
































At the Intersection of Medical and Linguistic Anthropology: Ethnographic 

insight into a Catalan Paediatric Oncological Ward 

Review by Letizia Bonanno

Uncertain Futures: Communication and Culture in Childhood Cancer Treatment

by Ignasi Clemente

Wiley-Blackwell, 2015

Uncertain Futures is an emotional and ethnographic journey in the paediatric oncological ward at the

Catalonia Hospital in Barcelona. Ignaci Clemente offers a compassionate blueprint of what medical

communication looks like when children with cancer, their families, and the medical staff struggle to

make the trajectories of cancer  and its  treatment  seem less uncertain.  This  ethnographic insight  is

offered through a captivating analysis of the communicative strategies that young oncological patients,

their  relatives  and  doctors  engage  in  at  the  different  stages  of  cancer  treatment.  Using  extensive

conversation  excerpts  to  sustain  his  ethnographic  inquiry,  Clemente  traces  the  dynamics  and

trajectories of the diagnostic process and the treatment children with cancer undergo and engage with

on a daily basis.

Interestingly, Clemente focuses on describing how the everyday commitment to optimism seems to

respond to a moral obligation to protect children from both the present and future suffering which

might derive from the diagnosis of cancer or of treatment side-effects. In this vein, the commitment to

optimism becomes apparent here through opaque communicative strategies, among which the notion of

disclosure figures as both the theoretical knot and challenge that Clemente’s volume revolves around.

As illness and hope may both be embodied through talking, Clemente argues, chatting always implies

and attunes itself to those moral discourses doctors and parents engage in with children on the necessity

of their active and collaborative involvement in their treatment. Indeed a collaborative approach may



enhance the recovery, avoid relapse and make patients more aware of their condition. In this regard,

awareness and compliant behaviors that patients are called to live through seem to resonate with the

making of a neoliberal subjectivity, in other words, the moral making of future healthy adults able to

care for themselves and increasingly able not to overburden the healthcare system. In this vein, Paul

Brodwin (2012) and Elisabeth A. Davis (2012) have clearly highlighted how likely discourses on health

are to blur with moralistic judgements on the patients’ conduct by doctors, while attempting to enhance

autonomy and responsibility in patients by stressing how the moral responsibility toward their own

health actually implies being responsible toward others and society as a whole. How this transnational

neoliberal turn has impacted in different ways on care practices and discourses was investigated in

depth by Annmarie Mol (2008), who has in fact drawn attention to the contrasting logics of care and of

the patients’ choices, and has made apparent how the patients’ free choices and good care are rarely a

good combination.

Although the author repeatedly hints at how moral responsibilities are performed and fulfilled when it

comes to  care,  Clemente does not broaden this  perspective.  A deeper  grip on the anthropology of

morality would probably have better enlightened how care is performed, enacted and experienced. In

this sense, both Kleinman’s hypothesis on care as a moral experience (2013) and Mattingly’s concept of

therapeutic emplotment (1991) would have provided Clemente with a broader perspective on care as a

moral experience, as a narrative effort to make sense of the complex realities that illness brings about,

and as the fulfillment of a moral obligation to maintain hope on a daily basis. In this regard, hope

figures as one of the main knots in Clemente’s ethnography, although he fails to problematize how

hope  is  experienced and thought  out  by  patients,  and it  is  alternatively  described  as  an  on-going

negotiation of the present as well as a future oriented attitude, as Zigon would put it (2009).

Nevertheless,  by  extensively  interrogating  the  limits  of  verbal  language,  Clemente  takes  into

consideration what roles are played by silence and postures, which are both graphically reported and

rendered into regular conversation transcriptions and illustrations. The use of illustrations enriches the

entire ethnography, and helps the reader better contextualise where and how verbal and non-verbal

interactions take place. At the intersection of medical and linguistic anthropology, Clemente provides

ethnographic  cases  throughout  with  which  it  becomes  possible  to  critically  rethink  conversational

dynamics  occurring  in  medical  settings  and  involving  children.  By  relying  on  the  methods  of

conversational analysis, the author contributes to implicitly challenge the axiom of power relations

supposedly driving the encounter between patients and doctors. In so doing, an accurate perspective on



how medical authority is constantly faced and challenged by patients is offered by providing the reader

with ethnographic vignettes. In this regard, Clemente defines the negotiation of information in order to

highlight the different degrees of child participation in medical decision-making. Whereas a certain

asymmetry in power between children, their family and doctors is undeniable, medical authority is

often contested through non-collaborative behaviors or the relentless questions that young patients and

their parents constantly confront doctors with. As such, the dynamic process of communication results

as not just the expression of meaning, but also as the enactment of power. As it appears from reported

conversations, strategically doctors tend to give patients cloudy and partial answers when patients’

anxiety to know about their health condition mutate into a desperate need and search for certainties

which are, however, beyond any medical predictability. Indeed, within the peculiar clinical context, the

speculative nature of diagnosis  couples  with the ambiguity and duplicity  of medical  language and

concurs  to  produce  a  situation  of  increased  uncertainty  and  instability  on  the  patients’  side.

Nevertheless,  symptoms  and  speeches  together  constitute  a  language  of  the  body  through  which

patients express a range of dispositions, conscience and critique towards the medical authority and

knowledge.

Beyond linguistic analysis, Uncertain Futures also focuses attentively on how cultural factors, medical

knowledge and emotional talks intertwine. Taking full advantage of his proximity with the Spanish

culture and languages, Clemente provides a unique perspective on making the hospitalization process

for children with cancer as favorable as possible, and brilliantly depicts how life intersects in different

ways with treatment at the Catalonian Hospital. Clemente shows how the routinization of hospital life

makes the paediatric ward look like a ‘small village’, a temporary microcosm of social relations which

are daily negotiated, made and undone through friendships, love, reciprocity, shared perplexities and

personal experiences which are always on the verge of becoming collective. Worth noticing is how fear

and negative emotions are stubbornly kept in the private sphere as they are felt to threaten children’s

wellbeing and the parents’ commitment to optimism. As a consequence, the parents’ emotional bursts

of despair, which generally happen far from the others’ eyes, parallel the apparent quietness of the

paediatric ward, while signaling what Clemente indicates as the process of becoming a parent of a child

with cancer. In this sense, Clemente’s argument seems to resonate with Addlakha and Das’ definition of

‘domestic citizenship’ (1998).

Although the feeling of togetherness stemming from the ward results from the proximity that the ward

seems to forcibly enhance by its very nature as a place of confinement, children’s parents seem to take



relief from their becoming closer to each other. Whereas proximity contributes to the production of lay

and practical knowledge which derives from sharing and exchanging experiences and helps parents to

cope with their children’s symptoms and suffering, equally it allows parents to better cope with those

changes that their children’s hospitalisation has brought in their daily lives. Indeed, life is seemingly

suspended in time and place: many of them have in fact quit their jobs to take care of their children,

others have left their villages to move to Barcelona so as to follow their children's hospitalisation more

closely.  In  the  effort  of  rebuilding  a  daily  routine,  proximity  helps  them  redefine  the  terms  of

parenthood and personhood.

Uncertain  Futures definitely  provides  original  insight  on  how  patienthood  and  childhood  are

experienced when illness reshapes the terms and meanings of time and hope for both children and their

kin. Navigating the ups and downs of cancer treatment is mirrored in temporal discontinuities in the

ordinary life of the ward – waiting for examinations results or for the side effects of their treatment to

become evident – and changes the experience of time which is not only felt to be escaping them, but

often  experienced  bodily  through  a  slow but  relentless  deterioration  of  health  conditions.  From a

phenomenological perspective,  the body becomes the hinge of experience and through an attentive

reading  of  symptoms  and  signs,  coping  strategies  and  predictions  of  diagnosis  and  treatment

developments may be inferred as well. Although Clemente is well aware of the role that time plays in

articulating the trajectories of illness and recovery, the texture of ethnographic and clinical time often

results  in  a  disjointed  reading  experience,  and  the  potentials  of  ethnography  do  not  seem  to  be

completely scrutinized. Furthermore, frequent theoretical digressions scattered throughout the volume

render the whole ethnographic picture slightly fragmented.

Clemente’s work undoubtedly opens up broader margins of reflection about how medical diagnoses,

and in  general  medical  communication,  are  delivered and negotiated and provides  the reader  with

extensive references with which the theoretical discussion is constantly confronted and challenged.

Uncertain Futures is a complex text which actively engages with the legacies informing the author’s

framing of the lives of young cancer patients and their relatives. In so doing, Clemente is surely paving

the way toward a more fertile and effective collaboration between medical and linguistic anthropology,

which might mutually benefit from theoretical contamination.

References Cited

Addlakha, R. and Das, V. (1998) Disabilities and Domestic Citizenship: Voice, Gender and the Making



of the Subject. Public Culture 13(3)

Brodwin, P. (2012) Everyday Ethics: Voices form the Front Line of Community Psychiatry. University

California Press

Davis, E. A. (2012) Bad Souls. Madness and Responsibility in Northern Greece. Duke University Press

Mattingly,  C.  (1991)  The  Narrative  Nature  of  Clinical  Reasoning.  The  American  Journal  of

Occupational Therapy 45(11): 998- 1005

Mol, A. (2008) The Logics of Care: Health and the Problem of Patient Choice. Routledge Paperback

Kleinman,  A.  (2013)  From Illness  as  Culture  to  Caregiving as  Moral  Experience.  <em>The New

England Journal of Medicine</em> 368(15): 1376- 1377

Zigon, J. (2009) Hope dies last.  Two Aspects of Contemporary Hope in Moscow.  Anthropological

Theory 9(3): 253-271

Letizia Bonanno is a PhD candidate in Social Anthropology at the University of Manchester. She is

currently  carrying  out  her  ethnographic  fieldwork  in  Athens,  Greece,  where  she  is  investigating

discourses and practices of care in the Social Clinics and Pharmacies of Solidarity, informal and self-

organized healthcare facilities that have spread through ‘Greece under austerity’ since 2010.

© 2016 Letizia Bonanno


