Analogical use of language
Continuing along from the last post on the core epistemological principles from Reid’s common sense realism we have come to the analogical use of language.
To review quickly. Epistemology is the theory of knowledge - including the origin of knowledge, the role of experience and reason in generating knowledge and the relationship between knowledge and certainty. When we practice (make decisions, do actions) we are using knowledge as premises for our inferences. A clinical epistemology seeks to address these topics within the clinical context. A clinical epistemology is the foundation of an evidence based practice and a knowledge based practice. (See an early post for why I believe there needs to a separation between an evidence based practice and a knowledge based practice.)
For us to discuss a clinical epistemology - to talk about knowledge - we have to use language. And when we are talking about things we know (or want to know) we must use language. The words we use are not actually the things they represent. There is an ontological distinction between the muscle and the word muscle. But we use the word muscle to represent muscle. For a clinical epistemology we have to assume this works from the start - we have to assume we can use language as an analogy of something real that is ontologically distinct from the word itself.
That is a very simple and easy to agree to core component - hence being part of “common sense realism.”
Though it is interesting how often we fall into the trap of defining words based on an initial analogy with a real, ontologically distinct entity and coming to believe that the word is then the same thing and how that may pass in discussion as incorrect knowledge.
I was reminded of this yesterday when teaching a lab on lung sounds. There are crackles (a certain sound we hear that is not normally present with auscultation of the lungs). There seem to be at least two distinct types of crackle sounds. So we then have a word to describe (modify) the analogical representation of sounds - fine or coarse crackles. All of these words are analogically related to the ontological entity (a sensory perception in our brain). Whether we hear “fine crackles” or “coarse crackles” has to do with our sensory perception and then we utter the words to represent what we hear. Simple enough. But sometimes people use the word “dry crackles” when they hear “fine crackles.” They are using a different word to modify their crackles. The words “dry crackles” represent something different ontologically don’t they? The word dry crackles is going beyond the sensory perception of sound to something about the nature of the cause of the sound. A dry crackle is presumed to be caused by a “dry” source - something that is not wet, not mucous, not secretions, not edema, not inflammation. So when discussing what we know, the use of the language “dry crackle” reports that we know the cause of the sound we hear (or at least some general characteristic of the cause.) Whereas a fine crackle merely reports on the sound we have perceived and, as such, is analogically related to only the effect (not the cause) and therefore contains less knowledge. A question is whether such a claim is justified? That has to do with the ontology of the cause - effect relationship of dry crackles. If the cause of fine crackles is only ever a “dry” cause then we probably are justified as fine crackles can only be caused by a dry cause. I am not making that claim here - just raising it as a point. But now we are really getting into abduction (see here).
One more example because it came to mind while sharing the above. There is much more knowledge in the statement: “That patient has angina.” Than the statement: “That patient has chest pain.” Even though we recognize that angina is often chest pain, chest pain is not always angina. Why? These words are referring to different real things ontologically. Chest pain is referring to pain in the chest (an effect) with no claim about the cause of that pain. But angina is referring to a symptom (usually pain in the chest) that, for some reason, we feel justified in claiming to know the cause of that pain (myocardial ischemia). In practice it is typical (or should be) to withhold the term angina for times when additional information brings additional knowledge that makes abduction to ischemia the best explanation of the chest pain prior to using the term angina.
So with a knowledge based practice we will have to be careful with how we use language to analogically represent ontology (being) of real things (realism). Accepting that need to do this as a core principle does not mean we can take it for granted. Whenever I feel like I am not understanding someone else’s knowledge, I first consider how we are using language to represent the objects of knowledge we are discussing.