身份类属机制的原理与应用--以医患沟通中的“老年”标识为例

On Principles and Application of Membership Categorization Device(MCD):Flagging“Oldness”in Doctor-patient Interaction

会话分析作为一种语用学领域的研究方法,对很多中国学者来说已不陌生。然而,与之同根同源,同在“民俗方法学”(ethnomethodology)框架下的“身份类属机制”(membership categorization device,简称MCD)却鲜为人知。本文先系统介绍身份类属机制如何构成会话中的显著诠释机制,以及其为互动交际构建交互主体性的重要价值;然后以新加坡某医院里的门诊语料为例,运用会话分析方法探讨“老年”这一身份类属在门诊互动中的作用。研究显示,不只老年华人患者在就诊时会标识个人的“老年”身份,将其作为拒绝医疗建议的理由,医生也会在特定的话语环境下用“老年”身份来标识患者,作为建议患者进行医疗检查的理由。这两种对“老年”身份类属看似矛盾的解读实际上反映了身份类属机制的重要运作原理:同一种身份类属在特定语境中的使用可能折射出不同的常识性推理,从而担负起不同的交际行为。门诊会话中“老年”身份类属的使用显示出身份类属机制这一会话互动资源的应用价值。

Conversation analysis(CA)as the foundation of interactional linguistics(IL)is already a well-known discipline in China.However,the communicative apparatus known as membership categorization device(MCD),which is also based in ethnomethodology,is still unfamiliar to most.In this article,we describe how MCD works as a common interpretive mechanism in interactional practice,which is key to constructing the intersubjectivity of interlocutors.We begin by introducing and explicating the MCD concept using a classic analysis by Sacks(1972).A key understanding of how membership categories work in interaction is that they are"inference-rich",as such social categories are also imbued with category-bound attributes and relevant category-bound activities.Hence,categorization in talk does not simply ascribe certain identity unto others,but can also be an interpretive mechanism used by speakers to understand how others are and/or how they should behave.This is what ethnomethodologists term as"documentary method of interpretation"for instinctively establishing characteristics or attributes to members of a category.Another key understanding is that a category(such as"baby")can belong to more than one"category sets"(i.e."baby"can belong to either the category set of"family"or that of"stages of life").Therefore,inferences of a category based on them being a member of one category set(eg.babies are cared for by their mothers)can differ from another(eg.babies have fewer health issues than the elderly).To illustrate how MCD works,we focus on the category of"oldness",and analyze its usage within the setting of medical consultations.The data were curated from 152 video-recordings of authentic first-visit consultations in urology clinics within a Singapore hospital.Our findings show that"oldness"as an MCD can not only be used by doctors as justification for medical recommendations,but also be used by elderly Chinese patients as a rationale to reject doctors'recommendations.While such interpretations of what"oldness"should mean to members of this category may seem contradictory,it in fact instantiates an important principle in the operational apparatus of MCD as a linguistic device.That is,the same MCD can facilitate different but equally valid trajectories of"common-sense reasoning"as an interpretive mechanism.Through detailed conversation analysis of the"oldness"MCD in medical interactions,we highlight the value of MCD(or categories in talk)as an important resource for accomplishing interactional objectives,as opposed to being static markers of identities.