Charles Briggs’s Incommunicable: Toward Communicative Justice in Health and Medicine offers a guided exploration of how communication–or lack thereof–shapes health outcomes, often reinforcing systemic inequities rooted in colonialism and racism. By examining historical figures, contemporary practices, and the COVID-19 pandemic, Briggs expertly threads his central argument that determinations and divisions of communicability are steeped in racial ideologies. The book’s narrative arc is carefully crafted to guide readers through a transformative intellectual journey. The first two parts provide rigorous foundational insights into medical linguistic anthropology and the complexities of communicability. Armed with newfound perspectives, the third part of the book mobilizes these freshly cultivated concepts toward analyses of interviews centered on the universal experiences of the COVID-19 pandemic. The reader experiences a moment of insight as the multifaceted theories crystallize into relatable human experiences, resulting in a deeper appreciation for communication theory and its intrinsic relation to empathy. Incommunicable is intellectually formidable for those outside of linguistic studies but rewards the persistent with enlightened perspectives on the intersections of language, power, and care.

Briggs begins by dissecting John Locke’s theory that incommunicability is pathological. Locke viewed misuses of language, like rhetoric and poetry, as distractions from its purpose to transfer ideas as simply and clearly as possible. Moreover, each individual was responsible for their own communicability which Briggs suggests arose from Locke’s lesser-known medical training under a physician who prioritized patient histories in diagnosing disease. Briggs goes on to expose a problematic aspect of Locke’s theory which claims that perceptually-disabled people are inherently incommunicable due to their inability to sense and therefore form ideas about the world around them. This ableist perspective, in addition to Locke’s complicity in the slave trade, sets up the historical foundation upon which incommunicability has been weaponized against marginalized groups.

Next, Briggs invokes W.E.B. Du Bois’s concepts of the Veil and double consciousness to extend his argument and incorporate racialized incommunicability. Du Bois argued that white people could not perceive life within the Veil, thus rendering communicability regarding Black experiences difficult if not impossible. As a consequence, Black people must employ a double consciousness and constantly scrutinize themselves and their use of language from external perspectives. This inequitable communicative footing leads to Du Bois’s observations in Philadelphia that poor health outcomes within Black communities were tied to systemic neglect rather than inherent deficiencies. Briggs goes on to confront Du Bois’s class-based elitism, noting that even someone so attentive to the injustices of incommunicability could perpetuate its prejudices. This accountability of Du Bois underscores the pervasiveness of the problems of communicability.

Briggs returns to the sphere of medicine by drawing from Frantz Fanon’s observations as a psychiatrist in colonial Algeria. Fanon highlights the white physicians’ utilization of translators and pidgin, a grammatically simple form of language, as well-intentioned tools that deepened the racial inequities of medical communicability. Translation inherently degrades communication through the loss of nuance in the patient’s narrative, and pidgin infantilizes patients, effectively casting them as the incommunicable Other. Also, Fanon self-reports failure in his efforts to uphold justice in his communication upon his usage of pidgin with the intellectually disabled. This humanization of Fanon mirrors Briggs’s critique of Du Bois, emphasizing how even those who strive for communicative justice are shaped by systemic forces.

Brigg’s final philosopher, Georges Canguilhem, provides an even more direct framework to analyze disease and communicability with his concept of the milieu. Canguilhem views an individual to be more than a passive recipient of their environment, but rather for the individual and environment to exist in a dynamic, co-constructed relationship known as the milieu. Conceptually, this theory explains how chronic illness forces patients into new “normals,” complicating the communicability of their experiences to those outside of their milieu. Briggs denotes a critical flaw in Canguilhem’s theory in its suggestion that each milieu exists in a vacuum, devoid of the broader social factors that span across milieus and apply to larger races or classes. This omission exemplifies the limitations of purely philosophical approaches to communicability in healthcare. 

Familiar with the theoretical complexities of communicability, Briggs uses the second section of his book to draw the reader’s attention to doctor-patient interaction research, namely by exposing its limitations in contributing towards communicative justice. He argues that the field’s primary focus on conversational analysis overlooks crucial contextual factors that underlie these interactions. These contextual factors are born from the subordinating power dynamic that exists between a physician and their patients. The Lockean assumption that communicability consists only of clear, direct language enables physicians’ shortcoming in not considering patients’ lives beyond the clinic; thereby, further entrenching these communication barriers. 

Briggs extends his critique to public health campaigns and reveals how these initiatives often reinforce stereotypes and inequities under the guise of promoting health literacy. He cites examples from Venezuela, where dengue prevention ads depicted unattainable middle-class ideals while disproportionately burdening women. Similarly, campaigns targeting Indigenous populations frequently framed cultural practices as the root of health issues, rather than addressing systemic neglect. Briggs also examines AIDS campaigns in Nepal and West Africa, demonstrating how culturally inappropriate messaging and code-switching can alienate target audiences. Through these case studies, Briggs powerfully illustrates how biocommunicability in public health often reflects white privilege rather than genuine inclusivity, further perpetuating health disparities.