In his book, Incommunicable: Toward Communicative Justice in Health and Medicine, Charles Briggs examines breakdowns in health communication across various levels, from doctor-patient interactions to global health initiatives. While past analyses of failures in health communication often "blame the victim," labeling certain bodies and populations as noncompliant with medical knowledge and practice, Briggs shifts the focus to the discourse of communicability itself. He critiques how his earlier work on communicability was steeped in colonial, racist, and white supremacist logics, and reframes incommunicability as a critical alternative analytic (9).
By decentering communicability and challenging its ideological dominance, he seeks to dismantle hegemonic practices, particularly in medical communication. The book aims to counter the "monopolies over biocommunicability" held by the medical establishment (20), while acknowledging that medical professionals, too, are often trapped in a double bind between "insufficient knowledge and overwhelming burdens of care" (25). Ultimately, Briggs hopes to challenge the Lockean orthodoxy that has shaped medical communication for the past 300 years, fostering a more inclusive space for dialogue among medical professionals, patients, and policymakers. As Briggs asserts, “if language and communication, health and care are woven so tightly together—like health and communicative inequities—then there will be no justice in health if there is not also health/communicative justice” (108).
Building on his earlier work, the main thrust of the book is to argue that the dominant conception of communicability in medical settings has historically been exclusionary. Through a decolonizing lens, Briggs shows how medical communication practices have marginalized certain groups—especially racial minorities, the poor, and the disabled—by deeming them incapable of rational communication or understanding a priori. In effect, it is the very discourse of communicability that has produced incommunicability, a phenomenon Briggs sets out to challenge by uniting medical anthropology and linguistics with other disciplines.
At the core of Briggs’s argument is a critique of the Enlightenment tradition’s penchant for “purification.” He focuses on John Locke’s ideas, particularly his argument for separating communication from other aspects of life. According to Briggs, Locke’s insistence on distancing communication from language, context, and the material realities of bodies—especially non-white, non-male, and disabled bodies—has laid the groundwork for the exclusionary practices in biomedicine today.
The first four chapters of Incommunicable (Part I) track Briggs’s reevaluation of in/communicability. Drawing on Du Bois, Fanon, and Georges Canguilhem (Foucault’s mentor), Briggs explores how communicability “became a fundamental part of the infrastructure of white supremacy and racial hierarchy.” Through their work, he seeks to “craft a philosophical and analytic basis for dismantling and creating alternatives” (23). Centering the material and processes of racialized embodiment, Briggs advocates for the importance of structural competency among health professionals. Where nosology would have doctors look no further than the patient’s body, a more thoroughgoing evaluation of what ails them would require them to look beyond the individual patient to understand the broader social, cultural, and political forces influencing health, including racism and power.
In Part II, Briggs deepens his engagement with the politics of refusal, first mentioned in the introduction. Drawing on the work of Hortense Spillers, Savannah Shange, and Audra Simpson, he explores the agency of the so-called “incommunicable” by evaluating the health activism of marginalized groups. Briggs examines how historically stigmatized communities living with AIDS—such as LGBTQ persons, immigrants, and drug users—used the space of refusal to transform their roles in health discourse through self-education and advocacy. These groups, once cast as “victims” or “patients,” used the spaces of incommunicability to become active participants and experts in emerging knowledge about disease. Their “biocommunicable appropriation” (adopting and reshaping medical discourse) not only empowered these communities but also contributed to the “democratization of knowledge production” in medical fields (154). Briggs also highlights the radical health practices of the Black Panthers, who integrated diverse healing traditions—such as Chinese medicine and other non-biomedical systems—into their care models. This "integrative critical transformation" (154) disrupted medical power dynamics, training doctors in radical theory before they could practice in community, and by creating more inclusive health frameworks that prioritized lived experience and collective knowledge.
In the third, ethnographic, portion of the book, Briggs turns to the COVID-19 pandemic, framing it within the concepts of “pandemic ecologies of knowledge” and “pandemic ecologies of care.” This framework enables him to explore the many ways different populations produced and engaged with biocommunicability during the crisis. Critically examining the so-called “pandemic-industrial-complex,” Briggs questions the concept of the "infodemic"—the idea that dis- and misinformation circulating on the internet was a primary driver of illness and death in the U.S. Instead of blaming consumers of health media for failing to engage in “boundary work” to safeguard the dominant biocommunicable discourse, Briggs critiques the biomedical community’s often rigid, one-dimensional approach to pandemic communication, which failed to address the complex social and political realities faced by various communities, and ultimately led to public distrust (165). By limiting definitions of care to what doctors provide, health professionals ignored the broader ecologies of care in which their patients existed, missing opportunities for collaboration (202).
Briggs argues that the Lockean framework that assumes a strict divide between knowledge and non-knowledge, and between experts and laypeople, ended up delegitimizing alternative perspectives in such a way that some publics interpreted them as “playing politics.” Where public health officials presented themselves as the sole bearers of truth and dismissed laypeople and activists, pre-existing social divisions—especially along racial, class, and political lines—deepened. To his (and our) credit, Briggs does not simply condemn misinformation or conspiracy theories but instead critically examines the underlying reasons for widespread skepticism, including communication failures at the CDC, which, ironically, led some to deem medical information “incommunicable.”
Ultimately, Briggs suggests that there was no single pandemic. Rather, “each person experientially constructed a different pandemic, as COVID-19 was inflected and refracted by the fine details of their daily lives” (198). Drawing on Merrill Singer's concept of syndemics, Briggs argues that “COVID-19 is less a singular, bounded pandemic than an assemblage of inequities that have disproportionately affected oppressed populations” (199). In areas where access to care was scarce, the public's innovations played a crucial role—yet these contributions were often overlooked or dismissed by public health officials.
One of the key strengths of Incommunicable is its interdisciplinary approach. Briggs draws from medical anthropology, linguistic anthropology, philosophy, Black studies, and Indigenous studies to reframe his theories of communicability and biocommunicability. Thinking with Spillers, Shange, Simpson, Fanon, Du Bois, and Canguilhem, Briggs constructs a rich theoretical framework that challenges dominant regimes of communicability, and even the idea of communicability itself. Briggs’s critique of the “biomedical monopoly” over communication is timely and essential. In an era of growing mistrust between patients and the medical establishment—exacerbated by the COVID-19 pandemic—his book offers a compelling argument for a more inclusive medical education that emphasizes structural competency. This approach encourages medical professionals to be aware of the socio-political factors that influence health outcomes, and to recognize the value of marginalized voices in shaping health policy.
While Incommunicable offers a powerful critique of health communication, it is not without its challenges. The writing, particularly in Part I, can be dense and technical. Many of the concepts introduced are deeply theoretical, requiring significant background knowledge in medical anthropology, philosophy, and critical theory. Additionally, for readers unfamiliar with Briggs's earlier work on communicability, the book can prove a heavy lift. This may limit the book’s accessibility beyond academic circles, a potential drawback considering Briggs’s goal of reaching medical professionals, policymakers, and the general public.
Incommunicable presents a critical analysis of the intersection of communication, health, and justice. The book excels in its interdisciplinary approach and theoretical depth, drawing from a wide range of intellectual traditions to explore the historical and contemporary dynamics of medical communication. Briggs’s critique of the medical establishment’s failure to recognize the communicative agency of marginalized communities is timely, particularly in light of global health crises that have exposed deep inequities in health systems. Briggs advocates for a more inclusive, participatory approach to health communication and care—one that values lived experience and the contributions of those labeled “incommunicable.”
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[Review length: 1348 words • Review posted on February 19, 2025]