Frankly, My Dear…

Article Outline

• What Is Nursing All About?
• The Power of Language
• References
• Copyright

Words, words, words, words, words, words, words.

—Eliza Doolittle

You will notice the following statement attached to some of the articles in this issue of JANAC:

This article contains graphic language and content. JANAC's editorial staff is dedicated to preserving the integrity of the work of all of our authors. In qualitative research, this includes input from participants who are willing to share their experiences with the researcher and—eventually—with the reader. In this article, we have honored those individuals by leaving their words intact.

This is a very special issue of JANAC. Guest editors J. Craig Phillips and Carol (“Pat”) Patsdaughter have worked diligently to gather manuscripts related to transgender issues in response to an obvious need to share information about how to more skillfully provide care and services to transgender individuals. Shortly after the review process started, however, Dr. Patsdaughter received a call from a JANAC reviewer stating that some of the language used in the manuscript she was reviewing was very graphic and might not be suitable for publication in JANAC. I knew the reviewer and, because I always considered her to be a clear-thinking person who was not likely to express concerns as a knee-jerk reaction, I offered to look into the issue.

Our publisher did not have a policy on the use of raw language and said that Elsevier would publish what we submitted. The President, President-Elect, and Executive Director of ANAC wrote that they were all comfortable with whatever decision I made. I was still concerned, and so I went to my other source of editorial advice: the International Academy of Nursing Editors, an organization of editors and writers who cumulatively have decades of experience from which to draw. I was encouraged and gratified by the response I received and asked permission to use some of their responses in this commentary.

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What Is Nursing All About? 

Thomas Lawrence Long, Associate Professor-in-Residence at the University of Connecticut School of Nursing, shared with me that he had written a book on language and the HIV epidemic (Long, 2005). He reminded me of the following extremely important point in the history of the epidemic:

One of the most irresponsible [occurrences] during the Reagan administration's mismanagement of the AIDS epidemic was its acute fastidiousness about language, which impaired clear communication and impeded effective education and transmission prevention. Only when local communities (like GMHC [Gay Men's Health Crisis] and ACT UP [AIDS Coalition to Use Power]) took charge of the language from prissy researchers and bureaucrats did effective health communication occur. Social science researchers need to understand and appropriately use the language of their research participants in order to accurately represent the linguistic and cultural contexts in which language and behavior are situated.

Toni Gilbert, Editor of Alternative Journal of Nursing, supported this stance.

Nursing is a profession that treats patients' most intimate concerns. It is our job to report our shared humanity, with its many perspectives, so that we all learn the depth and the breadth of human issues even if it may be ugly to some. As nursing steps into the 21st century, it shouldn't be reported as if it were the 1950s.

Her comment was echoed by Linda Shields, the Editor of Neonatal, Paediatric and Child Health Nursing.

How on earth can we call ourselves a profession that deals with people on the most intimate level if we can't accept their language, even if it is different to our own? Direct quotes of what people give as research data has to be accepted for what it is.

Patricia Yoder-Wise, Editor-in-Chief of Continuing Education in Nursing wrote, “If there is a lot of offensive language, I would be concerned about how that might blind readers to the real message. That said, would we change the words in a quote from a religious publication because it might offend another religion?” Diana Mason, Editor-in-Chief of the American Journal of Nursing, focused on the issue within the context of the readers of her journal: “Our readers are pretty squeamish at times but usually understand when it's direct quotes and part of a narrative. Sometimes our role is to cause a stir if we're reporting truth.”

I need to also thank Gloria McNeal, Editor of the Association of Black Nursing Faculty Journal, for reminding me of the scandal caused by Rhett Butler's final words in Gone with the Wind (Leff & Simmons, 2001), which gave me the title for this commentary. She made the excellent point that times change and standards of acceptability evolve. The result of that evolution may not be in the direction that you or I or my mother would want, but it is what it is, and we—as nurses who work in communities—need to know what is going on and the language used to describe it in those communities.

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The Power of Language 

And speaking of my mother, I remember when I broke the news to her that Greg Louganis was gay (don't ask, she was pushing my buttons). “No, he's not,” she said. I assured her he was. Her response was, “Well, it may be true, but you don't have to talk about it.”

Language is powerful. If you allow yourself to put a name to something—to describe and analyze it, to bring it to a conscious level—you give it life and you make it real. My mother is not unusual. She like many others knows that “not talking about it” denies “its” existence, makes “it” go away, keeps “it” from creating discomfort, and shames “it” into silence.

Transgender is an “it.” Transgender is an issue we don't talk about and, because we don't talk about it, we don't understand. We can't learn and come to terms with the issue. We can't accept transgender people. Nursing, of all the professions, knows that people need to express their identities and that they cannot be well or whole without that expression of self. This issue of JANAC talks about “it.” This issue will give you insight and care considerations for a diverse group of individuals who have specific nursing care needs. But most important, this issue of JANAC is going to give you the language you need to become enlightened.

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References 

1. Leff LJ, Simmons JL. The dame in the kimono: Hollywood, censorship, and the production code. Lexington, KY: University Press of Kentucky; 2001;
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2. Long TL. AIDS and American apocalypticism: The cultural semiotics of an epidemic. New York: State University of New York Press; 2005;
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