UC Davis

This dissertation draws on various discourse analysis approaches to uncover the grammatical, discursive, and prosodic linguistic features shaping the opioid crisis in order to understand how language provides a window into chronic pain management issues. Specifically, this dissertation is comprised of three interrelated investigations examining the language used by California policymakers in addressing the crisis and by physicians and patients at West Coast Medical Center (a pseudonym) to enact, negotiate, and reinterpret such policies.

Part I focuses on policymakers’ use of modality as a grammatical feature that calls attention to the gravity of local issues and reconfigures the interpretive spaces in which policy stakeholders could act. Part II reveals physicians’ use of face-saving discourse features when enacting restrictive opioid policies, demonstrating the communicative burden placed upon physicians by policy demands. Lastly, Part III focuses on patients’ use of prosodic features (i.e., low pitch and creaky voice) in describing their chronic pain symptoms and requesting opioids.

This dissertation demonstrates how the mining of modals could help streamline policy analysis on any pertinent issue and how the study of discourse could help identify opportunities for medical institutions to support their physicians and for physicians to support their patients.

This dissertation offers a top-down policy analysis and a bottom-up interaction analysis perspective on how communities linguistically address the opioid crisis, contributing to an applied sociolinguistic understanding of health policies and their discursive manifestations on the ground. This dissertation is also methodologically and theoretically informed by various linguistic domains and approaches, including language policy and planning, sociopragmatics, sociophonetics (prosody), and corpus linguistics. Such an interdisciplinary undertaking allows for a broader understanding of the discourses surrounding opioids and chronic pain while remaining sensitive to the subtlest—yet socially significant—linguistic features that could help us make sense of the linguistic choices made during medical crises.