Neutral Spanish, Spanglish and Medical Translation.

A Case of Heterodoxy

1. Introduction¹

he so-called knowledge society rests on a fundamental principle—that citizens should have access to information. Globalization entails the internationalization of communication and, as a result, the need to homogenize, even neutralize. And this also includes languages.

In the case of the Spanish language, we find that not only does it have to defend its position before the lingua franca of international communication—English—but also that the geographical distribution of its speakers creates a need to defend the unity of the language in the diverse territories where it is spoken. It becomes necessary to establish a neutralized variety of the language that can be used in public communication (and hence, also in translation).

In the field of scientific domains, such as medicine, this neutralized variety affects distinct features (essentially related to linguistic usage, the most common genres and standardization of terminology) that distinguish them from other. Such characteristics make it possible to advance hypotheses concerning the neutral variety of the language in translation, which cannot however be generalized to other areas of specialization.

Before tackling the question of the use of what is known as neutral Spanish in medical translation, I will briefly outline its chief characteristics.

2. Neutral Spanish²

The problem with so-called neutral Spanish is partly one of how to preserve the linguistic identity of the Spanish-speaking peoples while playing to the rules of globalization.

This particular variety of Spanish has been given many names. Together with the term neutral Spanish (which is the most widespread in the field of translation) in the scant literature dealing with this issue we can also find other denominations such as general Castilian (more frequently used in Latin America), common Spanish (José A. Millán, 1998), international Spanish (Navarro, 2000; Gómez Font, 2003) or standard Spanish ("a variety halfway between Latin American Spanish and peninsular Spanish," according to the technical translation company, SLS Internacional, cited by Gómez Font).

In fact, neutral Spanish is something that was thought up by several film production companies in Mexico in the mid-60s. In order to make their products cost-effective in the Spanish-speaking markets, these companies agreed to encourage the use of a new variety of Spanish, which they called neutral Spanish or Castilian. The aim was to establish a set of common rules that could work across political and geographical borders, although they would be descriptive rather than prescriptive. The result would be, as R. Ávila (1997) called it, a general Hispanic norm, without the predominance of any particular kind of Spanish, but which included variants. Nevertheless, since then, the proposal has continued to receive a certain amount of criticism, fundamentally on the grounds that we are talking about a Spanish language that claims to belong to everyone but in fact belongs to no-one. At the same time, these detractors call for an effort to maintain unity in diversity (see J.L. Cebrián, S. Douglas or any of the arguments raised on the issue during the 3^rd Congress of the Spanish Language held in Argentina in 2004). In short, it is impossible to preserve linguistic differences, which are markers of identity, while at the same time constructing a neutral variety of Spanish.³

There are, however, some who defend the existence of this neutral variety but not as an artifice devoid of any identity. Instead, they see it as a way of bringing the 400 million speakers of Spanish closer together without losing their identity in the process. This is, for example, the opinion of A. Grijelmo (1999), who endorses the existence of a so-called neutral variety (not to be mistaken for basic or poor) and which helps to enhance understanding among the different Spanish-speaking countries. In a similar vein, A. López González (2003) acknowledges the richness and variety of Spanish but claims that "existe una necesidad comunicativa, de índole económica en esta era de la globalización y de "las convergencias" de sintetizar esta diversidad" (p. 524).⁴

In the 2005 edition of the Diccionario Panhispánico de dudas, the 21 Official Academies of the Spanish Language advocate the existence of a pan-Hispanic educated norm and state (2005: XIV) that, because of its supranational nature (being spoken in more than twenty countries), Spanish is actually made up of a series of different norms. Nevertheless, they share a common foundation that can be observed in formal cultured communication, where there are few geographical variations (they are nearly always lexical and phonic when they do occur). In their opinion, standard Spanish is represented by that formal cultured expression we use "when we feel the need to express ourselves properly" in the media, in essays or in scientific and technical books. In short, this position somehow represents a compromise among the different opinions that we have outlined above, that is, the existence of a neutral/standard variety of Spanish that coexists with the linguistic diversity and richness of the different Spanish-speaking territories and which does not necessarily have to destroy it.

Nonetheless, the problem remains for texts that, despite being considered as specialized, do not follow the pattern of formal cultured expression referred to by the scholars, as we shall see.

Before going on to analyze the relationship between neutral Spanish and medical translation, we need to briefly consider the matter of Spanglish, which in recent years has burst into certain mass media, and even some genres belonging to areas of specialization, and has been mistaken for the neutral variety of the language. This problem is especially severe in the United States (and certain Central American and Caribbean countries)⁵, owing to the diverse linguistic and cultural origins of its population and to the large number of Spanish speakers living there.

The influence that English has historically had (and continues to have) in some Spanish-speaking areas of America is undeniable. Indeed, for some authors the usefulness of a neutral variant of Spanish would lie precisely in its capacity to challenge the hegemony of English (see, for example, Carmen Perilla, Professor of Hispano-American Literature at the UNT (Tucumán), La Gaceta, 11/11/2005).

The truth is, however, texts in Spanish that reproduce the syntactic and grammatical structures of English are found with increasing frequency (and more so in the USA). And what is more worrying is that they use new expressions that result from a random fusion of structures from the two languages and which blur the distinction between them. We are not just talking about the influence of English (an issue that has filled reams of paper in the literature and which can be felt in most European languages) in areas of usage such as computing or the new technologies, above all since they have become generally available to a large part of the population. In Spanish, for example, the matter has aroused conflicting opinions with respect to the way the Academy (Real Academia de la Lengua Española) has dealt with certain cases; and indeed nobody is surprised to hear that somebody is going to "hacer una rellamada," "revisitar la producción científica de un autor," or that someone "vuelve en cinco minutos" or "ha llegado en tiempo." Thousands of examples can be found in everyday speech.

In fact, there is a school of thought that came about in the USA in the 70s that considers Spanglish, as a hybrid culture, to be the only chance that the 40 million Hispanics living in the United States have to achieve full citizenship; it provides them with a set of distinguishing marks in a foreign country. Thus, as stated by A. Prieto (2005)⁶:

For Prieto, Spanglish is no longer just a kind of street slang, and a number of initiatives have sprung up to promote it, in some cases even under the supervision and guidance of university professors. Thus, in 2003, I. Stavans (Amherst College) published the only existing dictionary of this hybrid language to date and, in 2004, translated the first chapter of Don Quixote into Spanglish, the following fragment being an instance of the results: "In un placete de La Mancha of which nombre no quiero remembrearme, vivía, not so long ago, uno de esos gentlemen who always tienen una lanza in the rack (...)"

As I see it and quite apart from its anecdotal nature, such a proposal would not be acknowledged by any speaker of either Spanish or English as belonging to his or her own language. These are, then, isolated initiatives that do little more than confirm the fact that, despite the attempts that have been made, Spanglish is a form of street slang that has enjoyed some degree of popularity in certain means of communication but could in no way satisfy the needs of all the different areas of usage of a language.

As I have said, the problem of Spanglish is thus one that goes beyond that caused by a phenomenon that frequently takes place in the evolution of languages—the existence of borrowings. Spanglish is not the expression of a contact that takes place through the use of structures and words from other languages that has been standardized (either by the corresponding institutions or by generalized idiomatic usage). It is a form of slang that clearly fails to comply with the rules, since it is the result of the misuse of the two languages it draws upon, that is, it is the product of a process of linguistic interference. It is therefore not acceptable in Spanish or in English as a standard form of the language. And the upshot of all this is that, in many cases, the boundless spread of this linguistic variant is causing meanings to be lost, and always to the prejudice of Spanish.

It is true that, as pointed out by J.L. Cebrián (2004), languages develop according to the needs of their speakers. And thus, with regard to Spanglish, this author states that "Es una jerga. Y si se convierte en dialecto y luego en lengua depende de la evolución social de los hablantes de esta jerga. [...] Todos los idiomas se forman por mestizajes."

But it is nonetheless true that, as I see it, there should be some kind of filter that marks the limits of such creativity. Because is it acceptable for a text in Spanish to be written with no accents and with capital letters at the beginning of every word? To what extent can we accept that the use of the passive was just a slip? Are explicit use and reiteration of pronouns tolerable? Do we have to go on accepting the fact that words like evento or ignorar change their original meanings to those that event and ignore have in English? There are oral contexts in which it even sounds funny to hear fragments like "abre la window," or "voy a limpiar la carpeta" or "te llamo para atrás." But accepting slang forms in spontaneous speech is one thing and transferring this slang to written forms and attempting to normalize it is quite another.

For X. Castro (2001: 36):

He also adds that justifying its use by arguing that "that's the way people say it" is not a very serious linguistic criterion. In his opinion (2001: 41), from the point of view of translation, we have to try to render other cultures in terms of our reality, defend the language (Spanish, English, whichever) and create "necessary neologisms" that help us to perpetuate our language with the same respect as that shown by those who handed it down to us.

This incorrect invasion by English has also made itself felt in certain areas of specialization, and particularly in the popular informative genres. Thus, in the field of medicine (and more specifically public health) it is common to find poor translations from English, which make use of the spelling and typographical, lexical and syntactic parameters we mentioned above. Examples such as:

• El Cáncer En Etapa Temprana Puede No Tener Algún Síntoma (National Cancer Institute, www.cancer.gov)
• Justo audible (in a text from the National Institute on Deafness and Other Communication Disorders, http://www.nidcd.nih.gov/health/spanish/lovehear/common_sounds_sp.asp)
• Mientras asisten a la escuela del NIH, los estudiantes por lo general no son considerados como ausentes, (http://www.nih.gov/Institutes/ClinicalCentre)
• In a text entitled "Los Latinos en los Estados Unidos Tienen Tasas Altas de Enfermedades de los Ojos y Deterioro Visual" (National Eye Institute, http://www.nei.nih.gov/news/pressreleases/080904span.asp) we can find fragments like:

• Lastly, in an article about Genetic research in the periodical Genes y poblaciones (http://publications.nigms.nih.gov/genepop/research_esp.html) we find examples like the following:

That is to say, the (popular informative) scientific medical literature in Spanish contains numerous examples of hybrid syntactic and lexical forms as well as typographical conventions that reproduce English structures in the Spanish language. As a result, it is almost impossible to construct a coherent scientific or pseudoscientific discourse. It is within this context that the existence of a neutral variety of Spanish could help systematize usage. However, such a variant would be something more than a colloquial language made up of certain slang forms that allow or facilitate communication among people from different cultures, who have not acquired a good level of linguistic competence in the target language and therefore generate their own slang from the elements they know in the two languages, with the prime purpose of being able to communicate with each other.

Medical translation is part of what is known as specialized translation and therefore the materials it works with are specialized languages. In addition to the accepted features of this type of functional diatopic varieties (denotation, universality, predominant referential function, precision, conciseness, and so forth), from the linguistic point of view, we must also take into account the large amount of specialized terminology used ("terminological density"), which can be a serious problem for the translator. In fact, it has been claimed that the lexical and textual levels are the ones that most significantly condition the characterization of texts that use what are known as specialized languages (see Cabré and Estopà, 2005).

But what relationship can we establish between the so-called neutral Spanish and translation in the specialized field of medicine? The truth is that, as we have just seen, the debate over whether a neutral variety of the language is needed or not has focused mainly on the media and it could therefore be understood as an issue that affects the standard, general language more than specialized languages. Very few studies have been conducted to analyze the presence of neutral Spanish in translation and even fewer have centered their attention on the field of specialized translation. And of course medical translation is no exception. Special attention is paid to issues concerning the problems translators face when working with specialized languages (particularly in the English-Spanish language pair (see, for example, B. Gutiérrez, 1998: 265) in the case of informative scientific texts. These problems have often led to the degradation of Spanish "merced a las malas traducciones que traen consigo la introducción indiscriminada de palabras extrañas, sobre todo anglicismos" (B. Gutiérrez, 2002: 1). But no one associates the possible solutions to these problems with the existence of a neutral variety of the language, which a priori is understood to be linked to the standard language.

In an interview with the translator C. Márquez, F. Navarro stated that "la cuestión del español de España y los españoles de América es, en efecto, insoslayable para los traductores y redactores médicos de ámbito internacional, que en esta época mundializada somos casi todos" (2006: 18). There are then reasons that make it advisable to consider, albeit only as a hypothesis, the need for a neutral variety of Spanish in the translation of specialized medical texts (whether they are of a popular informative nature or not). This need has in fact already been contemplated for the case of English, and takes the form of defending what is known as Global English. For Rubens (2001: 33):

Furthermore, as we shall see, the case of medicine is rather heterodox because it displays characteristics that lead us to consider the need for a neutral variety more clearly than in other areas of specialization:

1. Because the boundary between the common and specialized language is not clear-cut. Thus, according to Cabré (1993: 168): "Intentar establecer una frontera nítida entre las lenguas de especialidad y la lengua común es una tarea imposible"⁷. One feature that specialized languages share with the general language is the use of linguistic variation and they therefore contain different dialectal manifestations and registers, as we shall see. Some authors in fact speak of general language and specialized language as actually forming part of a continuum. The degree of specialization of the text (which is sometimes determined by its function—more informative, more popular, more persuasive, and so forth) will determine where it is situated on that continuum. This aspect is reflected very clearly in medical language, as we shall see below. For instance, are the package leaflets for a medicine that are written for the patient/consumer and the technical specifications sheet aimed at the health professional both specialized texts? The answer would seem to be that they are. But does the pharmaceutical laboratory write them both in the same way? The answer now appears to be clearly negative (on this subject, see J. García Palacios, 2001 and 2004).
2. Because, additionally, there are medical genres that are used for popular informative purposes and which make systematic use of vocabulary and structures from the common language (e.g. medical genres providing information for the patient or in prevention campaigns).
3. Lastly, because the existence of a common neutral variety, which has been approved by the entire Spanish-speaking world, would prevent the problems that arise from the spread of incorrect varieties, such as Spanglish, into the more common genres used for disseminating medical research in the Spanish-speaking markets of the United States and South America, and which only help create more confusion in the popular informative texts in this specialized field.

Let us go on and take a brief look at how these aspects actually affect the particular case of specialized medical language.

As we have pointed out above, the existence of a continuum between common language and specialized language is more obvious in the field of medicine than in others used in the so-called experimental sciences. This is because, as we shall see below, medical language contains a number of characteristics that, in principle, do not tie in with those that are commonly accepted for specialized languages.

Díaz Rojo (2005) effectively defends the relation between the terminology used in medical discourse and what is known as social discourse. In his opinion, medical terminology, as the essential vehicle of communication for modern scientific biomedicine, is not restricted to the realm of specialized publications, congresses, hospitals and laboratories, for example. Rather, it is also to be found in many other spheres that, at first sight, would appear to be quite distinct, such as the discourse used in the mass media, political discourse or even, according to this author, colloquial language. Thus (2005: 77), far from the supposed neutrality that has traditionally been assigned to scientific terms, they actually have a manifest cultural content (see J. Bernabé et al., 1995: 13).

In their work they offer proof of this incorporation of medical terminology into the general language, with semantic fields, such as that of disease, that include terms that are loaded with denotation, designation and referentiality (in contrast to the norm in scientific discourse). They also provide examples like the term kleptomaniac, which is heavily loaded with negative moral connotations in the general language but is seen as a purely pathological concept in the field of medicine. The phenomenon of the relationship between the metaphors made up of medical concepts and political ideologies are also considered (with examples like: the health of the nation; corruption as a cancer that is either detected in time or ends up killing you; comparing the political situation to a festering sore or the virus of corruption), depending on the semantic content the speaker wishes to convey. In their opinion (2005: 86), it is a curious fact that these metaphors are always based on biomedical concepts (modern scientific medicine) and not on those from folk-medicine (popular medicine). Díaz attributes this to an attempt to cover up the predominant emotive function of this kind of political statements with the "aparente función representativa derivada de un léxico más científico y racional." His theory is directly linked to the critical medical anthropology of authors like Scheper-Hughes and Lock, who uphold that medicine is influenced by the cultural and social factors that surround disease, and thus the body is a reality that is charged with spiritual meaning; in other words, their aim is to resocialize medicine (Díaz, 2005: 88).

A similar line is taken by B. Gutiérrez (2005), who considers that accomplishing good communication between physician and patient is crucial in medicine and hence we need to analyze the interaction between the explanatory models used by each of the two parties when dealing with the same pathological condition. And this analysis will be largely focused on the language used by the two communities.

What determines the language that is utilized, according to Gutiérrez, is the point of view from which the disease is analyzed, which is necessarily going to be different in the two cases. Thus, the physician "busca parámetros que le permitan diagnosticar las enfermedades objetivas; pero el enfermo padece, y necesita ser comprendido en sus dolencias subjetivas" (2005: 134). Thus, what the doctor would call cansancio inespecífico ('non-specific fatigue'), for the patient will be a sensación de tener el estómago triste ('sorrowful feeling in his or her stomach').

Nevertheless, for Gutiérrez the positions are in no way irreconcilable because physicians "no son extraterrestres que hayan aterrizado en nuestro planeta y que carezcan de raíces familiares, culturales o sociales." This is also aided by the fact that the popular construction of medical knowledge takes place within the so-called information society, which means that anybody, especially those belonging to the higher socio-professional categories, can describe their pathological condition using the information available in the mass media and in the scientific media, even though they sometimes use metaphors to do so. However, according to Gutiérrez (2005: 135) these explanations "sufren invariablemente algún proceso de transformación ligado, en ocasiones, a las reformulaciones y mecanismos propios de la divulgación del conocimiento científico." And so, for example, high-density lipoproteins and their low-density counterparts become, in the layperson's words, good cholesterol and bad cholesterol. On other occasions, as we saw above (Díaz, 2005), medical terms take on positive or negative connotations that derive from historical events to which they are related and which they do not really have in specialized language, meningitis being a good example.

For Gutiérrez (2005: 139), the claim that the language used by medical professionals is systematic, precise and neutral as opposed to the lack of systematicity and the subjectivity of the popular language of medicine is commonly made but is erroneous. Thus, we can find examples where up to three terms are used to express the same concept, as is the case of lipoma, adipoma and steatoma to refer to tumors in fatty tissues. In his opinion, then, there are obvious ties between the health professional's world and that of the layperson: "[...] lazos que nos muestran que la atención que se preste a los lenguajes de la medicina debe tomar en consideración diferentes aspectos que no siempre se contemplan..." (2005: 140).

Therefore, and in conclusion, it becomes obvious that the language of medicine contains a series of specific characteristics (deriving from the very nature of the scientific knowledge it conveys and from the workings of the society in which it is immersed) that turn it into a paradigmatic case of hybridism between specialized language and the common language.

In addition, we must also take into account the prevalence of certain genres of text that are used to make the findings of research known. Broadly speaking, we could state that they are published mostly in essayistic genres (either as scientific or popular informative books or articles). This favors an increased usage of the standard language (together with the terms that make up the conceptual structure) and, depending on the degree of specialization, the use of different characteristics that can be established "[...] atendiendo especialmente a los factores pragmáticos implicados en los textos producidos (temática especializada, participantes en el acto comunicativo, y situaciones comunicativas), ya que una caracterización estrictamente lingüística se revela(ba) insuficiente" (García Palacios, 2001: 158).

We have already seen how the problem of neutral Spanish has a particularly significant influence on popular informative specialized texts. For, as we have stated above, popular informative texts are at the same time specialized texts. In actual fact, in line with García Palacios (2001), we could say that popular informative scientific texts:

Thus, in medical genres of a popular informative nature⁸, we can find lexical items from the common language, paraphrases that are pseudo-equivalent to the terms, terms with metaphorical definitions, and so forth, all of which furthers dispersion and may, in some cases, make the text more difficult to understand.

Some authors consider that the standard shared by different Spanish-speaking countries is so high that one could almost speak of the existence of a neutral variety of Spanish (cf. 2) that exists alongside the linguistic diversity and wealth of the different Spanish-speaking territories. Likewise, they claim that the differences arise from the use of certain collocations, verb forms or, generally, vocabulary that are not very common in some registers in peninsular Spanish (either because they are no longer used and are considered to be archaic or because they do not have that particular meaning in the Spanish used in Spain)⁹; they are not, however, an impediment to understanding. This would be case of the examples below, which were found in the Journal Adolescencia, published in Mexico, the Revista Cubana de salud pública, from Havana, or the Acta Odontológica Venezolana:

² See also I. García Izquierdo (in press): "Neutral Spanish and the translation of specialized languages."

³ See L. Castro (2004) and V. Colodrón (2004).

⁴ In fact, according to studies conducted by R. Ávila (2001) from El Colegio de México, as far as the mass media are concerned, the vocabulary currently used in international news programmes, and even the language heard in many national broadcasts, contains a low percentage of regional or local turns of phrase. It therefore falls "within the general Hispanic norm" and, hence, diversity would have no effect on a substantial part of the language.

⁵ On this subject, it is interesting to read the reflections about the Spanish of Puerto Rico made by López Morales in the Anuario 2004 del Centro Virtual Cervantes, where the author defends the scarcity of features that characterize this geographic variety of Spanish in comparison to the standard variety.

⁶ A. Prieto Osorno (2005): Spanglish, una nación de iguales ["Spanglish, a nation of equals"], Ómnibus, nº 4, July, http://www.omni-bus.com

⁷ A similar stance was taken by Schifko (2001: 25), who claimed that what is needed is a flexible definition of specialized languages that makes use of parameters that are prototypical but which at the same time can vary depending on the degree of specialization. Such a view stems from the fact that, for this author, specialized languages are specific variants of the common language.

⁸ Although not only these, because geographical markers also appear in highly specialized texts. For a characterization of popular informative as opposed to expert discourse, see B. Gutiérrez (1998: 320 et seq.)

⁹ This is what happens in places like Puerto Rico, where they still use their own terms, such as embeleco (fantasy), atrecho (shortcut), vellón (nickel, five cents) or famoso (magnificent), and archaic terms that are no longer used in the rest of the Spanish-speaking world, for example, cabildear, credenza or bregar (López Morales, 2004, El español de Puerto Rico,
http://cvc.cervantes.es/obref/anuario/anuario_04/lopez/p09.htm).