Born Still: Euphemism and the Double-Taboo of Women’s Bodies and Death

There are a growing number of terms for pregnancy loss, which speak to a social and historical shift in the ways that we speak about death before birth. In fact, historically such loss often did not have a language at all, and remained an unspeakable part of women’s experience (Chodorow 1978). she lost the baby…it was a stillbirth…she miscarried…all are terms that replace the medically specific “abortion,” which has come in lay terminology to connote a chosen or therapeutic abortion. Newer terms have emerged, such as born still, perinatal loss (rather than pregnancy loss), even a popular lay term, angels forever, has formed. What accounts for this language change, and even more basically, why do we have such indirect means to talk about death prior to birth? Indirect words for talking about difficult topics are euphemisms, and the difficult topics that they name are usually subjects that are socially taboo to speak of – death, illness, sex, and the body, among other unnamable subjects. Appreciating the linguistic and social functions of euphemism may help to understand the growing and shifting terms for perinatal loss, and the way that language use contributes to the social and psychological construction of the experience of perinatal loss.

Language and Taboo:

Taboo is a prescription of behaviour that affects everyday life (Allan & Burridge 2006). Taboos arise out of social constraints on an individual’s behaviour that might cause discomfort, harm or injury. Taboo is a community’s way of managing risk. These perceived risks range from metaphysical (fear of incurring the wrath or a lack of protection from the divine), to physical risk, with fears of disease and contamination. These attributions of risk often lead to taboos that constrain behaviour associated with the sacred (prescribed behaviours around religious objects and rituals) and behaviours associated with death, cleanliness, contagion and bodily fluids (e.g., menstruation). Such behaviours may become ritualized and/or become defining of belonging to or being ‘other’ to a community, as with the Jewish prohibition against eating pork, which defines believers as ‘clean’ and as belonging to the community, or being foreign and other (c.f., Douglas 1970).

Prohibitions within a culture may also lead to other, lesser forms of taboo associated with etiquette, and conversely with social ostracism or censure. Speech behaviours are one response to taboo subjects, where language use becomes shaped by fear or distaste. There are traces of taboo deformations, avoidances and omissions of speaking of certain topics, in many languages.

Euphemism: What indirect means do we use to talk about difficult, unspeakable and yukky things?

Some things are obviously difficult to speak about socially, even to the point of being unspeakable or taboo. Often when we want to ‘say the right thing,’ or want to avoid embarrassing ourselves when we have to say something awkward – if someone has died; if they are ill; if we need to excuse ourselves to use the bathroom – we resort to comfortable, often vague but still socially decodable turns of phrase to gloss over or disguise what we are saying. The term for such indirect, socialite-friendly words and phrases is euphemism.

The Oxford English Dictionary (euphemism, n.1, OED) defines euphemism as a rhetorical device or “figure of speech which consists in the substitution of a word or expression of comparatively favourable implication or less unpleasant associations, instead of the harsher or more offensive one that would more precisely designate what is intended.”

Euphemism can take different forms: i) figurative expressions (e.g., “go to the happy hunting ground” for die); ii) remodeling (e.g., “sugar” for shit); iii) circumlocutions (e.g., “go to the little girl’s room); iv) abbreviations and acronyms (e.g., S.O.B.); v) omissions (e.g., f***). They can employ different rhetorical strategies such as, hyperbole (e.g., “flight to glory” for death), or understatement (e.g., “sleep” for death) (Allan & Burridge 1991, 2006).

Euphemism has existed throughout the history of the English language, with examples for terms for prostitution and urination dating back to Old English, though it is difficult to know Old English roots because we do not have the spoken (social) context, which is where such language taboo deformations usually occur (Enright 1985). The word euphemism was first recorded in English in Thomas Blount’s Glossographia (1656): “a good or favorable interpretation of a bad word,” from the Greek ‘use of an auspicious word for an inauspicious word’ and ‘fair of speech’.

Euphemism and Taboo: A socio-linguistic perspective on euphemistic language use

The relation between taboo and euphemism is thus fairly intuitive. Euphemism occurs when there is a prescription of speech behaviour relating to a taboo. The topics most likely to be treated euphemistically are those associated with cultural taboos, such as death, disease, sexuality, and religion (Allan & Burridge, 1991; Douglas 1970). In other words, euphemism results from an interaction between semantics and the social, and has therefore been the purview of socio-linguistics, or of those interested in socio-historical dimensions of language use and transformation. One of the main social functions of euphemism is “face-saving” (McGlone & Batchelor 2003), first to protect one’s own face, or to protect the feelings of the other. Further, euphemism may decrease the emotional intensity of the topic under discussion (c.f., Tayler & Ogden 2005), which can even be measured physiologically (Gray et. al., 1982; Dinn & Harris 2002).

Euphemism is one field in which language change can be observed, not just in terms of semantic erosions, but related to larger social and historical shifts. Things taboo or unspeakable in one era become permissible topics in another period. In the Victorian period, for example, euphemism peaked in the English language as a result of the constrictive moral values of the era (Marsh 1998, 215-30). Marsh understands euphemism as a process, within the Victorian period, of “making language decent.” He examines the proliferation of Latinisms (particularly within medicine) and ‘frenchified prudery’ within this period as driven by a euphemistic purgation of the language. Marsh’s perspective is generally critical of euphemism, which he sees as a diminishment of language and communication that leads toward silencing.

Language transformation resulting from euphemism has been termed the

“the euphemism treadmill” by Stephen Pinker (1994). Euphemisms often evolve over time into taboo words themselves, or dysphemisms, through a process of pejoration or association with the taboo topic. Allan and Burridge (1991) have described this as the Allan-Burridge Law of Semantic Change and the X-phemism mill.

This hypothesis has been challenged in studies carried out by McGlone and colleagues (2006), who provide empiric support for an alternate hypothesis, that old, more familiar euphemisms provide “camouflage” for distasteful topics, compared with more novel euphemisms, rather than automatically eroding into dysphemisms over time. Familiar euphemisms were regarded by participants in the study as more socially positive, and those using them as having more positive attributes, than novel euphemisms.

Euphemism and the taboos of disease and death

Death is a fear-based taboo, with multiple associated fears relating to loss, metaphysical uncertainty, and uncertainty about what happens to the body after death. Allan and Burridge (2006) suggest that death may be a 20^th-century taboo, though many euphemisms for death are found in classical Latin and Greek. Cicero wrote of death: “to fall asleep in the midst of the sufferings of life, and with eyes closed to be lulled in everlasting slumber.” This has also long been reflected in English literature. Shakespeare referred to death in Hamlet as “that mortal coil,” and Samuel Johnson as, “kind Nature’s signal of defeat.” Thomas Gray called it “the dread abode” and “the inevitable hour.” Tennyson wrote of “crossing the bar,” while Byron looked upon it as a “dreamless sleep.”

Cook and Walter (2005) do provide some evidence that taboos around death, at least as measured by use of euphemism, may be more pronounced in contemporary Western culture. They use discourse analysis to examine the communication within rituals, namely funerary rites, associated with death. They find that late-twentieth-century funerary rituals, in contrast to Victorian and early-twentieth-century ceremonies, are marked by euphemistic reference to death. Zimmerman (2004) also explores the hypothesis of “death denial” in Western, English-speaking cultures. In turn, our language use is seen as contributing to the construction of our experience of death (Zimmerman 2004; Delvecchio-Good et al., 2004). The website “Dead and Buried: 213 Euphemisms for Death” <http://phrontistery.50megs.com/longpig/dead.html> exemplifies this current preoccupation.

Likely because of its association with death, or generally with misfortune, disease is often treated with superstition and misfortune, or associated with beliefs of illness as providential (Sontag 1978). This is likewise reflected in euphemistic references to illness that are softened to terms such as under the weather, out of sorts, or doing as well as may be expected.

These associations of illness and death with taboo make medicine and medical language an interesting register for examining euphemistic language use.

Medicine is one of the first domains of euphemism, starting in Old English, which had the term Sceandword to denote such opprobrious terms (Burchfield 1985, 20). Medicine borrowed mainly Latin terms in order to label and discuss disease, and conversely, many of these Latinate terms were absorbed into lay terminology as euphemistic ways of referring to dreaded illnesses. The history of terms for syphilis provides an illustrative example. Early terms for syphilis often linked the disease with foreigners – Spanish pox, Neapolitan bone ache, malady of France. In the twentieth-century, medicalized terms like treponemal disease, or even the ultimate medicalized euphemism, abbreviations like VD and STD, displaced these associations (Allan & Burridge 2006, 207).

Euphemism has had an interesting (and complicated) impact on physician-patient communication within medicine. Johnson and Murray (1985) argue that physicians tend to be direct about death and illness relative to the general population, which has become even more the norm with a decrease in paternalism in modern medicine. However, Parsons et al. (2000) have shown that uses of euphemism, such as “sugar disease” for diabetes, do exist and can be detrimental to patient care and health outcomes. Taylor and Ogden (2005) also tested the impact of these euphemisms on patients’ perceptions of illness, and found that patients experienced less distress and a greater estimation of their health and prognosis when alternate, euphemistic terms were used for cardiac disease, creating conflict between truth/accuracy and patient comfort/deception.

Euphemism and the taboos of the sexual (female) body

Taboo deformation and the use of euphemism can also be observed around sexuality and the body, particularly women’s bodies. Our language remains rife with terms like doing it, going at it, getting some loving, etc., to refer to sexual intercourse. Bodies have long been a source of euphemism, from Latinate medical terms to diminutive terms for its parts, particularly for the sexual organs. The medical term pudenda, from the Latin ‘that of which one aught to be ashamed’ (n.1, OED), to refer to the external genitalia, particularly the female vulva, says it all.

The singling out of the female body as a source of superstition, and thus taboo, is a tradition as old as Western civilization. This excerpt from a medieval Dutch medical text makes this link between the female body, sickness and silencing associated with shame:

Because women are much weaker… therefore they have many kinds of sickness. And especially in those parts which nature had added for pregnancy and the sickness affects them in secret parts, so that from shame they dare not reveal them to any master. Therefore I pity their shame and have prepared a book to help all women. (Daems 1300 CE, in Allan & Burridge 2006, 209)

The bible, particularly Leviticus, marks women’s bodies, and the effluvia from them, such as menstrual blood, as unclean and taboo, which resulted in women being temporarily set apart from the community:

The LORD spake unto Moses and Aaron, saying…And if a woman have an issue, and her issue in flesh be blood, she shall be put apart seven days (Leviticus 15:1)

And if a man shall lie with a woman having her sickness, and shall uncover her nakedness; he hath discovered her fountain, and she hath uncovered her fountain of blood: and both of them shall be cut off from among their people. (Leviticus 20:18)

Many cultural prohibitions, such as those around menstruation, may contribute to the continuing use, to the present day, of euphemism to talk about menstruation. Terms such as got my period, my monthly visitor, on the rag (though one could argue this is a dysphemism), and that time of the month, all replace direct reference to menstruating. Another reproductive phase that has historically generated silence and euphemistic reference is pregnancy, with terms like period of confinement, she’s expecting, and she has a bun in the oven, replacing more direct references, though this has markedly abated over the last two decade.

A Test Case: Perinatal loss and the use of euphemism in medical and lay contexts

One possible explanation, suggested by Allan and Burridge (2006), for the decreasing taboos around pregnancy may be related to advances in technology and maternal-infant care that have resulted in fewer maternal and infant deaths. This makes sense if we concede that the taboos associated with death and illness may have been superimposed onto women, their bodies and reproductive cycles as a result of the high rates of death associated, particularly with labor, with pregnancy until modern medicine. In other words, death, as has been discussed above, is associated with fear, and would thus compel euphemistic language use; if this association with pregnancy decreased, then the need for this language function would also theoretically lessen.

So can euphemistic language use help to account for some of the social changes in terminology for perinatal loss? There are several reasons to suspect a strong link with language to describe perinatal loss and euphemism: loss during pregnancy is at the nexus of two taboo subjects, women’s bodies and death, and thus linked to both fear and shame.

The male speaker in Robert Frost’s poem “Home Burial,” speaking to his wife after her “mother-loss of a first child” (l.67-8), and in response to her “silence” (l.14), says, “My words are nearly always an offense./ I don’t know how to speak of anything..But I might be taught…/A man can’t speak of his own child that’s dead.” (l.48-74).

The term miscarriage to apply to pregnancy loss emerged in 1615 (n.4a, OED 2002); related to the original meaning of miscarriage as “an instance of misconduct or misbehaviour,” or a “failure to carry or convey properly,” the blame (and shame) of a woman for the miscarriage is embedded in the word. Stillbirth dates back to 1785 (n.1, OED 1989). The terms stillbirth and miscarriage can generally be distinguished by the gestational age of the fetus at the time of the loss, with stillbirth denoting the death of a potentially viable infant (c.f., Jutel 2006). Other euphemistic terms include pregnancy loss and fetal demise.

Early 19^th-century obstetrical textbooks, such as John Burns’ Obstetrical Works (1809), use the medical term abortion, of which there exist numerous variants depending on the cause and timing of the loss, a term that persists in medical terminology today. There is no empirical literature on how physicians and other healthcare professionals vary in the terms they use for perinatal loss when communicating with patients, though there has certainly been a recent problematizing of these terms (Jutel 2006), and also the emergence of new terms.

Within the medical register, there has been a move away from the terms miscarriage and stillbirth toward the more general early- or late- perinatal loss. There is an assumption, though untested, that such terms shift the blame away from the mother. A good example of this is the term TOPFA to refer to pregnancy loss by maternal (and paternal) choice due to fetal anomalies. One could read the acronym, a euphemistic device, as being important in this highly charged arena where parental guilt, blame and shame are common reactions. There has been a parallel move in lay terminology to shift or reclaim terms like stillborn. Websites and web-based support groups (see links below) often reverse this term to born-still, changing the emphasis of the phrase.

Terminology for the pregnancy loss is also complicated (and may shape) the language used to refer to the lost product of the pregnancy. Early literature, such as Burns’ Obstetrical Works (1809), commonly refers to the stillborn child, while more contemporary texts tend to use the term fetus. Popular websites frequently refer to a child who was born-still, which constructs the dead fetus as having been born, rather than never born or never alive. References to the afterlife existence of the fetus as an angel (e.g., www.angels4ever.com) have also become common.

So how does understanding euphemism help us to understand these alterations in terminology? The socially contingent nature of these terms is clear. There has been a marked shift from complete silence around perinatal loss, often coupled with terms that implicitly blame the mother, to a greater reflexivity about the language that is used, and an attempt to remove stigma and blame from the labels. As explored above, euphemism tends to flourish around taboo areas. Fear and shame appear to be potent motivators for taboo (and vice versa), resulting in corollary sociolinguistic transformation. Social advocacy to change these terms may be understood as a refusal to accept either the shame or silence that have accrued around older terms.

Another relevant socio-historical shift has been in the debates surrounding the personhood and autonomy of the fetus. Jutel (2006) explores how shifting debates around the prolife and prochoice movements have led to a parallel battle over the ‘naming’ of the fetus versus the child. If the fetus/child is understood as having personhood, this is associated with greater maternal guilt and responsibility in the case of therapeutic abortion or pregnancy loss. If personhood is denied to the fetus then the mother retains complete autonomy and choice, and stands to shoulder less blame and guilt for such losses, though this may lead to difficulty for some parents who feel that the life of their stillborn child has been negated or denied.

Foucault (1990) and Bourdieu (1991) make the claim for language use operating within a system of power, and for euphemism as a part of a socio-political system that exerts implicit control of communication. The social and ethical debates that surround the rights of fetuses, and which define responsibility for fetal death, are highly politicized. Language, and the ways that it is used or not used, can be an important manifestation of such struggles, and can also contribute to the actual construction of social experience. The ability to directly reference a perinatal loss, and/or the use of indirect references to the loss, can shape the experience of parents who sustain such losses, and the subject positions of both mothers (parents) and fetuses.

Psychological functions of euphemism?: Has euphemistic language use been adequately theorized?

That the changing linguistic terms for perinatal loss signal social shifts in the perception of fetal death seems clear, and this phenomenon is at least partially explained by cultural taboos, norms, and euphemistic language use (and change). However, looking at perinatal loss and its sociolinguistic association with euphemism also reveals some gaps in the sociolinguistic literature on euphemism. The emphasis has been on the social function of euphemism (to manage taboo, to save face) to the exclusion of psychological explanations for the use of euphemism, or at least to explain individual variation in the use of euphemism. In the case of loss and death, this would place an emphasis on the individual psyche, rather than on the interpersonal domain, or on the internal representation of loss.

Mary Main, for example, developed an elaborate coding scheme that identifies discourse characteristics of the ways that people talk about death. Those with unresolved grief tend to, among other things, avoid direct reference to death, and/or use highly poetic or eulogizing speech about the death or about the deceased. In other words, their speech may be punctuated by euphemisms and clichés. Bakermans-Kranenburg, et al., (1999) have extended Main’s work to people who have experienced perinatal loss. Those who demonstrate markers of being unresolved about the perinatal loss in their discourse have the worst psychological outcomes. Euphemistic language use, thus, for some, may either be a marker of unresolved grief, or may interfere with adequate grieving processes.

These findings are complicated by the physiologic data that show that euphemistic language use may lessen bodily stress reactions to taboo topics, such as death (Gray et al., 1982; Dinn & Harris 2002). This might suggest that, for some, euphemistic language use can contain overwhelming bodily and emotional responses. There is clearly much that needs to be understood about individual difference shaping the use and the response to euphemism. Perhaps the best model would be one that recognizes both the socio-historical-cultural dimensions of euphemism use and change, and the psychological functions of euphemistic language use, and the complex interactions between them. Within the domain of perinatal loss, what is at stake is of great social and psychological importance.

For Further Reading

Euphemism – Sociolinguistic Approaches

Allan, K and K Burridge. (1991). Euphemism and Dysphemism: Language as a Shield and a Weapon. Oxford: Oxford University Press.

-----. (2006). Forbidden Words: Taboo and the Censoring of Language. Cambridge University Press.

Bourdieu, P. (1991). Language and Symbolic Power. Ed. J.B. Thompson. Trans. G Raymond and Adamson. Cambridge: Harvard University Press.

Douglas, M. (1970/2003) Natural Symbols. London: Routledge.

Enright, D.J, Ed. (1985). Fair of Speech: The Uses of Euphemism. Oxford: Oxford University Press.

Foucault, M. (1990). The History of Sexuality, Vol. I. New York: Vintage Books.

Marsh, J. (1998). Word Crimes: Blasphemy, Culture, and Literature in Nineteenth- Century England. Chicago: University of Chicago Press.

McGlone, MS, G Beck and A Pfiester. (2006). “Contamination and Camouflage in Euphemisms.” Communication Monographs, Vol. 73(3): 261-282.

McGlone, MS and JA Batchelor. (2003). “Looking out for number one: euphemism and face,” Journal of Communication, June 2003: 251-264.

Pinker, S. (1994). The Language Instinct. New York: William Morrow.

Euphemism – Dictionaries

Anderson, D. (2001). The Dictionary of Dangerous Words. London: Social Affairs.

Holder, R.W. (1995). A Dictionary of Euphemisms. New York: Oxford University Press.

Neaman, JS and CG Silver. (1983). Kind Words a Thesaurus of Euphemisms. Oxford: Facts on File.

Rawson, H. (1981). A Dictionary of Euphemisms and Other Double Talk. New York: Crown Publishers.

Euphemism and Medicine

Eliott, JA and IN Olver. (2003). “Legitimating do-not-resuscitate orders: a discursive study of cancer patients’ speech,” Journal of Palliative Care, Vol. 19(2):100-6.

Frankel, FH. (1975). “What’s in a name? The ‘mental health’ euphemism and the consequences of denial,” Hospital and Community Psychiatry, Vol. 26(2): 104-6.

Johnson, D, J.F. Murray. (1985). “Do Doctors Mean What They Say?” In Fair of Speech. Ed. D.J. Enright.

Parsons JE, PJ Phillips, DH Wilson and A Scadigno. (2000). “’A touch of sugar’ – A

dangerous euphemism still alive and well,” Australian and New Zealand Journal of Medicine, Vol. 30(6):739.

Sontag, S. ( 1978). Illness as Metaphor. New York: Vintage Books.

Tayler, M and J Ogden. (2005). “Doctors’ use of euphemisms and their impact on

patients’ beliefs about health: an experimental study of heart failure,” Patient Education and Counseling, Vol. 57(3): 321-6.

Euphemism and Death

Cook, J and T Walter. (2005). “Rewritten rites: language and social

relations in traditional and contemporary funerals,” Discourse and Society, Vol. 16(3): 365-391.

Delvecchio Good, MJ, NM Gadmer, P Ruopp, AM Sullivan, E Redinbaugh, RM Arnold

and SD Block. (2004). “Narrative nuances on good and bad deaths: internists’ tales from high-technology work places,” Social Science and Medicine, Vol. 58(5):939-53.

Zimmerman, C. (2004). “Denial of impending death: a discourse analysis of the palliative care literature,” Social Science and Medicine, Vol. 59(8): 1769-80.

Perinatal Loss and Discourse

Bakermans-Kranenburg, MJ, C Schuengel, and MH van Ijzendoorn. (1999). “Unresolved loss due to miscarriage: and addition to the Adult Attachment Interview,” Attachment and Human Development, Vol. 1(2):157-170.

Jutel, A. (2006). “What’s In a Name? Death Before Birth.” Perspectives in Biology and Medicine, 49(3):425-34.