Inspiration for what to write about comes from many places. Often, they may be only tangentially connected to teaching English. That’s the case with today’s study which comes from The Lancet, a journal not typically known for its classroom insights. What caught my attention wasn’t medicine, but rather what the study has to say about how people navigate meaning.
The study
Written by Scott Stonington, Preeyanoot Surinkaew & Thidathit Prachanukool, the study is based on 30 months of ethnographic research in northern Thailand. It centres on Misa, a 75‑year‑old Akha‑speaking woman, an emergency physician (Dr Ann) who speaks Thai but not Akha, & Ado, an Akha‑speaking janitor drafted in as an informal interpreter. The entire interaction took place through Thai & Akha, with no English involved – which matters, because the communicative challenges weren’t about proficiency but about pragmatics, norms & expectations across two unrelated languages.
The authors introduce linguistic pragmatism – using knowledge of communication styles (silence, gesture, allusion, indirectness) to improvise strategically in real time. Rather than relying on fixed cultural “facts”, clinicians are encouraged to treat communication as experimental, responsive & co‑constructed.
Although Misa & Dr Ann were both living in northern Thailand, their languages sit far apart.
- Akha is a Tibeto‑Burman language, tonal, rich in particles & spoken across the northern borderlands of Thailand, Laos, Myanmar & China.
- Thai is a Tai‑Kadai language, also tonal but structurally very different, with distinct pronoun systems, evidential patterns & norms around indirectness.
The two languages are not mutually intelligible, so communication relies entirely on shared pragmatics, gesture, silence & whatever the interpreter can co‑construct in the moment.
The findings
- Indirectness, silence & allusion play a major role in many Thai & Akha communicative norms, but cannot be reduced to simple cultural rules.
- Cultural competence alone is insufficient. Clinicians cannot realistically “know” every cultural group they encounter, especially in highly diverse regions.
- Interpretation is always co‑created, whether or not the interpreter is trained. Even with a skilled interpreter, communication remains dynamic & uncertain.
In this case, a direct message delivered via an untrained interpreter led to shock, withdrawal & ultimately a refusal of care. Misa’s family later suggested the communication itself hastened her decline. Ado’s directness wasn’t “wrong” — he simply wasn’t trained to mediate between two very different pragmatic systems. But without that mediation, the message landed with maximum force. This is why the authors argue for linguistic pragmatism: not cultural facts, not fluency, but the ability to sense when a communicative strategy is needed & to adjust in real time.
They propose a three‑step pragmatic approach:
1- identify when a strategy is needed,
2- float “test balloons” or “therapeutic trials”,
3- adjust based on response.
To give an example from the paper: a US clinician encountering a patient who says “I don’t like doctors” might float a test balloon (“Doctors are arrogant, maybe?”) to see what lands. The point isn’t guessing correctly; it’s creating space for the patient to adjust, clarify & co‑construct meaning.
I’m sure we can all relate this to what goes on in the classroom: imagine a learner who says “This grammar is confusing.” Instead of explaining again, we might float a tentative paraphrase – “Is it the word order that feels strange?” – giving them something to push against.
A “test balloon” is essentially scaffolding in conversational form – a provisional guess the other person can confirm, reject or refine, helping meaning emerge collaboratively.
Teacher Takeaways?
- Treat communication as co‑constructed. Meaning emerges between people, not from one speaker.
- Use “test balloons” when learners are silent or hesitant. Try a tentative paraphrase to help them shape their own meaning.
- Avoid assuming cultural explanations. Instead of “students from X culture don’t like speaking”, focus on interactional cues in the moment & adjust experimentally.
Why this matters for ELT
The encounter is a vivid example of negotiating meaning: speakers offering partial interpretations, watching for uptake & reshaping their message in real time. It echoes Long’s interaction hypothesis, but in a context where misunderstanding isn’t just inconvenient -it’s consequential.
This case isn’t about language teaching, but it’s deeply relevant to it. We also work in multilingual, multicultural spaces where silence, indirectness & interpretation shape participation. Linguistic pragmatism offers a way to move beyond stereotypes & towards responsive, moment‑to‑moment communication that respects uncertainty. It’s a reminder that teaching, like clinical care, is improvisation with consequences.
How do you navigate silence, indirectness & interpretation in your classroom?
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