Laurie Anderson: Language is a Virus
https://www.youtube.com/watch?v=KvOoR8m0oms
Knowledge Translation is defined as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.
This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user (Graham, 2010).
CIHR https://cihr-irsc.gc.ca/e/29418.html#2
“The man who used that voice had no native language. He had learned the use of an alien tool.”
The Ticket that Exploded, p. 9. William S. Burroughs
“The word is now a virus…The word may once have been a healthy neural cell. It is now a parasitic organism that invades and damages the central nervous system…The word is spliced in with the sound of your intestines and breathing with the beating of your heart.”
The Ticket that Exploded, p. 50. William S. Burroughs
The academic-bureaucratic complex demands first that all thought is translated into its lingua franca, which is in English but not English. It is deracinated, universal, transmissible – it emanates an aura of authority and truth, yet can be used as readily to express utter nonsense as sound scientific knowledge. Like Latin in medieval Europe, it is the language of political and religious elites – inasmuch as modern university scholars overlap in their social and ideological functions with priests and monks. Knowledge, from the researcher to you, the mere “user” of knowledge, has already been translated.
Translation broken down into its Latin roots means simply carrying across – taking something from one place and putting it down in another. Translation commonly means taking words from one language and carrying the meaning across to put it down in another language. However: “Life is not just crossing a field” as Boris Pasternak wrote – originally in Russian. Read the translator’s introduction to any work of literature and you will soon learn it is not so simple.
The definition of knowledge translation quoted above mentions complexity, twice, in the conditions under which the process of knowledge translation takes place. I don’t think this is quite the same thing as acknowledging the inherent complexity of translation itself. For one thing, KT (words translated into letters – we’re all busy people) appears to assume that knowledge in the end is being carried from place to place, from the hands of researchers to knowledge users. Whereas in fact, knowledge is being converted into practice, which is enacted knowledge. George Steiner, in his magisterial work on translation, After Babel, introduces a term of Roman Jakobson’s, “transmutation” to indicate not simply translation but “an intersemiotic process” (p. 274) from one form of communication to another. Steiner gives as examples of intersemiotic forms, plotting graphs, dance or music. These are a long way from the usual concerns of KT but the principle applies if we take note of the embodied forms of dancing or music making. Healthcare practices, where the actions of clinicians are required to shift in the light of new knowledge, are also embodied forms – moving differently in space in response to new objects or processes, or in another sense, the patient’s body ingesting a new drug and the observation of its visible effects.
Steiner is chiefly concerned with translation of literary texts, not of technical texts that are designed for functional communication, and he does not pursue Jakobson’s point about translation between forms except in the case of music. But coming from the world (and its language games – Wittgenstein) of healthcare research and taking the textual avatars of KT at their word, it is worthwhile taking the translation in KT at its word, and considering it in the light of what Steiner had to say about it.
George Steiner proposed a four-part hermeneutic of translation, thinking primarily in terms of translating literary texts. First, trust, that there is meaning to be had in the text – that translation is worth it. Second, aggression, the translator “invades, extracts and brings home” (p. 314). Meaning is not simply transferred but has to be seized and brought into shape, as a sculptor uses force to produce form from a block of stone (however smooth, however light the final effect). Third, there is adjustment to the new meaning in a new language, Steiner employs a string of words for this, “incorporation…embodiment…incarnation…infection” (pp. 314-5). Lastly, there is “an enactment of reciprocity to restore balance” (p. 316).
Here I attempt to follow Steiner’s steps through the KT process.
The researcher needs to trust that the new knowledge is worth it, but so do the end users. Unlike literary translation, where a translated text can be published and it is then up to potential readers to decide if they think it was worth translating, in KT the “potential readers” are already implicated in the translation. Trust is mingled with authority. Good evidence-informed practitioners will, in general, “trust” the new evidence provided they can see it has been arrived at through proper methods, but in each particular case, they may have their own ideas about how valuable the new knowledge is to them. At the same time, the “translation” takes place within institutional power structures that are not equivalent to the literary-market concerns of translators, agents, publishers, and book buyers. A family doctor has discretion about which drugs to prescribe, nurses in hospitals have none at all about a new computer operating system being introduced. There can still be trust – that the system works, that it will have better functionality than the old one – but there is also unmistakeably authority.
Steiner’s second stage is compatible with the element of authority, making plain the element of force entailed in transformation, of words from one language to another, or a new idea into changed practices. But here the translation metaphor is imperfect. If, as Steiner puts it, the translator “invades, extracts, and brings home” (p. 314), who is the translator and where is home? If home is the new language of the translation, that is for the benefit of readers in that language who do not have fluency in the original, but in KT, the translator and reader are in effect the same – the end-user. The hinge of translation is not with the researcher, but with the end-user. Home is where the practice is. Invasion, extraction might refer to the “text” of the research, translated from academic language into usable terms for practitioners, but they also apply to the incursion into current practices – which need to be “translated” into new practice. These are the raw material that has to be reformed into something new.
The third stage of the hermeneutic is the most readily transferable (translatable?) to KT. Everyone knows basic change theory, the period of adaptation that follows the disruption of change. Steiner’s terms, however, are telling since they are all bodily, organic metaphors. If KT entails “an intersemiotic process,” not so much from one language to another as one form of communication to another, it is about embodied practice. As such it needs to be not only learned but used, to become natural to the user. Infection is a curious choice by Steiner. It is reminiscent of Burroughs but has a worrying hint that incorporation of the translated might have negative effects. It is a rare change in practice, in a complex context, that does not have some unforeseen, unwanted effects even when they might be greatly outweighed by benefits. More positively, incarnation and embodiment, among Steiner’s other stage three words, point to the end result of doing things differently in the light of new knowledge. With these organic metaphors, Steiner points to a process of absorption, not simply a rational, cognitive learning of new knowledge, but letting new knowledge work its way into an interconnected system like the body, circulating, and entering tissue. He says, “the act of importation can potentially dislocate or relocate the whole of the native structure” (p. 315). KT is not about knowledge in separated minds but ways-of-thinking and ways-of-doing in existing networks of multi-layered relationships that make up institutional ecologies. Again, it is not the home-structure of the researcher that stands to be dislocated but that of the recipient of the knowledge.
Continuing his metaphor of infection, Steiner warns, “the native organism will react…to neutralize or expel the foreign body” (p. 315). Some translations fail – they are not faithful enough to the original meaning, or they do not sound like the target language. In KT, there is perennial worry about change not happening as intended, often couched in terms of resistance from those who should know better. Years ago I witnessed an attempt to introduce the Tidal Model on an in-patient mental health unit. It is a model of mental health nursing that is patient focused, built around the patient’s account of their own difficulties in living – in some ways similar to principles of trauma-informed care now in vogue. The model involved a lot of paperwork (actual paper, pre-computer system) that took some getting used to though it comprised a logical structure of directed assessment and collaborative care planning. Educators on the unit went to great lengths to introduce the model, in the end unsuccessfully. The native organism, in the form of established beliefs and practices – and in the person of some powerful personalities among the nurses, did indeed react to neutralize and eventually expel the foreign body. Going back to Steiner’s first stage, implementation in this case did depend on trust – in the model, in the educators – and without additional institutional authority, which approved of but did not require the new practice. The infection was not strong enough for the immune system.
Steiner’s fourth and final phase is “enactment of reciprocity in order to restore balance” (p. 316). This sounds like the integration of new knowledge/practice to the point where people no longer think of it as new anymore, as when a new building goes up in the neighbourhood and it quickly becomes hard even to recall what was there before. The reciprocity in KT could be seen as the necessary adaption of the new knowledge to the setting and as whatever learning researchers might take away about the practitioners’ view of things.
In KT, who is the translator? When researchers apply for grants, they are expected to write in their KT plans, which suggests they are in charge of translation. But increasingly, there is an expectation of a more participatory model where end-users are involved in earlier stages of projects. Are they translating practice to research in a feedback loop? Partly perhaps. But a feedback loop like an eddy in a flowing river – the river is still heading to the sea. The CIHR guide is clearly one-way. By whatever means, superior knowledge is to be delivered over to practitioners and alchemically transformed into better practice (for the health of Canadians etc).
To take KT at its word, as a metaphor for once, rather than to take it in the other direction, towards implementation science with its promise of stable variables and measurable degrees of certainty, is to admit the metaphor, like all metaphors, has its limits. But that is why we use them, they both illumine meaning and unsettle it, provide precision – and provoke by its absence towards greater clarity.
Steiner, G. (1998). After Babel: Aspects of language and translation (3rd ed.). Oxford University Press.
Nursing and Humanities 