End-of-life interviews . . . and verbs Part II

A quick review

In my last post, I discussed modals and how they’re used to make predictions about the future. More importantly, I consider modals as grammatical markers that indicate that a palliative care patient is discussing the legacy they’ll leave behind after they die. As promised, this post is about grammatical aspect: which is a grammatical marker that relates information about whether an event described by a verb is ongoing, has been completed, or is being repeated. Again, I’ll include the caveat that modality and aspect are my focus for my discourse analyses of end of life psychotherapeutic interventions between doctors and palliative care patients. By better understanding how patients use grammar at the end of life, I believe that we can better understand how they situate their stories in relation to themselves as dying patients, and the individuals they were before they were diagnosed with a terminal illness.

Primary auxiliaries

You’ll recall that auxiliary (‘helper’) verbs encode information about plausibility, and temporality into sentences. Modal auxiliaries are one kind of auxiliary verb, but the primary auxiliaries relate perfect aspect, progressive aspect, and passive voice (the last, as mentioned in my last post, I won’t be focusing on).

The perfect aspect or the perfect “have”

Unlike the verb “to have,” which means to possess, the perfect “have” introduces the perfect aspect into a sentence and is always followed by the past participle form of the next verb (Remember the mouse“might have been being eaten” by the owl.)

My research argues that, along with using modals to discuss legacy, dying patients’ narratives contain other grammatical markers that indicate a relation between the patients’ narratives of the past and their present situation—in other words, patients use aspect to relate the character they are now to the characters they were before terminal diagnosis. That being said, the perfect “have” has three different contracted forms: in the present tense ‘s (for has) and ‘ve (for have), and in the past tense ‘d (for had.)

So it’s important to note how patients use the perfect aspect. Below are amended examples taken from narratives where patients connect their pasts with their present using the present perfect aspect and the past perfect aspect:

Present perfect aspect

1) “Like I say, you’re busy and when you’ve got your health, you don’t stop and think. I’ve had many years with cancer, but when it became malignant, I was angry.”

2) “I hope I haven’t cried too much for you.”

3) “I’ve made lots of mistakes. Don’t we all?”

4) “I’ve lived a good life and I’ve had a wonderful life. Life is hard, but like everybody else, you just go through it.”

5) “I’ve always said that man upstairs, he’s got your number and when that number comes up, there’s nothing you can do.”

6) “I was sick when I was eight, and that’s continued all my life.”

Past perfect aspect [for this aspect, the auxiliary perfect “have” is in the past tense and distinguished by italics]

7) “You know my husband and I went to Malaysia and we’ve been to a number of other places. We’d planned when we were in Malaysia to go back and just drive around the islands. We’d planned to have many, many more trips . . . unfortunately we’re not able to now.”

8 ) “Last year I wrote good bye letters to all of my family members. If I’d have left it even until now I think I wouldn’t have been able to write as clearly as I did. I can’t remember what I said in them, but I know that I was quite satisfied with what I’d written at the time.”

9) “We went to Spain once with another couple, though I certainly wouldn’t have done that if my wife hadn’t been alive.”

Language as timeline

How can I prove that the perfect tense indicates a relation between the present and the past? Using Reichenbach’s system of temporality in language (from Experience and prediction [1938]), we use language to relay three points of time that are relevant to a normal statement:

· Speech Time (S): the time the statement was spoken or written

· Reference Time (R): the time on which we focus

· Event Time (E):the time at which the event took place

If we imagine these points on a timeline, which tense and aspect are used depends on the relation between S,R, and E.

So let’s consider the following statement:

6) “I was sick when I was eight, and that’s continued all my life.”

In every case, we understand S to be the moment of the interview; R, the time on which we focus, is the patient’s lifespan since age six; and E, the time the event took place, began when the patient was six, but has continued to S (the time of the interview.) On a timeline, we can represent this relation as follows (where the dotted line represents that the time the event took place is the patient’s lifespan since age six.)

- – - – - – - – - – - – - – - – - – - – - – - S

E_____________________________R–>

Age six                                Time of interview

As you can see, the present perfect aspect creates a relation between the past and the present.

 

To contrast this, though, here’s an example of the less common past perfect aspect:

7) “We’d planned to have many, many more trips . . . unfortunately we’re not able to now.”

We don’t have any set dates here, but we do know that at some point in the past plans were made to travel but were interrupted by a terminal illness. Again, S is the moment of the interview; yet this time R, the time on which we focus, is the implied interruption of “many, many, more [trips];” and E, is the past instance of planning those trips—pre-diagnosis.

E______________R_______________S–>

Planning        Interruption        Time of interview

Perfect aspect is a way of indicating the relation between the focus point (R) and the time at which an event took place (E). Tense, on the other hand, is a way of indicating the relation between the focus point (R) and speech time (S): in the first sentence, R and S coincide and we get the present tense; in the second sentence, R precedes S and we get the past tense.

For an event that happened in the past, if we use the perfect aspect, we are focusing not on the time of the event, but on some later time, for instance “now” or “the moment of terminal diagnosis.” Hence, the perfect aspect is used when we want to indicate the importance of an event for what is going on now. And therefore, patients use the perfect aspect to connect moments from their past on a timeline between the moment of their terminal diagnosis (past perfect) or the present moment of the dignity interview (present perfect.)

Obviously we don’t need to draw timelines to situate every example; the contexts of patients’ narratives provide all of the information we need. Yet, I think this is a useful exercise for proving the relation between the past and present in dying patients’ narratives

The progressive aspect or the progressive “be”

In a similar vein, another primary auxiliary is the progressive “be” that follows modals and the perfect “have”—if they occur—and indicates that something is in progress. The progressive “be” is followed by a lexical verb in its –ing form—so, if “been” appears in a verb string but isn’t followed by a verb in its –ing form, then it isn’t the progressive “be.” In many cases, the progressive occurs in a verb string with the perfect “have” to further ensure that the listener is aware there is a direct relation between the narrative event and the patients’ current life:

1) “Well, you won’t believe this. I’ve been writing a biography of myself.”

But the progressive “be” doesn’t have to be used in a verb string with the perfect “have:”

2) “Palliative care wasn’t just offering me hope it was like ‘we’re gonna find that you have no pain anymore.’”

3) “One of the things when I became ill, was that I decided that I was not going to be angry anymore with anyone because it was a waste of time. It’s better to be nice to people than to be angry.”

I haven’t fully synthesized my argument about the progressive “be.” But I believe, pending a bit more research, that the progressive is a way of relating past events more directly to the present moment by implying that they are ongoing. This is powerfully important for differentiating statements made by palliative care patients–especially for psychotherapy–because this verb tense indicates that the sentiment is incomplete and therefore may require closure. If a therapist can use grammatical markers to determine statements that suggest a lack of closure, they can use these markers as focal points for discussion and therapeutic intervention.

Conclusion

I don’t have any major findings to report as of yet but I will publishing this research in a forthcoming academic article along with my research supervisor and a psychiatrist. As I’m sure you can imagine, this research causes me to think about some of the most profound existential issues that we must all face: death, dying, and legacy. I find myself brought nearly to tears when I read these documents and this series of blog posts serves to functions: first, to share with you just what the hell I do when I tell you my second job is discourse analyses of end of life psychotherapeutic interventions between doctors and palliative care patients; but second, to invite you to understand the remarkable nature of palliative care as I see it. On this second point, have you ever thought of volunteering at a hospice or palliative care ward? Dying patients have stories to tell and they have a lot to teach us about life. After this research project, I think about it a lot–I’m just in grad school right now and can’t find the time. But I will someday . . . if I ever finish school.

 

End-of-life interviews . . . and verbs

A lot of people ask me for more information when I tell them that my second job is discourse analyses of end of life psychotherapeutic interventions between doctors and palliative care patients. When I explain that I do both thematic and grammatical analyses of these interviews, people still ask what that means. Today I will discuss what I mean by grammatical analyses and I’ll save an explanation of thematic analyses for another post. Specifically, I am looking at the way that palliative care patients use verbs and how verbs are grammatical markers that evince a sense of mortality for these patients.

What are verbs?

Verbs are the central part of a sentence, especially because they select what other parts can occur in a sentence. So take this sentence as an example:

He wears her pendant as a reminder of days long past.

In this sentence the verb is wears and we know that the verb must be followed by more information because “He wears.” is an impossible sentence. Yet, have a look at these two sentences (the one with the asterisk is another impossible one):

*He wears her her pendant as a reminder of days long past.

He gives her her pendant as a reminder of days long past.

Here, the verb decides what type of phrase can follow it. In these examples I’ll illustrate more examples of how verbs allow certain concepts to follow them:

*He wears her concept as a reminder of days long past.

*He wears her pendant quickly.

He grabs her pendant quickly.

These simple examples illustrate that verbs are the central part of a clause (a clause simply means the smallest meaningful part of a sentence) and therefore are the most influential aspects of how a sentence can be understood. I’m explaining this because I believe that studying how people use verbs can reveal how they situate themselves in relation to time and space, and their own personal beliefs.

Lexical vs auxiliary verbs

Okay, here’s where things get kind of complicated, but I’ll try to keep this interesting and use good examples. In brief, the English language strings together verbs to relay the complexity of space and time into sentence meaning. So, for example, here is a string of verbs about an owl eating a mouse:

The mouse might have been being eaten by an owl.

Here we have the word might (a modal) followed by a string of four verbs (have been being eaten)—each of these verbs contribute to how this sentence can be understood in terms of space and time.

In this sentence, the most important verb is the verb eaten as it is the main focal action of the sentence. Eaten is the lexical verb of this sentence, the most ‘contentful’ verb. The remaining verbs in this sentence (“have been being”) are auxiliary verbs—verbs that contribute to other ways a sentence can be understood; they ‘help’ the lexical verb and can only occur as part of a verb string.

Auxiliary verbs

Auxilliary verbs provide information about the modality, aspect, or voice of a sentence (for our purposes, I’ll define voice here, but I’ll elaborate on it in another post; here my focus is modality and aspect):

Voice

Grammatical voice describes the relationship between the action that the verb expresses and the participants identified by its arguments (the subject or object). So, when the subject enacts the verb, the verb is in the active voice; when the subject undergoes the action described by the verb, it is in the passive voice.

Modal auxiliaries

Modality relates to how plausible the speaker thinks it is that what the sentence says will actually happen (this is why modality is sometimes referred to as grammatical “mood” and why grammatical markers of modality, as mentioned, are called modals). English does not have a separate verb form for the future as some other languages do. And, because my work studies palliative care patients discussing the future after they have died, I look at how patients use grammatical markers to indicate a future after they’ve passed away. Below are amended examples of how palliative care patients use modals to discuss their futures:

1) “I’ll always think about my family, even if I be in heaven. I will always protect my family.”

2) “I believe that your essence continues after death, you don’t end, so to speak. The body disappears, so you shouldn’t spend too much time worrying about small things.

3) I know I’m going to die and I’m ready as most people can be. I don’t know what it will be like when it happens.

4) All in all, I’m not going to miss much. (9.4)

5) “I could die in six months or it could be six weeks. Who knows?

6) “I hope my husband can manage himself and eat well.

The core modal verbs are can-could, may-might, shall-should, will-would, and must. The modal will most commonly indicates a focus on the future (as in the first and third examples), and the second most common way we discuss the future is the verb string “be (am, are, is; was, were) + going to,” as in the third and fourth examples. However, as we can see, other modals also refer to the future.

So in the above example, dying patients discuss the future with the following modal constructions: “it would,” “you should be,” “I could be,” “he can,” and “I will,” etc.

So, overall, the modals used here are really used to make predictions about how likely it is that something will happen in the future. The choice of verb, then, depends on how confident the speaker is about the statement.

Next up: Aspect

So in English we use modals to make predictions about the future, and which modals we choose indicate our belief in the likelihood of the statement occurring. Think about how you talk about the future, and you’ll realize that we almost always use modals. I thought I could fully discuss verbs in this post but I’m already running a bit long. I’ll follow up this post with another about grammatical aspect: which is how we relate information about whether the event described by a verb is ongoing, has been completed, or is being repeated. In case you forgot the reason I am telling you all this: modality and aspect are my focus for my discourse analyses of end of life psychotherapeutic interventions between doctors and palliative care patients. By better understanding how patients use grammar at the end of life, I believe that we can better understand how they situate their stories in relation to themselves as dying patients, and the individuals they were before they were diagnosed with a terminal illness.