Understanding misunderstandings. Presuppositions and presumptions in doctor-patient chronic care consultations

Abstract

Pragmatic presupposition is analyzed as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for presupposing a proposition is represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely they need to be the reasonable conclusions of an underlying presumptive reasoning, which does not or may not contain contradictions with other presumptions. Presumptions are in turn analyzed considering their nature and their hierarchy, namely their subject matter and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between misunderstandings deriving from presuppositional failures and the underlying system of presumptions. This approach is applied to the investigation of communicative issues within the medical context, and more precisely doctor-patient communication in diabetes cases.

How can metaphors communicate arguments?

“…A frequent case is the use of "a little moment" (un attimino) (a temporal indication) to express a modal adverb (quickly, rapidly) and thus lead the interlocutor to performing an action that can be refused based on time consumption reasons. Rapport-building metaphorical moves are used to express intimacy or distance, or pointing out the characteristics of the relationship ("right now I have an agreement with you," see Macagno and Bigi 2017a) These examples illustrate the most frequent and most prototypical uses of metaphorical moves in a specific corpus. However, this analysis appears to be incomplete.…”

The Complex Process of Mis/Understanding Spatial Deixis in Face-To-Face Interaction

“…A number of causes or triggers of misunderstanding that can also cooccur in unsuccessful communication has been pointed out, such as the following ones: external sources such as channel disturbances, responsible for mishearing, the characteristic features of face-to-face interaction, that is, among others, elliptical speech and the 'micro-planning' of spoken language, ambiguity, 4 indeterminacy and vagueness of language (Jucker, Smith, & Lüdge, 2003;Bazzanella, 2011), metaphorical meaning, figurative language and non-literal meaning, the high frequency of implicit meaning, presuppositions/ "presumptions" (Macagno & Bigi, 2017) and the need for conversational inferences, inter-and intra-linguistic varieties, as in, respectively, examples (1) above (with regard to Hungarian in comparison to English and Italian), and (2) above (with regard to the regional language spoken in Tuscany and standard Italian), both speaker's and interactant's "mental worlds" (Mustajoki, 2017a) and their unshared beliefs, knowledge, and competence, 5 interactants' idiosyncratic failures related to asymmetries in role/competence/culture, speaker's failures regarding her/his cognitive load, lack of proper recipient design, slips of the tongue and imprecision (e. g. Mustajoki, 2012), interlocutor/s' cognitive load, lack of attention and inappropriate inference.…”

Types of Dialogue and Pragmatic Ambiguity

“…Some patients act based on the presumption that the doctors shall impose a treatment and the patient has no other role than obeying or not obeying. Our analysis was aimed at identifying instances of misaligned presumptions at different levels that could be considered as the causes for such "cultural" differences (Macagno and Bigi 2017b). Indeed, the latter can be conceived as presumptions at various levels that can be subject to default and may result in ambiguity and misunderstanding at a semantic (the language used), encyclopedic (the knowledge about relations between facts or events), pragmatic (presumed communicative intentions), or mutual (how people generally behave or what they like most) level.…”