation and scientific disciplines, are reviewed in Section 2.3. Section 2.4 presents studies which compare various hedging devices between spoken and written genres. In Section 2.5, based on the literature, I recapitulate four functions what hedges demonstrate in academic discourse. The categorization of hedges is discussed in Section 2.6, including modal auxiliaries, lexical hedges, and non-lexical hedges observed in both English and Chinese literature. 2.1. Studies in hedges: from semantics to pragmatics The concept of hedges can be probably traced back to Zadeh’s (1965) work on logic of. fuzzy sets. According to Zadeh, a fuzzy set is “a class of objects with a continuum of grades of membership” (p. 338), and there are not precisely defined criteria of membership in the real physical world. In other words, most classes of objects in the natural world do not have sharp boundaries. It is highly unlikely to constitute a set of ‘beautiful women’ or ‘tall men’ in the light of the usual mathematical sense. In psychology, Rosch (1973) conducts experiments 12 .

(24) to test whether category membership is perceived as a clear-cut issue or a matter of degree, and the results consistently show the latter. For example, Rosch finds that there is a welldefined hierarchy of ‘birdiness’ which emergers in the subjects’ minds, in that robins are typical members of birds, eagles are less typical, and penguins are further away from the central prototype. Her further experiment demonstrates that while being asked to respond with ‘true’ or ‘false’ to sentences of the form ‘A (member) is a (category)’, subjects tend to respond faster on typical members than on peripheral members. That is, subjects take shorter time to respond to the sentence like ‘A robin is a bird’ than to ‘A chicken is a bird’. Rosch’s work shows that category membership seems to be in accordance with speakers’ uncertain rather than clearly defined perception. Based on Zadeh’s (1965) early work on fuzzy logic and Rosch’s (1973) work on category membership, George Lakoff (1973) relates the observations of natural phenomena in the physical world to natural language concepts. He suggests that: …natural language concepts have vague boundaries and fuzzy edges and that, consequently, natural language sentences will very often be neither true, or false, nor nonsensical, but rather true to a certain extent and false to a certain extent, true in certain respects and false in other respects (p. 458). The correlation between the idea of fuzzy concept and the practice of natural language brings up the notion of hedges. Lakoff (1973: 471) refers to hedges as “words whose meaning implicitly involves fuzziness -- words whose job is to make things fuzzier or less fuzzy.” An experiment is conducted to examine the effect of the hedging expression sort of in the case of birdiness: (1). a. A robin is a bird. b. A chicken is a bird. c. A penguin is a bird. d. A bat is a bird. e. A cow is a bird.. (true) (less true than a) (less true than b) (false, or at least very far from true) (absolutely false) 13. .

(25) (2). a. A robin is sort of a bird. b. A chicken is sort of a bird c. A penguin is sort of a bird d. A bat is sort of a bird. e. A cow is sort of a bird.. (false – it is a bird, no question, about it) (true, or very close to true) (true, or close to true) (still pretty close to false) (false). In Lakoff’s experiment, some subjects do not distinguish the sentences (a), (b), and (c) in example (1), and tend to regard them as all being true. However, after adding the hedge sort of, as in example (2), those subjects undoubtedly distinguish the sentence (a) from the (b) and (c). The subjects can instantly recognize the difference due to the ability to make an underlying distinction in degree of birdiness, and such a distinction is what the effect of sort of depends on. In the examples, the degree of truth is corresponding to degree of category membership. Robins are conceptualized to be the best exemplar of birdiness since they inherit the attributes, has wings, can fly, has feathers. Dirven and Verspoor’s (1998) definition may give a better idea of what the best exemplar is. They state that “the best member, called the prototypical member or most prominent member of a category, is the subtype that first comes to mind when we think of that category” (p. 16). Since subjects clearly know that robins are the prototypical members of birds, the sentence (2a), with the predicate modifier sort of, violates the knowledge they have. They then can determinately judge it as a false statement. Lakoff’s experiment reveals that people do make the full range of distinctions in the birdiness hierarchy, with robins judged to be the most representative member of the bird category, chickens less typical, penguins far less typical, and bats hardly at all. The following examples may better demonstrate Lakoff’s assertion that hedges serve both attenuating and reinforcing functions. That is, how hedges function to increase fuzziness, to make things fuzzier, and to decrease fuzziness, to make things less fuzzy. The practice of these functions is correlated to the concept of category 14 .

(26) membership existing in human’s cognition. (3). a. ＊A penguin is a bird par excellence. b.. A penguin is sort of a bird.. Sentence (3a) is false since the hedging expression par excellence requires the highest degree of category membership, yet a penguin is not the prototypical exemplar of birds. However, if we use the hedge sort of to describe a penguin’s birdiness, it becomes acceptable, as in (3b). With its implication of vagueness and imprecision, the hedge sort of is entrusted to describe more accurately an untypical member of a category. The status of a penguin is then modified by the hedge sort of to be a less prototypical member in the birdiness hierarchy, and which matches human’s conceptual knowledge in that a penguin is not a typical bird but is classified as a partial member in the bird category. In this sense, the hedge sort of makes the category boundary of birdiness fuzzier. Although Lakoff (1973) initiated the notion of hedges in terms of semantics, he does point out that pragmatics plays an important part in constituting truth values of sentences. The following example extracted from Lakoff’s (1973: 474) best demonstrates his view toward the significance of pragmatics: (4). a. John is a bachelor. b. John is a regular bachelor.. Sentence (4b) would not be said of a bachelor as we normally perceive, but rather it might be said of a married man who acts like a bachelor. It is because the word regular picks out certain ‘metaphorical’ properties and those properties make ‘bachelor’ deviate from its original literal meaning. In other words, regular asserts the connotations of ‘bachelor’. The connotations of words are usually recognized as part of pragmatics, and they are deemed to be irrelevant to truth values of sentences. However, the truth value of (4b) not only depends 15 .

(27) on the literal meaning of the predicate, but also strictly on the connotation. It indicates that “semantics cannot be taken to be independent of pragmatics, but that the two are inextricably tied together” (p. 474). Later on, Lakoff touches upon the notion on how hedges interact with performatives. He argues that if a sergeant says (5): (5). You might want to close that window, Private Snurg.. It would be appropriate to describe such a situation by the following two conditions: (6). a. Strictly speaking, the sergeant didn’t order the private to close the window. b. Essentially, the sergeant did order the private to close the window.. Therefore, Lakoff indicates that hedges obviously interact with felicity conditions for utterances and with rules of conversation. He then in this same article attributes to Robin Lakoff (personal communication) the observation that certain verbs and syntactic constructions convey hedged performatives which modify the force of a speech act, as in (7): (7). I suppose (guess/think) that Harry is coming.. The idea of hedged performatives becomes one way of widening the concept of hedges. Fraser (1975) follows up on Robin Lakoff’s observations and introduces the term “Hedged Performative” (p. 187). He proposes that when certain performative verbs such as apologize, admit, and request are preceded by specific modals, such as can, should, and must, or semi-modals. such as have to, intend to, would like to, the sentences result in an attenuated illocutionary force of the speech act designed by the verb: (8). a. I should apologize for being rude on the phone yesterday. b. I have to admit that you have a point. c. I must request that you sit down. 16 .

(28) The models and semi-models in example (8) are considered to function as hedges. After applying the model should, example (8a) is still an apology, but one less strong. Brown and Levison (1978, 1987: 145) elaborate on Lakoff’s definition of hedges and assert that hedges can modify the degree of membership of a predicate or noun phrase in a set, and “it says of that membership that it is partial, or true only in certain respects, or that it is more true and complete than perhaps might be expected.” They further develop hedging concept in the speech act. They argue that hedging acts not only on the propositional content, as considered by Lakoff (1973), or on the performative clause, as proposed by Fraser (1975), but also on the illocutionary force and speaker commitment in general. Brown and Levison incorporate Goffman’s (1967) notion of ‘face’ into their theory of politeness. They see politeness as a social reason to deviate from Grice’s (1975, 1978) conversational principles. Hedges are regarded by Brown and Levison as expressions which show that the speaker does not adhere to Grice’s (1975, 1978) maxims, and the use of hedges mainly as means of negative politeness. In Brown and Levison’s work, both the attenuation and the reinforcement aspects of hedges are maintained though they focus more on the former. Since hedges are pervasive in language use, Prince et al. (1982), defining hedges as linguistic means that make things fuzzier, makes a further distinction between different types of hedges: “fuzziness within the propositional content proper” and “fuzziness in the relationship between the propositional content and the speaker” (p. 85). The former type is referred to as “approximators”, as sort of in His feet were sort of blue, and it is further divided into “adaptors” (e.g. sort of ), which modify a term to fit a non-prototypical instance, and “rounders” (e.g. approximately), which indicate a term that is not precise. The latter type is referred to as “shields”, as I think in I think his feel were blue, and it is further divided into “plausibility shields” (e.g. I think, I guess, probably), which are expressions related to doubt, and “attribution shields” (e.g. according to her estimates, as far as I could tell from the 17 .

(29) mother), which are expressions attributing the responsibility of a proposition to someone other the speaker. According to Prince et al. (1982), only “approximators” affect the truth value of propositional content, whereas “shields” affect the degree of speaker commitment but leave the truth condition of proposition unchanged. A similar two-way distinction of hedges is proposed by Hübler (1983), who distinguishes linguistic indetermination into “understatements” (expressions of “phrastic” indetermination) and “hedges” (expressions of “neustic” indetermination), under the cover term “understatement”. Hübler presumes that there are oppositions to all sentences, and hedging devices are utilized by the speaker to prepare for possible opposition from the hearer. This underlying assumption manifests the interactional aspect of hedging phenomena, and shows that Hübler’s framework is pragmatic by nature. “Understatements” concern the propositional content of a sentence and its correspondence with the outside world, whereas “hedges” concern the speaker’s attitude to the hearer regarding the proposition. Thus, the understatement a bit as in the sentence It is a bit cold in here modifies the “phrastic”, that is the propositional content, while the hedge I suppose as in It is cold in Alaska, I suppose, modifies the “neustic”, that is the speaker’s attitude toward the utterance (p. 11). Hübler’s (1983) division of hedges is found to be quite similar to that of in Prince et al.’s (1982). Prince et al.’s “approximators” corresponds to Hübler’s “understatements,” and their “plausibility shields” corresponds to Hübler’s “hedges” (Markkanen and Schröder 1997, Varttala 2001, Fraser 2010). Caffi (1999, 2007) lately extend the bipartite distinction of Prince et al. (1982) and Hübler (1983) to a tripartite model. In her framework of mitigation devices, Caffi (2007: 16) ascribes the concept of mitigation, a synonym of attenuation, “is a result of a weakening operation on one of the interactional parameters.” Mitigation serves to smooth interactional management in that it “reduces risks for participants at various levels, e.g. risks of self-contradiction, refusal, losing 18 .

(30) face, conflict, and so forth” (Caffi 1999: 882), and it is argued to work in a “multi-layered and multi-dimensional way, simultaneously affecting a plurality of linguistic levels and interactional dimensions” (p. 883). Based on different scopes of mitigation, Caffi distinguishes mitigating mechanisms into “bushes”, “hedges”, and “shields”. The three domains where these mitigating devices operate on are the proposition (and within it, reference and predication), the illocution (e.g. illocutionary verbs, expressions modifying the strength of the illocution), and the deictic origin of the utterance (e.g. the I-here-now of the utterance). In “bushes”, the focus of the mitigating device is on the propositional content, which is typically made less precise. “Bushes” then refer to lexical expressions which reduce precision of the propositional content; therefore, it corresponds with Prince et al.’s (1982) “approximators” and Hübler’s “understatements”. An example extracted from Caffi’s Italian corpus of doctor-patient and psychotherapeutic interaction demonstrates how bushes (e.g. diminutive suffix –ino) work to attenuate the speaker’s utterance (in the following examples, the capital D stands for the doctor): (9). D. le do uno sciroppino da prendere.+due eucc I’ll give you ((lit. I give you)) a cough syrup+DIM to take.+two table sp (Caffi: 2007: 99). The doctor utters example (9) as he is about to write a prescription. The diminutive suffix – ino in sciroppino (lit. ‘a cough syrup+DIM) makes the reference act in the prescription fuzzy. With its semantic feature [-serious], the diminutive suffix –ino functions to reduce both the severity and the unpleasantness of the therapeutic prescription. It not only downgrades the imposition on the patient to comply with the prescription but also indirectly mitigates her possible worries about her pathology. In “hedges”, the scope of mitigation centers on the illocution, i.e. on illocutionary force indicating devices, and the speaker’s commitment to the propositional content. The notion of Caffi’s “hedges” covers Prince et al.’s (1982) 19 .

(31) “plausibility shields” and Fraser’s (1975) “hedged performatives”. “Hedges” are illustrated in the following examples: (10). D. […] io le proporrei se vuole una medicina apposta per vedere se riescxx – se riesco a farla dormire= […] I’d propose to you if you want a special medicine to see if I caxx – if I can make you sleep= (Caffi: 2007: 102). (11). D. Probabilmente è: - dove c’è l’attacapanni – probabilmente è una:: conseguenza di un problema intestinale: che è cominciato con I’influenza eh:? probably it is – where the clothes-stand is – it is probably a consequence of an intestinal problem: that began with the flu eh:? (Caffi 2007: 103). io le proporrei (‘I’d propose to you’) in sentence (10) is a hedged performative since the verb in the conditional mood is a weaker form than the performative expression ‘I propose”. In the doctor-patient relationship, although the doctor acts a strong role as the healer, he formally downgrades his directive to a proposal which is up to the patient to accept. In (11), the mitigation, which works on the aspect of the illocution, displays the speaker’s epistemic commitment to the propositional content. Probabilmente (‘probably’) is employed to weaken the speaker’s degree of certainty about the proposition. In other words, the doctor downgrades his diagnosis to a hypothesis, “nothing more than an attempt to trace abductively the temporal and causal sequence of facts” (p. 103). “Shields” are devices to avoid selfascription to the utterance and shift responsibility to another source, which is comparable to Prince et al.’s (1982) “attribution shields”. In “shields”, according to Caffi (2007: 106), “the act is not mitigated by explicit linguistic devices, but rather it is dislocated by means of backgrounding and de-focalizing strategies, or even by the deletion of the utterance source.” “Shields” appear to realize some strategies of displacement, which associate with the three components of deictic origin, the “I”, “here” and “now”. “Shields” in the “I” component are cases where the act is ascribed to someone else or cases where the author is simply deleted, as 20 .

(32) in impersonal constructions or agentless passive constructions. The other two means of replacement are interconnected since the displacement involves the “here and now” component of the utterance. “Shields” in the “here and now” component are cases where a narrative replaces a sequence focusing on the present context. Caffi claims that these “shields” can either work locally, at the level of a single utterance, as in (12), or globally, as textual strategies, as in (13). Example (12) illustrates a ‘non-I’, a non-ego strategy, whereas (13) displays a “I, not-here, not now’ mitigating device (C stands for the client and T stands for the therapist). (12) (13). D. c’è un’i:perplasia estrogenica – c’è scritto qui. there’s an estrogenic hyperplasia – it is written here. (Caffi 2007: 107) C. e poi: dall’85 I due anni diciamo in cui: stavo male ma non: per altri versi ma non Così male come sto adesso sono comunque riuscita a continuare a avorare mi hanno cambiato la respo*nsabilità+ T. *adesso sta male? +in questo momento? C. be’ adesso io sono qua e sono entrata per degli accertamenti: ulteriori= T. =no dico adesso ora qui. C. sì. T. sta male? C. be’ – certo. T. perché parla con me? C. no: non mi dà nessun fastidio parlare con lei. C. and then from 85 to 87 the two years when: let’s say I felt bad but not in other respects but not so bad as I feel now anyway I managed to keep working they changed my du*ties+: T. *now are you feeling bad?+ at the moment? C. well now I’m here and I’ve come in for further tests= T. =no I mean now at this very moment here. C. yes. T. are you feeling bad? C. well – of course. T. because you are speaking to me? C. no: I don’t mind speaking to you. 21. .

(33) In (12), the mitigation focuses on the utterance source, the deictic origin. By shifting responsibility to some other impersonal source, the doctor is able to weaken his personal commitment to the diagnosis. Furthermore, the utterance makes no reference to either interlocutor: it is not only a ‘not-I’ but also a ‘not-you’ statement. Example (13) is a transitional case between deictic shields. This interaction demonstrates a ‘narrativization’ shield, i.e. a global strategy of de-actualization o f a topic. In this specific context (the first session in a course of psychotherapy), the topic is the patient’s present state; however, with the process of de-actualization2, a present feeling is shifted to the past and is told in a rather detached way than being enacted. Caffi (1999: 905, 2007: 118) concludes that “mitigators mitigate because they manage speech act responsibility in different ways.” “Bushes” and “hedges” are scalar devices which work along a scale of degrees of epistemic commitment to the proposition and degrees of endorsement of the illocution respectively, whereas shields are yes-no devices (e.g. ‘I’/‘not I’, ‘now’/‘non-now’) which work directly on the core of the utterance act, the deictic origin, the formal support of subjectivity. 2.2 Hedges in medical research In the early days, the roles of doctors and patients were seen as asymmetrical, with doctors described to be dominant and active while patients are depend and passive. Ordinary people regarded doctors as the almighty experts who know causes of their discomfort and have the ability to cure their diseases. Until these few decades, the mysterious veil of medical profession is gradually uncovered, and people began to realize that medical diagnoses and prognoses involve an inherent degree of uncertainty. Smith et al. (2013) propose that no matter what physicians do, there will always be some uncertainty in prognosis, and the uncertainty “have profound influence on physicians, as well as on patients and families” (p.. Caffi (1999, 2007) points out that the process of de-actualization signals a separation from the present communication, and this strategy is claimed to aim at self-protection, with the notion of ‘resistance’ in traditional psychoanalysis.. 2. 22 .

(34) 2449); therefore, physicians need to recognize their reaction to uncertainty and how these reactions may influence their communication with their colleagues and patients. The language used in medical profession inevitably and necessarily reflects this degree of scientific uncertainty, and which is instantiated through the employment of hedges. In the literature, hedging phenomena in different medical environments have gained certain attention. While most of the studies focus the hedging investigation on written discourse (Adam Smith 1984, Salager-Meyer 1994, Webber 1994, Nwogu 1997, Skelton 1997, Varttala 1999, 2001, Li & Ge 2009), there are several researches examining the utilization of hedging devices in the medical spoken discourse (Prince et al. 1982, Bonanno 1994, Ferguson 2001, Webber 2005, Caffi 1999, 2007, Carter-Thomas & Rowley-Jolivet 2008). Among those studies, Prince et al.’s (1982) work is the only one which centers on hedging phenomena in specialist-to-specialist spontaneous talk. In the following subsections, hedging strategies employed in medical writing, physician-to-physician discourse, and doctor-patient interaction will be introduced in turn. 2.2.1. Hedges in medical writing Varttala (2001) states that, “scholars appear to put forth, the (explicit or implicit). presumption that hedging is an important strategy in communication between experts” (p. 41). Skelton (1997: 124) makes a comprehensive description on the utilization of hedging devices in medical writing. He states that “when we use language we both say things and talk about our relationship to what we say.” This is a common phenomenon that people share with while using languages. As we speak or write, the content we utter is propositions, and we comment on our attitude to the propositions. The comments we make are concerned with one or both of two things: our attitude towards the truth of the proposition and our attitude towards its value. For example, in the sentence, It has been argued that the earth is flat, The earth is flat is the proposition, and this proposition is modulated by a comment, It has been 23 .